Open Access Original Research Article

An Audit on Intravenous Drug Preparation and Administration in Various Departments of a Tertiary Care Hospital

Ruqiya Sultana, Muna Masaratunnisa, Sana Afrooz Sajid, Mir S. Adil

Asian Journal of Medicine and Health, Page 1-8
DOI: 10.9734/AJMAH/2017/33644

Background: Intravenous administrations have a high incidence of errors but there is limited evidence of associated factors or error severity.

Objective: To evaluate and categorise the attentiveness and negligence of nursing staff during the administration of intravenous drugs to the patients in order to reduce the medication errors.

Methodology: This was a prospective, descriptive audit done in a hospital setting where 19 intravenous drugs were taken into consideration and their dilution parameters like the name and volume of diluents used were collected in a data collection form by verbally interviewing the nurse in-charge of preparing and administering their dilutions to patients admitted in eight different wards of the hospital. The results were categorised into 6 categories and compared to the standard dilution parameters.

Results: Emergency was the only location where nurses reported that they were aware of all the dilutions involved in the study. Nurses from wards were not aware of many dilutions while very few drugs were out of nurses knowledge in ICUs. Majority of drugs were administrated in a proper way i.e. appropriate volume and diluent type as well. Diluents and their volumes were appropriately (category I) administered to patients in ICU’s when compared to general wards.

Conclusion: There is a need to formulate a standard dilution protocol and training programmes to acknowledge the staff regarding volume and proper diluents to minimise the haphazard dilution techniques and medication errors in the hospital.


Open Access Original Research Article

Long-term Observation of the Serum Level of Anti-influenza Antibody Titers in Patients with Rheumatoid Arthritis on Receiving Vaccination with Identical Strains in the 2010 to 2012 Season

Toshiaki Kogure, Kanoko Yamamoto, Naoyuki Harada, Takeshi Tatsumi

Asian Journal of Medicine and Health, Page 1-9
DOI: 10.9734/AJMAH/2017/33586

Aims: Influenza vaccination is effective in patients with rheumatoid arthritis (RA), although the humoral immune response to influenza vaccine is weak with some kinds of strain in RA patients having biologics. This study’s purpose is to investigate the immune response in RA patients who are weak at a humoral response to the vaccination, because we assume CD4+ T cells already recognize the epitope of influenza viral antigen presented by antigen-presenting cells, while the humoral response is not yet sufficient.

Study Design: Observational study.

Place and Duration of Study: Department of Japanese Oriental Medicine, Gunma Central & General Hospital (GCH), between October 2010 and February 2012.

Methodology: The strains of influenza vaccine in 2011-2012 were the same as those in 2010-2011 in Japan. Therefore, we investigated whether booster effects exist in the 2nd season compared with the response in the 1st season. In 38 RA patients (m/f: 2/36; age:60.4+/-13.7 mean+/-SD), we monitored the change in the serum level of anti-influenza antibody titers for 2 years.

Results: Booster effects were observed in the A/H3N2 strain; however, those effects were not observed in the A/H1N1 and B strains. There was no difference in the B strain at the baseline and at 4 weeks later, respectively, between 2010 and 2011. Titer’s fold in 2011 was not higher than that in 2011 in the 5 RA patients treated with biologics.

Conclusion: The interaction between CD4+ T cells and B cells may be variable with each strain among influenza vaccine. The clinical efficacy of influenza vaccination with the B strain against RA patients having biologics may be not clear until further observational studies are developed concerning incidence rate of each strain.


Open Access Original Research Article

Predictors of Osteopathy among Adult Patients with Thalassemia Major

Maher Abo Bakr Al Amir, Heba Mahmoud Zein El Abdeen, Ghada Mohamed Ezzat, Asmaa Abdel Maksoud Ghanem, Ahmed Abdalla Hassan

Asian Journal of Medicine and Health, Page 1-9
DOI: 10.9734/AJMAH/2017/33874

Background: Beta thalassemia comprises a group of inherited (autosomal recessive) hematologic disorders characterized by decreased or absent synthesis of β-globin chains. Beta thalassemia patients exhibit an unbalance in bone mineral turnover with increased resorptive rates and suppression of osteoblast activity, resulting in diminished bone mineral density (BMD).

The Aim of Study: The aim of study was to determine the prevalence of low BMD in patients with β-thalassemia and to find a possible relationship between osteopathy among adult thalassemic patients and multiple variables as different endocrinal disorders, iron chelation therapy, calcium and vitamin D levels, ferritin levels and history of splenectomy.

Subjects and Methods: The current study had been conducted on 80 patients with β-thalassemia major. Thirty seven were males (46.2%) and 43 patients were females (53.8%). Their ages ranged from 15 to 33 years with a mean of 20.6 ± 4 years. All patients were subjected to full medical history, full clinical examination and investigations that included total calcium, 25 (OH) vitamin D, FBG, 2hPPBG, TSH, free T4 and ferritin levels. Assessment of BMD was done by DEXA scan at three sites (AP-spine, left femur and right forearm).

