Shawqi S. Saleh

Nosocomial infections in the intensive care units at a university hospital in a developing country: comparison with National Nosocomial Infections Surveillance intensive care unit rates.

OBJECTIVE As a measure of the quality of care provided to patients in the intensive care unit, comparison of nosocomial infection rates with those of the National Nosocomial Infection surveillance was completed during a 3-year observation period. DESIGN The study design was a prospective study during 3 years between 1993 and 1995. During that period, patients at the medical/surgical and neurosurgical intensive care units and the high-risk nursery were surveyed for nosocomial infections. Device use, bloodstream infection, urinary tract infection, and ventilator-associated pneumonia nosocomial infection rates were calculated and compared with the National Nosocomial Infection Surveillance published rates for the same period. SETTING The study setting was the medical/surgical intensive care unit, the neurosurgical intensive care unit, and the high-risk nursery at the Jordan University Hospital. RESULTS Overall infection rates were 17.2 per 100 patients in the medical/surgical intensive care unit, 14.2 to 18.5 per 100 patients in the neurosurgical intensive care unit, and 13.4 to 73.5 per 100 patients in the high-risk nursery. When compared with the weight of the infants, these rates were 61.9 to 94 per 100 in infants weighing <1500 g, 26 to 30.8 per 100 patients in infants weighing >1500 g to 2500 g, and 11.7 to 14.4 per 100 in infants weighing >2500 g. Whereas device use was moderate, bloodstream infection and ventilator-associated pneumonia rates were >90th percentile for National Nosocomial Infection Surveillance in the high-risk nursery, and urinary tract infection was >90th percentile in the medical/surgical and neurosurgical intensive care units. Nosocomial infections at the intensive care units in developing countries need further investigation and control.

Outcome of adolescent pregnancy at a university hospital in Jordan

Objective: To determine whether adolescent pregnancies are associated with increased risk of adverse obstetrical outcome. Materials and methods: This is a retrospective study comparing the obstetric outcome of 267 adolescent pregnancies to 500 adult women pregnancies during the same period at a university hospital. Results: Medical and obstetric complications including pregnancy-induced hypertension, diabetes mellitus, anemia, placenta praevia, abruptio placenta and multiple pregnancy were not different in both groups, where there was a significant increase of preterm labor in adolescent pregnancies compared to adult pregnancies (14.6 and 8%, respectively). Moreover, adolescent pregnancies when compared to adult pregnancies, were associated with a significantly higher incidence of forceps delivery (4.5 and 1.4%, respectively), neonatal intensive care unit admission (22.7 and 13.5%, respectively) and a lower incidence of caesarean section (7.1 and 16.8%, respectively). Conclusion: Adolescent pregnancies are associated with a favorable obstetric outcome apart from the higher incidence of preterm labor.

Atosiban and nifedipine in the suppression of pre-term labour: A comparative study

This is a retrospective study comparing the efficacy and safety of atosiban and nifedipine in the suppression of pre-term labour. A total of 75 patients were included in this study; 34 received atosiban and 41 received nifedipine. There were no statistically significant differences in the baseline characteristics for both groups. A total of 68.3% of women in the atosiban group remained undelivered at 7 days or more, compared with 64.7% in the nifedipine group, which was not statistically significant. Average birth weight, admission to the neonatal intensive care unit and mode of delivery were similar in both groups. However, the gestational age at delivery was significantly higher in the nifedipine group. We concluded that atosiban and nifedipine are effective in delaying delivery for 7 days or more in women presenting with pre-term labour. They have the same efficacy and associated minor side-effects. However, flushing, palpitation and hypotension were significantly higher in the nifedipine group.

The value of frozen section Pipelle endometrial biopsy as an outpatient procedure in the diagnosis of ectopic pregnancy

Summary This is a prospective study evaluating 28 patients who were suspected to have ectopic pregnancy. Frozen section Pipelle endometrial biopsy was performed as an outpatient procedure to look for the presence of chorionic villi in the specimen. The sensitivity of the frozen section endometrial biopsy in detecting the presence of chorionic villi was 13.3% and the specificity was 100%. The positive predictive value was 100% and the negative predictive value was 50%. We concluded that frozen section endometrial biopsy was not helpful in predicting intrauterine gestational process; therefore, it has a limited application in patients suspected to have ectopic pregnancy.

Postpartum Enterobacter Pyogenic Sacroiliitis

Postpartum pyogenic sacroiliitis is a rare condition. Accurate diagnosis is frequently delayed because of poor localization of initial symptoms and the rarity of this disorder. Pyogenic sacroiliitis has been related to trauma, intravenous drug abuse, and gynecological infections1-3, but it is rare without a predisposing factor. We report the case of a thirty-one-year-old woman with postpartum pyogenic sacroiliitis caused by the Enterobacter species, and we also provide a review of the pertinent literature. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A thirty-one-year-old woman (gravida 4, para 4) presented to our emergency department with symptoms of fever and pain in the right buttock for three days. The pain had begun two hours after a normal vaginal delivery. The past medical history noted sclerotherapy for varicose veins on both lower extremities two years earlier. The patient denied any recent history of intramuscular drug injection. Vital signs included a temperature of 38.8°C and a pulse rate of 99. On physical examination, there was limitation of right hip motion and a positive test for flexion, abduction, and external rotation (FABER). The right leg had normal muscle strength, with no swelling, warmth, or erythema. Laboratory studies, including complete blood-cell count as well as kidney and liver function tests, were normal except for leukocytosis (white blood-cell count: 14 × 109/L; lymphocytes: 9%; neutrophils: 84%), an elevated C-reactive protein level of 132 mg/L (normal, less than 5 mg/L), and an elevated erythrocyte sedimentation rate of 110 mm/h (normal, 0 to 15 mm/h). The urinalysis and the subsequent urine culture specimen were negative. The rose bengal test for Brucella was also negative. The patient was admitted to the hospital with a diagnosis of postpartum pyrexia and was administered ceftriaxone (1 gm …

Perceptions and Expectations among Pregnant Women Receiving Second-Trimester Ultrasound Scans at Jordan University Hospital

Objectives: To evaluate women’s information about the purpose of the second-trimester ultrasound scan, their expectations before the scan, the extent to which these expectations are fulfilled after the scan, and their perceptions of the foetus. Methods: A sample of pregnant women (540) attending a second-trimester ultrasound scan at Jordan University Hospital were asked to complete two parts of a questionnaire during a 3-month period in 2011. The first part included patients’ characteristics, the purpose of the scan, and expectations before the scan. The second part included patients’ perceptions of the foetus and how the expectations of the scan were fulfilled. Results: Both parts of the questionnaires were completed by 503 (93%) of the women. Three fourths of the participants were accompanied by their husband or a family member. Sixty (12%) women were referred specifically to rule out congenital anomalies. Comparison between patients’ expectations before and after the scan using the chi-square test showed significant improvement in all expectations variables (P–value < 0.001). Conclusion: A routine second-trimester ultrasound scan is an important event for most participating women. Improvements are required in the provision of pre-ultrasound information.