Impact of poor muscle strength on clinical and service outcomes of older people during both acute illness and after recovery

Abstract Background Although Low muscle strength is an important predictor of functional decline in older people, however information on its impact on clinical and service outcomes in acute care settings is still lacking. The aim of this study is to measure the impact of low muscle strength on clinical and service outcomes in older adults during both acute illness and recovery. Methods Randomly selected 432 hospitalised older patients had their clinical characteristics and nutritional status assessed within 72 h of admission, at 6 weeks and at 6 months. Low muscle strength-hand grip was defined using the European Working Group criteria. Health outcome measures including nutritional status, length of hospital stay, disability, discharge destination, readmission and mortality were also measured. Results Among the 432 patients recruited, 308 (79%) had low muscle strength at baseline. Corresponding figures at 6 weeks and at 6 months were 140 (73%) and 158 (75%). Patients with poor muscle strength were significantly older, increasingly disabled, malnourished and stayed longer in hospital compared with those with normal muscle strength. A significantly higher number of patients with normal muscle strength discharged home independently compared with those with poor muscle strength (p < 0.05). One-year death rate was lower in patients with normal muscle strength 5(6%), compared with those with poor muscle strength 52(15%), however, results were not statistically significant after adjusting for other poor prognostic indicators [adjusted hazard ratio 0.74 (95% CI: 0.14–3.87), p = 0.722]. Conclusion Poor muscle strength in older people is associated with poor clinical service outcomes during both acute illness and recovery

Effect of Antioxidants and B-Group Vitamins on Risk of Infections in Patients with Type 2 Diabetes Mellitus

Previous studies have revealed that diabetic patients have a decline in immunity and an increased risk of infections, and this may be associated with poor micronutrient status. The aim of this study was to measure the effect of dietary supplements on risk of infection in patients with type 2 diabetes mellitus. One hundred patients with type 2 diabetes mellitus were randomly assigned to receive an oral dose of daily B-group vitamins and antioxidant vitamins (n = 50) or an identical placebo (n = 50) daily for 90 days. Patients had baseline, three and 12 month assessment for nutritional status, fruits and vegetables intake, physical activity and self-reported infections. Supplementation with antioxidants and B-group vitamins significantly increased the plasma concentration of vitamin E and folate and reduced homocysteine in the intervention group (p-values were 0.006, 0.001 and 0.657, respectively). The number of infections reported by the treatment group after three months of supplements was less than that reported by the placebo group, 9 (27%) vs. 15 (36%) (p = 0.623). Corresponding numbers of infections at 12 months were 25 (67.5%) and 27 (56.3%), respectively (p = 0.488). Up to 90% of the diabetic patients were either overweight or obese with a sedentary life style, and their body weight increased further during three months of follow up. The study showed that multivitamin supplements improved vitamin blood concentrations; however, this did not reduce the number of infections in diabetic patients

Quality of Life Assessment in Intestinal Stoma Patients in the Saudi Population: A Cross-Sectional Study

Background: A stoma poses numerous physical, social, and psychological challenges and interferes with some religious practices, thus potentially negatively affecting the quality of life. In the contemporary era of stoma care, the study sought to assess this impact in a population with distinctive sociocultural characteristics. Methods: A modified City of Hope Quality of Life ostomy questionnaire was used to survey patients with intestinal stomas. The scoring was dichotomous on a 0 to 10 scale, where 0–3 indicated severe impact, 4–6 moderate, and 7–10 minimum. Statistical analysis involved Student’s t-test, one-way ANOVA, Spearman’s correlation, and multivariate linear regression. Results: There were 108 patients, with 59 males and 49 females. The mean age was 40.8 years. The overall quality of life score was 6, for the social domain 7, the physical domain 6, the psychological domain 5, and the spiritual domain 6. The stoma’s impact on the quality of life was severe in 2%, moderate in 61%, and minimal in 37% of patients. Young patients, women, and those with benign diseases or without a job had low scores. Furthermore, 90% of patients had difficulty performing religious activities. For the regression analysis, life quality predictors were dietary, religious, pouch and stoma site issues, leak, odor, diarrhea or constipation, depression, anxiety, and future and disease concerns. Conclusions: Despite advances in stoma care, stoma patients had multiple impediments to their life quality. These were mainly psychological, but the physical and religious ones were also significant. A holistic approach to managing stoma patients is thus needed to help them have fulfilling lives

Adherence to the monitoring of metabolic syndrome in patients receiving antipsychotics in outpatient clinics in Saudi Arabia

