Prevalence and mortality rate of healthcare-associated infections among COVID-19 patients: a retrospective cohort community-based approach.

Background: The prevalence of HAI among COVID-19 patients ranged between 4.8% and 42.8% with the highest occurrence observed in critically ill patients. The present study aimed to evaluate the clinical features of HAI in severe and critical COVID-19 patients, their microbiological characteristics, and the attributable risk factors. Methods: This is an analytical observational, retrospective single-center, cohort study that included 723 patients with severe-critical COVID-19 admitted to Saint George Hospital between September 2020 and February 2021. Data collection included demographic variables (sex, age), comorbidities, laboratory findings, HAI types and agents, COVID-19 treatment modalities, hospitalization settings, length of stay, and mortality rate. Data was analyzed using SPSS version 25. Results: The prevalence of patients developing HAI was 7.3% (53 of 723). Five types of nosocomial bacterial infections were tracked noting ventilator-associated pneumonia (41.26%), catheter-associated urinary tract infection (28.6%), hospital-acquired pneumonia (17.44%), catheter-related bloodstream infection (6.35%), and bloodstream infection (6.35%). Binary logistic analysis showed that HAI are statistically affected by four factors noting patients' age (p = 0.039), Length of Stay (p < 0.001), BIPAP (p = 0.019), and mechanical ventilation (p < 0.001). The risk of having HAI increases 3.930 times in case of mechanical ventilation, 2.366 times in case of BIPAP, 1.148 times when the LOS increases 1 day, and 1.029 times when the age is higher with 1 year. Conclusion: Since the prevalence of HAI is high among severe and critical COVID-19 patients, it is important to prepare a treatment with diagnostic, preventative, and control measures for this infection.

The beneficial effect of Adansonia digitata products success to modulate lipid profiles and inhibit LDL oxidation in-vitro: An associational study.

Background: There is a growing interest in medicinal plants in recent years due to their many therapeutic benefits and low side effects. Among the medicinal plants is the African Adansonia digitata (baobab) that has edible fruit. In the current study, the effect of A. digitata juice consumption on the lipid profile was investigated. In addition, inhibition of the oxidation of low-density lipoprotein cholesterol (LDL-C) in-vitro by A. digitata essential oil (EO) was also investigated. Methods: In this cohort study, a total of 70 subjects of A. digitata users (AD group, 42 male and 28 female) and 70 non A. digitata users (Non-AD group, 44 male and 26 female) were recruited to participate in this study. We evaluated lipid profile, HbA1c, liver/kidney functions, and phytosterol contents in fasting blood samples of all participants. Results: The present findings illustrated significantly lower levels of total cholesterol, triglycerides, and LDL in the AD group compared to Non-AD (p < 0.01). In addition, essential oil of A. digitata inhibited LDL oxidation in-vitro as shown by the significant decreases in the formation of malonaldehyde (MDA), protein carbonyl (PC), and lipid hydroperoxide (LHP) (P<0.05). No significant changes in fasting blood glucose, HbA1c, HDL, kidney function, and liver function enzymes between the two groups were detected (P>0.05). Conclusion: The juice of A. digitata has hypolipidemic and antioxidative effects and might be beneficial for the management of lipid levels in the body.

Use of vitamin/zinc supplements, medicinal plants, and immune boosting drinks during COVID-19 pandemic: A pilot study from Benha city, Egypt.

BACKGROUND: The COVID-19 infection is characterized by a wide spectrum of severity that ranges from mild to severe lethal symptoms. The optimal status of vitamins and minerals in the body is important to maintain proper immune response to overcome infections including COVID-19. Certain foods and medicinal plants have been shown to boost the immune system. OBJECTIVES: In the current study, the use of vitamin and zinc supplements, medicinal plants, honey, garlic, and immune-boosting drinks among Egyptian living in Benha city were investigated during the corona pandemic. METHODS: An online questionnaire was distributed through Google forms. A total of 301 adult participants (age range: 18-82) from Benha city, Egypt were included in the study. The Chi2 goodness of fit test was used to determine the differences in the distribution of the participant responses. RESULTS: The use of vitamin C and D were reported by 27% and 17.7% of participants. About one-third of participants reported the use of immune-boosting drinks, honey, and garlic during the pandemic to strengthen the body immunity. The use of Zingiber officinale and Curcuma longa was reported by 47.2% and 31.6% respectively. Concerning zinc supplements, only 5.6% of the sample reported using it during the pandemic. The use of examined nutrients was found to be associated with age (P < 0.05) and the fear score from the virus (P < 0.05), but not with other factors such as sex, income, and educational level. CONCLUSION: The uses of supplements, medicinal plants, and immune-boosting drinks to strengthen the immune system during the pandemic were common among the participants. The present findings may help comprehend some health practices related to the COVID-19 pandemic that might be considered by health policymakers.

Cardiac rehabilitation in skilled nursing facilities: a missed opportunity.

