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Home > Acinetobacter Infections: A Retrospective Study to Determine in – Hospital Mortality Rate and Clinical Factors Associated With Mortality

Acinetobacter Infections: A Retrospective Study to Determine in – Hospital Mortality Rate and Clinical Factors Associated With Mortality

Thesis Info

Author

Patel, Rajiv

Department

Internal Medicine (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2018

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728036360

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Background: Acinetobacter infections are increasingly being recognized as a cause for significant in – hospital morbidity and mortality worldwide. Increasingly multi – drug resistant strains of Acinetobacter are being isolated, increasing the burden on healthcare resources. Our objectives were to determine the outcomes and clinical factors related to outcomes of Acinetobacter infections at the Aga Khan University Hospital. Methods: A retrospective study of Acinetobacter infections (from any site) was conducted. Patient records were used to gather relevant clinical information. The collected data was tabulated and analysed for any significant differences in demographic or clinical variables. The Pearson Chi squared test was used for categorical variables and the Student’s t-test was used for continuous variables. Significant factors were entered into a logistic regression model. Survival analysis using Kaplan Meier and log rank tests were performed to assess for significance between the different subgroups. Results: Between 2010 and 2017, 80 infections were identified (32 VAP, 24 BSI, 13 skin and soft tissue, 9 pneumonia and 2 UTI) from 204 positive cultures. Thirty six (45%) of the infected patients died. The mean length of stay for the entire cohort was 35.5 days. Diabetes was the most common comorbid condition and Carbapenems were the most frequently prescribed antibiotic prior to infection. Sixty nine (86.25 %) of the Acinetobacter isolates were MDR. The Mean SOFA score, presence of a CVC, Mean age and COPD were found to be significantly different between the two survival groups. Using logistic regression models, the mean SOFA score was significantly associated with mortality. Conclusion: The mortality from Acinetobacter infections at our institution was 45 %. The most common infection was VAPs. The mean SOFA score, age, COPD and CVC were significant factors between the two survival groups, however, only the mean SOFA score was a predictor of death.
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پریت

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تیرے انتظار وچ کلی نوں سجایا میں
تیرے باہجھوں سوہنیا قرار وی ناں پایا میں

پھلاں نال سجدی اے باگاں دی بہار اے
پہلی واری تکیا تے ہو گیا سی پیار اے
سہنا پیا ہن مینوں دکھڑا ہزار اے
دکھاں والا بھار بھارا خوشیاں تھیں چایا میں
تیرے باہجھوں سوہنیا قرار وی ناں پایا میں

دن راتیں ہر ویلے تیرا ہی خیال وے
گلی گلی کوچے کوچے رہی تینوں بھال وے
ڈھونڈ ڈھونڈ تھکی میرا ہویا برا حال وے
دل میرا من دا نہیں بڑا سمجھایا میں
تیرے باہجھوں سوہنیا قرار وی ناں پایا میں

کلی وچ بہہ کے تیرا کراں انتظار وے
عشق تیرے نے ماہی دتا مینوں مار وے
چھیتی آ جا ہن ماہی لَے میری سار وے
تیرے باہجھوں دکھڑا ناں کسے نوں سنایا میں

کلی وچ بہنا تینوں عرشاں دی سیر وے
اک دن سوہنیا توں پا نہ آ کے پیر وے
ہر دم منگنی ہاں پیا تیری خیر وے
تیرے لئی ویکھ کِناں دکھڑا اٹھایا میں
تیرے باہجھوں سوہنیا قرار وی ناں پایا میں

قادریؔ کلی وچ بیٹھی مر جاواں گی
لگیاں وی سوہنیا میں توڑ نبھاواں گی
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پیا دی پریت نوں اے شوق تھیں نبھایا میں
تیرے باہجھوں سوہنیا قرار وی ناں پایا میں

Teaching Challenges Using the Zoom Application That Focuses on Student Concentration in Online Classrooms

The fast advancement in information technology stimulates educational creativity as well. Learning and training practices are often not only carried sout in the traditional manner, but also with the usage of a multitude of learning technologies options. The zoom program is one of the learning resources used in online courses. Zoom was an application developed during the Covid-19 timeframe to address the limitations between educators and students, especially in terms of space and time. With E-learning, educators and students are not limited to one dimension of time and space, and learning will run and neglect both. Learning by simulated children's attention, on the other hand, causes disruption in the learning phase. During the learning phase, students must maintain a high level of concentration. The level of concentration of students has a significant impact on the learning process' outcomes. Since attitude and focus have a beneficial association, high focus may often affect a person's attitude in a learning phase in order to produce optimal performance. Many factors may affect a person's attention, one of which is the learning environment. A peaceful atmosphere can undoubtedly improve a person's concentration level, while a silent / noisy environment will exacerbate one's focus during the learning phase.