BACKGROUND: Monitoring protocols have been developed because patients taking atypical antipsychotics are more prone to developing metabolic syndrome, which leads to possible increased mortality and morbidity. The aim of this study was to assess the degree of adherence to the recommendations of metabolic syndrome monitoring. MATERIALS AND METHODS: This study was conducted in two large psychiatric facilities in the Eastern Province of Saudi Arabia. A retrospective analysis of the medical records of 350 patients taking antipsychotic medications was done, and an assessment was made of the frequency of metabolic monitoring at each of the intervals as suggested by the American Diabetes Association. Data was analyzed using SPSS; descriptive statistics. were computed and Chi-square test was used to determine statistical significance for association between categorical variable. RESULTS: The mean age of the patients was 34.9 ± 18 years; 64.6% were males. Olanzapine was the most prescribed medication (43.7%, n = 153), followed by quetiapine (17.4%, n = 61). Only one-third of the patients (29.6%) completed all the baseline parameters. Documentation of baseline parameters was low for glucose level (38.9%), lipid panel (17.3%), weight (25.2%), and waist circumference (1.4%). Adherence to yearly monitoring was much lower than at baseline (mean percentage: 29.6% vs. 1.7%). Furthermore, 45% of the patients were classified as obese and 10% had metabolic comorbidity. CONCLUSION: Individuals with mental illness who were taking antipsychotics did not undergo proper metabolic screening during antipsychotic treatment. Barriers to adherence to the monitoring guidelines should be examined and addressed. Giving assistance to practitioners to recall the required laboratory tests and vitals at certain intervals could help improve metabolic monitoring practices

Self-efficacy for taking Preventive Measures against COVID-19 among Undergraduate University Students in Saudi Arabia

The COVID-19 pandemic has imposed various stresses on individuals and communities. Coping with sudden, tense, demanding situations during an infectious disease outbreak requires self-efficacy. Increasing the public’s self-efficacy for preventive and control measures is important in the management of the COVID-19 pandemic. This research was aimed at evaluating the self-efficacy and associated factors of students at a public university in the southwest region of Saudi Arabia during the COVID-19 pandemic. This was a cross-sectional study, and a snowball sampling method was used to recruit participants. Data were collected from the beginning of April to the end of June 2020 using an online questionnaire. A total of 761 students were included in the study. The participants’ demographic data were collected, and self-efficacy was analyzed using the General Self-efficacy Scale. The results showed that self-efficacy for dealing with the COVID-19 pandemic was moderate in almost half of the students but was low in approximately 25% of the participants. There were statistically significant associations between self-efficacy regarding the COVID-19 pandemic and gender, college type, marital status, and family income (p < 0.05). However, the participants’ self-efficacy was not associated with age, residence, or history of chronic illness. In dealing with the COVID-19 pandemic, most students had either moderate or low self-efficacy. Certain demographic variables were positively associated with self-efficacy as perceived by the students. These findings provide data central to the development of self-efficacy initiatives. They may also be useful for the effective implementation of public health preventive behavior programs during the COVID-19 pandemic

New-onset and relapsed liver diseases following COVID-19 vaccination: a systematic review

Background: Liver diseases post-COVID-19 vaccination is extremely rare but can occur. A growing body of evidence has indicated that portal vein thrombosis, autoimmune hepatitis, raised liver enzymes and liver injuries, etc., may be potential consequence of COVID-19 vaccines. Objectives: To describe the results of a systematic review for new-onset and relapsed liver disease following COVID-19 vaccination. Methods: For this systematic review, we searched Proquest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses PRISMA guideline for studies on the incidence of new onset or relapsed liver diseases post-COVID-19 vaccination, published from December 1, 2020 to July 31, 2022, with English language restriction. Results: Two hundred seventy-five cases from one hundred and eighteen articles were included in the qualitative synthesis of this systematic review. Autoimmune hepatitis (138 cases) was the most frequent pathology observed post-COVID-19 vaccination, followed by portal vein thrombosis (52 cases), raised liver enzymes (26 cases) and liver injury (21 cases). Other cases include splanchnic vein thrombosis, acute cellular rejection of the liver, jaundice, hepatomegaly, acute hepatic failure and hepatic porphyria. Mortality was reported in any of the included cases for acute hepatic failure (n = 4, 50%), portal vein thrombosis (n = 25, 48.1%), splanchnic vein thrombosis (n = 6, 42.8%), jaundice (n = 1, 12.5%), raised liver enzymes (n = 2, 7.7%), and autoimmune hepatitis (n = 3, 2.2%). Most patients were easily treated without any serious complications, recovered and did not require long-term hepatic therapy. Conclusion: Reported evidence of liver diseases post-COIVD-19 vaccination should not discourage vaccination against this worldwide pandemic. The number of reported cases is relatively very small in relation to the hundreds of millions of vaccinations that have occurred and the protective benefits offered by COVID-19 vaccination far outweigh the risks

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research