Day: February 15, 2023

Categories : HospitalsTags :

Buckets to Catch Water in Free State Hospital’s Leaking Wards

On By ModernMedia
A theatre recovery room at Boitumelo Regional Hospital. The photo was taken in January. The hospital says leaks have since been fixed. Photo: Rethabile Nyelele

By Rethabile Nyelele for GroundUp

Crumbling infrastructure is hampering patient care at Boitumelo Regional Hospital in Kroonstad, Free State.

We first visited the hospital two weeks ago. Buckets have been set out on the floors of some wards and theatre rooms to catch water leaking from broken ceilings.

An extension of the hospital building and upgrades started in 2010. In July 2014, further renovations were done. But staff, who spoke to GroundUp on condition of anonymity, said conditions at the hospital are deteriorating, with leaking ceilings, and broken windows covered with cardboard.

Last week, nurses and other staff downed tools over the poor condition of the hospital. They also demanded to be paid for overtime. Most staff resumed their duties on Monday night, pending further negotiations with management on 17 February.

Boitumelo is the only regional hospital in the Fezile Dabi District and caters for patients from about 19 surrounding towns. The hospital has six theatres but we were told of at least 80 patients whose surgeries had to be rescheduled between October and December 2022.

“I’ve been going to the hospital for surgery since 2018 … They keep postponing,” said Langelihle Makhoba.

Another patient, Mamiki Mnguni from Oranjeville, who lives about 100km from the hospital, said, “I was scheduled for a gallstone removal on 19 January 2023, but I was told the theatre is not working. I was told to return in April.”

Hospital CEO Sibongile Mthimkhulu referred our questions to the Free State Department of Health.

The department’s spokesperson, Mondli Mvambi, responded to our questions with a screengrab from a memo sent by Mthimkhulu which details progress made on infrastructure repairs. The memo stated that ceiling panels had been replaced and two theatres had been painted, among other things.

But when we visited the hospital again on 6 February, ceiling panels were still broken and we were told that some of the theatres were not yet fully functional.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : Ageing COVIDTags :

COVID Deadlier than Bacterial or Viral Pneumonia for Older ICU Patients

On By ModernMedia
Source: National Cancer Institute on Unsplash

For older patients in intensive care units (ICUs), COVID is more severe than bacterial or viral pneumonia, suggests new research published in the Journal of the American Geriatrics Society.

Among 11 525 patients aged 70 years and older who were admitted to Dutch ICUs, ICU-mortality and hospital-mortality rates of patients admitted with COVID were 39.7% and 47.6%, respectively. These rates were higher than the mortality of patients admitted because of pneumonia from causes other than COVID. (ICU- and hospital-mortality rates of patients admitted with bacterial pneumonia were 19.1% and 28.8%, respectively, and with viral pneumonia were 22.7% and 31.8%, respectively). Differences persisted after adjusting for several clinical characteristics and intensive care unit occupancy rate.

“In ICU-patients aged 70 years and older, COVID is more severe – with approximately double mortality rates – compared with bacterial or viral pneumonia. Nevertheless, more than half of these older patients admitted to Dutch ICUs with COVID survived the hospital,” said corresponding author Lenneke E. M. Haas, MD, PhD, of Diakonessenhuis, in the Netherlands. “Our findings provide important additional data to include in informed goals-of-care discussions.”

Source: Wiley

Categories : Diet and Nutrition Immune SystemTags :

Salt Cuts off Regulatory T Cells’ Energy Supply

On By ModernMedia
Spilled salt shaker
Source: Pixabay CC0

Regulatory T cells ensure that immune responses happen in a controlled way. But eating too much salt weakens these cells’ energy supply, thus rendering them temporarily dysfunctional. This salt-induced ‘load shedding’ may have implications for autoimmunity, researchers report in Cell Metabolism.

Excessive salt consumption not only causes cardiovascular problems, it could also adversely impact the immune system. The study found that salt can disrupt regulatory T cells by impairing their energy metabolism. The findings may provide new avenues for exploring the development of autoimmune and cardiovascular diseases.

A few years ago, research by teams led by Professor Dominik Müller and Professor Markus Kleinewietfeld revealed that excess salt in the diet can negatively affect the metabolism and energy balance in certain types of innate immune cells called monocytes and macrophages and stop them from working properly. They further showed that salt triggers malfunctions in the mitochondria. Inspired by these findings, the research groups wondered whether excessive salt intake might also create a similar problem in adaptive immune cells like regulatory T cells.

Important immune regulators

Regulatory T cells, also known as Tregs, are an essential part of the adaptive immune system. They are responsible for maintaining the balance between normal function and unwanted excessive inflammation.

Scientists believe that the deregulation of Tregs is linked to the development of autoimmune diseases like multiple sclerosis. Recent research has identified problems in mitochondrial function of Tregs from patients with autoimmunity, yet the contributing factors remain elusive.

“Considering our previous findings of salt affecting mitochondrial function of monocytes and macrophages as well as the new observations on mitochondria in Tregs from autoimmune patients, we were wondering if sodium might elicit similar issues in Tregs of healthy volunteers,” says Müller, who co-heads the Hypertension-Mediated End-Organ Damage Lab at the Max Delbrück Center and the ECRC.

Previous research has also shown that excess salt could impact Treg function by inducing an autoimmune-like phenotype. In other words, too much salt makes the Treg cells look like those involved in autoimmune conditions. However, exactly how sodium impairs Treg function had not yet been uncovered.