Results: Seventy-nine (98.7%) patients had abnormal BMD where 34 (42.5%) patients were osteoporotic, 6 (7.5%) were osteopenic and 39 (48.7%) had both osteopenia and osteoporosis. Bone mineral density positively correlated with vitamin D levels at left femur and AP spine, and Calcium levels at RT forearm, LT femur and AP spine. BMD negatively correlated with 2-hour postprandial blood glucose and ferritin levels at RT forearm, LT femur and AP spine. There was a statistically significant difference with p-value of 0.02 between number of sites affected and history of splenectomy, where (40.6%) of these who underwent splenectomy had affection in the three sites.

Conclusions: The prevalence of low BMD in patients with β-thalassemia is high. Many factors contribute to the development of such complication. BMD is a good index of bone status in patients with thalassemia. Regarding the high prevalence of osteopenia/osteoporosis in patients with thalassaemia major, all patients should be screened periodically for bone disease. Future studies including larger number of patients with different types of hemoglobinopathies are recommended.


Open Access Original Research Article

Evaluation of Antimicrobial Activity, Phytochemical Screening and Gas Chromatography-Mass/ Spectrophotometric Profile of Essential Oil from Persea americana & Citrus sinensis

Oludare Temitope Osuntokun, Peace O. Ukwuoma, A. M. Yusuf-Babatunde, O. O. Ige

Asian Journal of Medicine and Health, Page 1-17
DOI: 10.9734/AJMAH/2017/33766

This study aims to determine the phytochemical characteristics, structural determination of bioactive component from the leaf extract  using GCMs and experimentally investigation of the antibacterial activity of essential oil from Persea americana and Citrus sinensis leaf against seven bacteria (Gram-positive and Gram-negative) which are Staphylococcus aureus, Bacillus subtilis, Salmonella typhi, Klebsiella pneumonia, Escherichia coli, Proteus mirabilis and Pseudomonas aeruginosa known to be pathogenic to human causing high mortality among human. This study involves the extraction of essential oils from air- dried leaves of medicinal aromatic plant (Persea americana & Citrus sinensis) using soxhlet method with n- hexane as solvent. Antibacterial activity was carried out using agar well diffusion technique. Both plants essential oil shows high antibacterial property. The antibacterial sensitivity test revealed Escherichia coli having the widest zone of inhibition (20.0 mm) with Citrus sinensis essential oil at 100 mg/ml while the least zone of inhibition (5.0 mm) was recorded for Staphylococcus aureus at 12.5 mg/ml with essential oil of Persea americana however, Pseudomonas aeruginosa was found to be resistant to the oil. Phytochemical analysis of the plants shows the presence of active components such as Cardiac glycoside, Steroid, Anthraquinone, Flavonoid, Phenol, Alkaloid and reducing sugars. The presence of these components enhances the effectiveness of plants essential oil in the treatment of various diseases and also helps to act as an antibacterial agent. Persea americana essential oil was further analyzed by gas chromatography–mass spectroscopy (GC/MS), the main constituents were Squalene (45.94%), vitamin E (12.50%), Diisooctyl phthalate (7.45%) and 12-Methyl-E,E-2,13-octadecadien-1-ol (7.20%). These components aid the antibacterial activities of Persea americana essential oil.


Open Access Opinion Article

The Hospital: A Complex Adaptive System

Díaz, Carlos Alberto, Castilla, Rodrigo Alberto, Lebersztein, Gabriel

Asian Journal of Medicine and Health, Page 1-5
DOI: 10.9734/AJMAH/2017/34421

Introduction: Numerous contemporary authors have described modern sanitary organisations as complex adaptive systems. Therefore, the behaviours and response patterns of their services and units are hardly intelligible if analysed by rationalist or Cartesian points of view.

Methodology: The information used in this study’s process was extracted from Medline and LILACS databases, using the key words “Hospital”, “Health Care Economics and Organizations”, “Complexity Analysis”, and “Healthcare Systems”. No selection or exclusion criteria were used, due to the fact that the opinion developed in this article is based in the authors’ personal experience and not in a structured revision methodology.

Results and Discussion: Hospitals are complex medical services companies due to many factors which alter their behaviour and work environment. They are governed by paradigms of complexity, and their structure, which needs to be particularly designed for the institution’s purpose, is also complex. Medical care is provided within an interdisciplinary matrix, in which agency relationships are not always translated into coherent diagnosis and therapy plans. Furthermore, these relationships usually increase, or do not modify, the gap between effectiveness and efficiency. Hospitals are open systems, and work dynamically, out of equilibrium. Therefore, contradictory or unpredictable agent’s behaviours are often seen affecting not only the organisation as a whole, but also the environment with which it interacts. Hospitals’ limits are diffuse and flexible, and their results are greater than the sum of its parts.

Conclusion: The mentioned factors, among others, allow us to define a hospital as a complex adaptive system, which demands a new analytical approach, and the abolition of reductionist thinking. In this context, hospitals’ leaders will have to know the institution’s values, and simultaneously be used to working with tense flow logistics.