BACKGROUND: After hospitalization for a cardiac event, older adults are frequently discharged to a skilled nursing facility (SNF) for postacute care. The American Association of Cardiopulmonary Rehabilitation recommends that cardiac care be integrated into procedures at SNFs. OBJECTIVE: We undertook this research to describe the characteristics of patients in SNFs after a cardiac event and the cardiac care delivered at SNFs. METHODS: A dual approach included (1) a retrospective medical record review of consecutive patients admitted to 2 hospital-based SNFs after a cardiac event (n = 80), and (2) surveys from healthcare professionals (n = 21) working in these facilities. RESULTS: Thirty-two percent of patients were not candidates for cardiac rehabilitative interventions because they had been rehospitalized, discharged to long-term care facilities, or manifested contraindications to exercise. No standard assessment of exercise tolerance was evident, and although 70% of patients were discharged home, cardiac-specific discharge education was seldom evident. Healthcare professionals in SNFs reported that standard procedures for cardiac care services were lacking. CONCLUSION: The integration of cardiac care into SNFs is important to ensure the safety of therapy and improve the transition of patients from SNFs to outpatient cardiac rehabilitation programs.

The dose effect of pulmonary rehabilitation on physical activity, perceived exertion, and quality of life.

PURPOSE: Pulmonary rehabilitation (PR) programs have been shown to improve functional status, exercise performance, and quality of life (QOL) and decrease perception of exertion in individuals with chronic obstructive pulmonary disease. The purpose of this study was to identify the dose effect of PR on the outcome variables of activity level, perceived exertion, and physical and mental QOL. METHODS: The study used a retrospective explanatory design. The sample (N = 104) included records of individuals diagnosed with chronic bronchitis and emphysema who attended a PR program from 2000 to 2005 at a Midwest inner-city, academic medical center. Participants attended rehabilitation sessions 2 to 3 days per week for approximately 90 minutes each day; maximum duration of the program was 3 months (24 sessions). The PR dose was calculated by multiplying the number of PR sessions with the number of weeks attended. RESULTS: There were 32 men and 72 women, with a mean age of 59.9 years +/- 10.2 years. All patients were retired or unemployed, and 99% used oxygen during exercise. A higher PR dose was significantly related to improvement in activity level measured by maximum metabolic equivalent (MET) level achieved. A nonsignificant but minimally clinically important difference was found on the Medical Outcomes Study Short-Form 36 (SF-36) outcomes of mental and physical QOL. CONCLUSIONS: The findings of the current study support a significant relationship between PR dose and activity level (maximum MET level achieved). Physical and mental QOL improved clinically after PR. Optimal program outcomes were related to greater patient participation in supervised PR.

Which chronic obstructive pulmonary disease patients will be likely to attend consistently a pulmonary rehabilitation program?

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States, and millions of COPD patients are disabled and unable to work. Pulmonary rehabilitation (PR) programs are available to assist with disability, but it is not clear who is likely to consistently participate in them. The purpose of this study was to determine which participants were likely to consistently attend a PR program. METHODS: A retrospective medical record review was used to assess 104 community-dwelling adults with COPD who completed the PR program at a Midwest medical center between 2000 and 2005. SAMPLE: The sample consisted of 32 men and 72 women with a mean age of 59.9 years (±19.10 years), mean predicted one-second forced expiratory volume (FEV(1)) of 46.45% (SD = 20.1), mean percent forced vital capacity (FVC%) of 67.61 (SD = 16.61), mean FEV(1)/FVC% ratio of 51.15% (SD = 18.17), and mean residual volume (RV) of 150.66% (SD = 67.01). RESULTS: Contextual variables of current smoking (beta = -.36), male sex (beta = .19), not having emphysema (beta = -.27), and FVC% (beta = .32) were significant predictors of attendance at (a dose of) PR. The number of selected comorbidities significantly predicted the dose of PR (beta = -.20). CONCLUSION: These findings support the ability to identify factors that predict attendance at a PR program. Nurses can assess patients at risk for lack of consistent PR attendance and implement interventions to improve attendance. Specifically, smoking cessation prior to or as an integral part of PR programs may improve attendance.

Church-based heart health project: health status of urban african americans.

One of the major health disparities in the African-American population is the high incidence of underdiagnosed cardiovascular disease prior to onset of symptoms. Cardiovascular diseases are one of the chief causes of decreased longevity, reduced quality of life, and poor treatment outcomes among African Americans. The Church-Based Heart Health Project, a pilot initiative of Kaiser Permanente (KP) Ohio's Center of Excellence for Health Disparities and Cultural Competency for African American Health, was implemented in 2004 as an innovative and proactive response to confront this cardiovascular health disparity in greater Cleveland's African-American population. The goal of this program was to reduce individual participants' risks for cardiac events (that is, heart attack, heart disease, or cardiac death) by 1) providing individual risk assessment and interpretation and 2) cataloging the generalized health status of urban churchgoing African Americans in greater Cleveland. We describe the cardiovascular risk factors present in a random population of urban churchgoing African Americans participating in sponsored health screenings at their church. A convenience sample of 144 African-American adults participated in this study. Twenty-five percent (37) were men and 75% (107) were women, and participants' mean age was 54.2 years. Ninety percent were not members of KP Ohio. Cardiovascular risk factors measured included body mass index, lipid levels (cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides), blood pressure, brief health history, Framingham Coronary Heart Disease Prediction Score, and National Heart, Lung, and Blood Institute prediction score for ten-year risk. A large portion of the population was found to have at least one risk factor for coronary heart disease (CHD).