Salt interferes with mitochondrial function of Tregs

The new international study led by Kleinewietfeld and Müller has now discovered that sodium disrupts Treg function by altering cellular metabolism through interference with mitochondrial energy generation. This mitochondrial problem seems to be the initial step in how salt modifies Treg function, leading to changes in gene expression that showed similarities to those of dysfunctional Tregs in autoimmune conditions.

Even a short-term disruption of mitochondrial function had long-lasting consequences for the fitness and immune-regulating capacity of Tregs in various experimental models. The new findings suggest that sodium may be a factor that could contribute to Treg dysfunction, potentially playing a role in different diseases, although this needs to be confirmed in further studies.

“The better understanding of factors and underlying molecular mechanisms contributing to Treg dysfunction in autoimmunity is an important question in the field. Since Tregs also play a role in diseases such as cancer or cardiovascular disease, the further exploration of such sodium-elicited effects may offer novel strategies for altering Treg function in different types of diseases,” says Kleinewietfeld, who heads the VIB Laboratory for Translational Immunomodulation. “However, future studies are needed to understand the molecular mechanisms in more detail and to clarify their potential relationship to disease.”

Source: Max Delbrück Center for Molecular Medicine in the Helmholtz Association

Categories : HospitalsTags :

Evidence-based Healthcare Improves Patient Outcomes

On By ModernMedia
Photo by Andrea Piacquadio on Unsplash

A recent study found improved patient outcomes after receiving care based on scientific and clinical evidence, while also reducing costs. Published in Worldviews on Evidence-Based Nursing, the article also reviewed the extent and type of evidence-based practices (EBPs) performed across clinical settings. 

A total of 636 published articles addressing EBP and patient outcomes met investigators’ inclusion criteria. There were many differences in approaches, designs, and outcomes measured among the articles included in the review. 

Most articles (63.3%) were published in the United States, and 90% took place in the acute care setting. Various EBPs were implemented, with just over a third including some aspect of infection prevention, and most (91.2%) linked to reimbursement. The two most reported outcomes were length of stay (15%), followed by mortality (12%). 

“Although our study revealed that EBP improves patient outcomes and reduces costs for healthcare systems, there is much opportunity to improve healthcare quality and safety with EBP as healthcare executives still do not invest enough in their budgets to ensure that all clinicians take this approach to care and that all care is evidence-based, not steeped in tradition, or outdated policies or procedures,” said corresponding author Linda Connor, PhD, RN, CPN, of The Ohio State University. 

Source: Wiley

Categories : Injury & TraumaTags :

Evidence Piles up for Repetitive Head Impacts Resulting in Encephalopathy

On By ModernMedia
Rugby players
Photo by Olga Guryanova

Over the past 17 years, evidence on chronic traumatic encephalopathy (CTE) has piled up. While some sports organisations like the National Hockey League and World Rugby still claim their sports do not cause CTE, a new review article in the journal Acta Neuropathologica strengthens the case that repetitive head impact (RHI) exposure is the chief risk factor for the condition.

CTE is characterised by a distinctive molecular structural configuration of p-tau fibrils that is unlike the changes observed with aging, Alzheimer’s disease, or any other diseases caused by tau protein.

Though CTE made US headlines in 2007, it wasn’t until 2016 that the National Institute of Neurological Disorders and Stroke/National Institute of Biomedical Imaging and Bioengineering (NINDS-NIBIB) criteria for the neuropathological diagnosis of CTE were published, and they were refined in 2021. Rare, isolated case studies reporting aberrant findings or using non-accepted diagnostic criteria have been disproportionately emphasised to cast doubt on the connection between RHI and CTE.

In the review, Ann McKee, MD, chief of neuropathology at VA Boston Healthcare System and director of the BU CTE Center, stresses that now over 600 CTE cases have been published in the literature from multiple international research groups. And of those over 600 cases, 97% have confirmed exposure to RHI, primarily through contact and collision sports. CTE has been diagnosed in amateur and professional athletes, including athletes from American, Canadian, and Australian football, rugby union, rugby league, soccer, ice hockey, bull-riding, wrestling, mixed-martial arts, and boxing.

What’s more, 82% (14 of the 17) of the purported CTE cases that occurred in the absence of RHI, where up-to-date criteria were used, the study authors disclosed that families were never asked what sports the decedent played.

According to the researchers, despite global efforts to find CTE in the absence of contact sport participation or RHI exposure, it appears to be extraordinarily rare, if it exists at all. “In studies of community brain banks, CTE has been seen in 0 to 3 percent of cases, and where the information is available, positive cases were exposed to brain injuries or RHI. In contrast, CTE is the most common neurodegenerative disease diagnosis in contact and collision sport athletes in brain banks around the world. A strong dose response relationship is perhaps the strongest evidence that RHI is causing CTE in athletes,” she added.

“The review presents the timeline for the development of neuropathological criteria for the diagnosis of CTE which was begun nearly 100 years ago by pathologist Harrison Martland who introduced the term “punch-drunk” to describe a neurological condition in prizefighters,” explained McKee, corresponding author of the study. The review chronologically describes the multiple studies conducted by independent, international groups investigating different populations that found CTE pathology in individuals with a history of RHI from various sources.”

Source: Boston University School of Medicine