Hospital Practices and Research

Abstract Background: Hospital-acquired infections (HAIs), particularly device-associated infections (DAIs) in ICUs, pose a significant global health burden, especially in low- and middle-income countries.
Objectives: This study aims to estimate the HAI burden by analyzing DAI rates and resistance patterns in ICU settings, contributing to evidence-based infection control strategies.
Methods: We conducted a six-month prospective observational study in the adult ICU of GTBH (July–December 2024), focusing on patients with DAIs. Incidence and device utilization rates were calculated using CDC-standardized metrics based on device and patient days.
Results: Out of 286 patients, 40 developed a total of 62 DAIs, comprising 25 cases of ventilator-associated pneumonia (VAP) (40.3%), 19 cases of catheter-related bloodstream infections (CLABSI) (30.65%), and 18 cases of catheter-associated urinary tract infections (CAUTI) (29.03%). VAP had the highest cumulative infection rate (22.6%), followed by CLABSI (21%) and CAUTI (10.8%). Acinetobacter baumannii was the dominant isolate in VAP cases, Klebsiella pneumoniae and Enterobacter spp. were predominant in CLABSI cases, and non-albicans Candida was the leading pathogen in CAUTI cases. Significant antimicrobial resistance was observed, especially among Acinetobacter and Pseudomonas species. Notably, the case fatality rate among DAI patients reached 57.5%.
Conclusion: In conclusion, our surveillance study highlights a substantial burden of DAIs in the ICU, with VAP being the most prevalent. The dominance of multidrug-resistant pathogens and the striking 57.5% fatality rate emphasize the urgent need for robust infection control, tailored stewardship programs, and continuous local epidemiological monitoring.

Abstract Background: Craniosynostosis, is defined as the premature fusion of the cranial sutures, which can cause impair brain development and cognitive problems.
Objectives: The purpose of this study was to assess the epidemiological features of children with craniosynostosis. This assessment includes the characteristics of the patients, their parents as well as their socioeconomic status.
Methods: This cross-sectional study was performed from 2015 to 2020 in Imam Hossein Children's Hospital, Isfahan, Iran. For this purpose, 220 patients under craniosynostosis treatment were included. Accordingly, multidisciplinary team examined the participants. Furthermore, a CT-scan was performed on all patients. Participants underwent surgical intervention. The recorded information was classified into four sections: 1. characteristic data of children with craniosynostosis 2. Family history and parental information, including underlying diseases and drug history 3. Socioeconomic status 4. Treatment and surgery.
Results: According to findings, 151 (68.7 %) of participants were male and 171 (77.9%) had term delivery.  The average birth weight was 2.92 kg and head circumference were 34.4 cm. The mean age of children at the time of surgery was 7.74 months and the mortality rate was 3 (1.4%). Moreover, 90% were operated once and 10% were operated two or three times. The most common type of craniosynostosis was Metopic 59 (59.4%). In relation to parenteral data, 96 (43.6%) of parents had consanguineous marriage and 6.4% had 1st and 2nd degree family with craniosynostosis.
Conclusion: To coclude, attention must be directed towards the potential risk of craniosynostosis in offspring born to consanguineous couples. Moreover, parents must receive guidelines for managing children affected by craniosynostosis.

Abstract Background: Investigating the frequency pattern and types of skin diseases is considered to be extremely important in order to improve the diagnosis process and patients' conditions.
Objectives: The aim of this study was to investigate the epidemiological pattern of skin diseases in patients referred to the skin clinic of Baqiyatallah Hospital.
Methods: This cross-sectional study was conducted on 400 patients who had referred to the skin clinic of Baqiyatallah Hospital during 2016 and 2017. These participants were selected using a convinced sampling model. The type of skin diseases were determined in patients and then collected data were analyzed using the SPSS(V-22) software.
Results: Out of the 400 patients who had referred to the abovementioned clinic, 281 (70.3%) were women and 119 (29.7%) were men. The most common reasons for visiting the skin clinic were acne, warts, wrinkles and acute eczema, respectively. The most affected area was the face. The skin disease diagnosed in patients had a significant relationship with patients' age (P = 0.001), gender (P = 0.001), and education (P = 0.011).
Conclusion: According to the findings of the present study, acne, warts, and wrinkles are the most common skin problems in patients who had referred to the skin clinic of Baqiyatallah Hospital, respectively. Demographic and background factors have a significant effect on the type of skin disease.