Analysis of the Effect of Socio-Economic and Proximate Determinants of Fertility on Birth Interval and Children Ever Born to Women in Pakistan

In Pakistan rapid population growth is a great hindrance in the economic growth of country. Many policies were implemented in the past to control rapid population growth. Pakistan has entered into the early transitional period of fertility. To get immediate results and for the formulation of future population policy, it is essential to understand the dynamics of fertility behavior. Fertility level of any population varies due to variability in the number of children ever born to women and birth interval length. Individual fertility can be assessed by these two methods. The identification of magnitude and direction of effect of socio-economic and demographic factors on children ever born and birth interval analysis helps in population policy implications. The results will entail to control those factors which effect stopping behavior of fertility (children ever born) and spacing behavior of fertility (birth interval). Following the family planning policy of Pakistan that women should have two children, children ever born is dichotomized at two. The effect of socio-economic and demographical factors is investigated which motivate couple to have more than two children (above replacement level of fertility). Women age, husband age, women age at marriage, husband education (no and secondary), women current work status, wealth index (poorer, poorest and middle), ideal number of children, number of children died, ever use of contraceptives, cousin marriage and region (Punjab) has significant impact on size of family (two family norm). Positive relationship is found between women age, husband education, women who is currently not working or for those who never worked, women whose husband desire more children than her, ideal number of boys, ideal number of children, contraceptive knowledge, contraceptive users and number of children died with size of family. Age at marriage, husband age, women education, women current work status, wealth index, women whose husband desire same number of children than wife, polygamous marriage, cousin marriages and urban residents have negative association with family size.Poisson regression model for completed and incomplete fertility data is also run on children ever born. The analysis is carried without categorization of children ever born to understand general fertility behaviour. Age of women, age at marriage, education of women (secondary and higher level), wealth index (richer and richest), husband desire for children, ideal children, ever use of contraceptives, child mortality and polygyny contribute significantly on fertility. Factors which have positive effect on fertility of women are age of women, lack of agreement among spouses on number of children, high fertility intentions, son preference, contraceptive use and consanguineous marriages. Age of women at marriage, age of husband, education of wife, education of husband (secondary and Higher), wealth index (richer and richest), polygyny and urban residents have inverse effect on fertility. Birth interval analysis exposed the length of interval between subsequent births which is helpful in understanding the reproductive behavior. Factors affecting the spacing behavior of Pakistani women are also studied. It is studied with the help of analysis of two birth intervals i.e. marriage to first birth interval and higher order birth intervals. It can be concluded after observing prediction model that in marriage to first birth interval, age at marriage and age at first birth has played vital role in its determination. It is evident from prediction model (preferred model) of higher order births that major contribution towards subsequent birth interval is due to proximate determinants of fertility or biological variables (age of women, age at marriage, period of breastfeeding, period of amenorrhea and period of abstinence). Some socio-economic, demographic or cultural variables have also shown significant results even in the presence of biological factors in higher order birth intervals. These are region (Punjab) and birth order. The significance of these factors may be due to non inclusion of some important proximate determinants such as frequency and duration of contraceptive use etc. Finally it is concluded that urbanization and modernization factors are playing its role in declining the fertility through control of stopping behavior (children ever born to women) but not spacing behavior (birth intervals). Attitudinal factors through stopping behaviour (lack of agreement between spouses about fertility desires, fertility intention, son preference and contraceptive use) are causing increase in the fertility. Biological factors for both stopping and spacing behavior have expected universal effect. There is need to lower fertility by changing the attitudes of couples towards fertility. Family planning programs should be revised to get the replacement level of fertility by changing the behaviours of both couple and family.