Abstract Background: Craniosynostosis is a congenital deformity of the skull that occurs at birth.
Objectives: This study aimed to investigate the frequency of different types of craniosynostosis in Isfahan, Iran.
Methods: In this retrospective study, the records of all patients referred to the pediatric neurosurgery clinic of Imam Hossein children’s hospital in Isfahan, Iran from 2013 to 2018 were diagnosed with craniosynostosis. Incomplete files were excluded. Demographic information of patients and type of delivery, underlying diseases of their parents, diseases of maternal pregnancy, type of craniosynostosis, syndromic or non-syndromic craniosynostosis were collected. Data were analyzed using SPSS software version 22.
Results: The diagnosis of craniosynostosis in 63% of cases (n=121) was a single suture and in 37% of cases (n=72) was a complex suture. There was no significant difference in the frequency distribution of craniosynostosis in males and females (P>0.05).
Conclusion: Due to the prevalence of 16 cases per 100,000, we can reduce the complications of this disease by educating doctors and parents.

Abstract Background: Traumatic brain injury (TBI) is the damage to brain tissue and disruption of the brain function caused by an external mechanical force as evidenced by documented medical records.
Objectives: The study aimed to estimate the prevalence of TBI through age-groups, severity, and mechanism of TBI.
Methods: This cross-sectional study contained all TBI patients who were admitted at the main level one trauma center hospital located in southeastern Iran.
Results: The number of reported patients was 445 young and old adults with TBI. In total, the mean age of the patients was 32.35 ranging from 17 to >80 years. Of the studied patients 361 (81.1%) were male and 84 (18.9%) were women. The most common principal severity of TBI among patients aged 20–29 years was moderate. This corresponds with the age groups that are known to be at higher risk for three levels of TBI. Car accident multiple trauma and head trauma show severity of TBI in both genders.
Conclusion: The research findings determined the lack of ignoring the traffic control system in southeastern Iran that was the main cause of the injury; consequently, the focus of all essentials in traffic management should be considered for this problem. It must be noted that the incidence of TBI is necessary as there remains no cure for mild-to-severe TBI. As the evidence for effectiveness and specific treatment is limited, it must be subjected to demanding research.

Abstract Background: Septic shock (SS) is a health priority in sub-Saharan Africa. However, there is a dearth of data in this regard.
Objective: This study aimed to determine the epidemiology, therapeutic patterns, outcome, and challenges in managing SS in a tertiary intensive care unit (ICU) of sub-Saharan Africa.
Methods: The hospital files of 36 consecutive patients admitted to the ICU of the Douala General Hospital (DGH), Cameroon over the year 2018 were reviewed for SS. SS was diagnosed based on Sepsis-3 definition. Demographic and clinical characteristics, treatment details, and outcomes of patients with SS were reviewed. Data was analyzed using the chi-square or Fisher exact tests and Bonferroni correction.
Results: SS accounted for 36 (9.4%) ICU admissions. The majority of patients were males (63.9%). The most common site of infection was the lungs. The mean age, average mean arterial pressure (MAP), and mean sequential organ failure assessment (SOFA) score of patients were 52.9±25.2 years, 52±18 mm Hg, and 9.2 ±2.3, respectively. Noradrenaline was the sole vasopressor used. Therapeutic challenges included the inability to have a specific antibiogram before a mean duration of 7 days. The mortality rate was 39% and associated with age ≤1 year, MAP ≤ 65 mm Hg, Glasgow Coma Score (GCS) ≤8, and mechanical ventilation, which were not attenuated after Bonferroni correction.
Conclusion: SS is a frequent cause of ICU admission and is associated with a high mortality rate. SS mortality-related factors can be screened during SS management for more aggressive ICU management geared at preventing death.