Physical therapy protocols to attenuate skeletal muscle atrophy in critically ill patients: narrative review / Protocolos de terapia física para atenuar la atrofia del músculo esquelético en pacientes críticos: revisión narrativa

SUMMARY: To describe the physical therapy protocols used in critically ill patients to attenuate skeletal muscle atrophy. We conducted a search in PubMed and Embase from inception to November 2020. Observational or experimental studies published in English or Spanish that evaluated the effect of physical therapy protocols on the attenuation of skeletal muscle atrophy in critically ill patients through muscle strength or mass measurement were considered eligible. Studies were only included if they reported a detailed description of the dosing of the interventions. Seventeen studies met the eligibility criteria. We included randomised clinical trials (n = 16) and observational studies (n = 1). The total population of the included studies was 872 critically ill patients. The studies aimed to evaluate the reliability, safety or effectiveness of neuromuscular electrical stimulation (n = 10) protocols, early mobilisation (n = 3), ergometer training (n = 2), transfers in tilt table (n = 1), and blood flow restriction (n = 1). Physical therapy protocols are part of the critically ill patient's integral management. Strategies such as passive mobilisation, in-bed and out-of-bed transfers, gait training, ergometer training, and neuromuscular electrical stimulation substantially impact critically ill patients' prognoses and quality of life after hospital discharge.

RESUMEN: Describir los protocolos de terapia física usados en pacientes críticos para atenuar la atrofia muscular esquelética. Realizamos una búsqueda en PubMed y Embase desde el inicio hasta noviembre de 2020. Se consideraron los estudios observacionales o experimentales publicados en inglés o español que evaluaron el efecto de los protocolos de terapia física en la atenuación de la atrofia del músculo esquelético en pacientes críticos a través de la medición de la fuerza o la masa muscular. Los estudios solo se incluyeron si informaron una descripción detallada de la dosificación de las intervenciones. Diecisiete estudios cumplieron los criterios de elegibilidad. Se incluyeron ensayos clínicos aleatorizados (n = 16) y estudios observacionales (n = 1). La población total de los estudios incluidos fue de 872 pacientes en estado crítico. Los estudios tuvieron como objetivo evaluar la confiabilidad, seguridad o efectividad de los protocolos de estimulación eléctrica neuromuscular (n = 10), movilización temprana (n = 3), entrenamiento con ergómetro (n = 2), transferencias en mesa basculante (n = 1) y restricción del flujo sanguíneo (n = 1). Los protocolos de terapia física forman parte del manejo integral del paciente crítico. Es- trategias como la movilización pasiva, los traslados dentro y fuera de la cama, el entrenamiento de la marcha, el entrenamiento con ergómetro y la estimulación eléctrica neuromuscular tienen un impacto sustancial en el pronóstico y la calidad de vida de los pacientes críticos después del alta hospitalaria.

Comunidade de remanescentes de quilombolas: práticas culturais de cuidado utilizadas no puerpério / A quilombola remnants community: cultural health care practices used in puerperium / Comunidad de remanentes quilombolas: prácticas cultual de atención utilizadas en el puerperio

Objetivo: descrever as práticas culturais de cuidado no puerpério de mulheres quilombolas. Método: estudo descritivo, de abordagem qualitativa e delineado por meio da Teoria da Diversidade e Universalidade do Cuidado de Madeleine Leininger. Participaram do estudo quatorze mulheres quilombolas que já tinham vivenciado o período puerperal. A coleta das informações ocorreu de junho a setembro de 2018. Projeto aprovado por Comitê de Ética em Pesquisa. Resultados: observou-se a manutenção das crenças e valores, considerando a cultura local relacionada às práticas de cuidado de puérperas quilombolas. Considerações finais: as práticas de cuidado desenvolvidas por mulheres quilombolas no pós-parto se caracterizam por receber influência das crenças, valores e modos de vida que foram transmitidas por meio da oralidade por outras mulheres que já tinham vivenciado esse período.

Objective: to describe cultural practices of health care for quilombola women in puerperium. Method: this qualitative, descriptive study was framed by Madeleine Leininger's Theory of Culture Care Diversity and Universality. Fourteen quilombola women who had already experienced the puerperal period participated in the study. Information was collected from June to September 2018. The project was approved by the research ethics committee. Results: beliefs and values were observed to be maintained in the local culture as regards practices of care for puerperal quilombola women. Final considerations: the postpartum care practices applied by quilombola women were characteristically influenced by the beliefs, values and ways of life transmitted orally by other women who had already experienced puerperium.

Objetivo: describir las prácticas culturales de atención a la salud de las mujeres quilombolas en el puerperio. Método: este estudio cualitativo y descriptivo fue enmarcado por la Teoría de la Cultura Cuidado de la Diversidad y Universalidad de Madeleine Leininger. Participaron del estudio catorce mujeres quilombolas que ya habían pasado por el puerperio. La información se recopiló de junio a septiembre de 2018. El proyecto fue aprobado por el comité de ética en investigación. Resultados: se observó el mantenimiento de creencias y valores en la cultura local en cuanto a prácticas de cuidado de las puérperas quilombolas. Consideraciones finales: las prácticas de atención posparto aplicadas por las mujeres quilombolas estuvieron característicamente influenciadas por las creencias, valores y formas de vida transmitidas oralmente por otras mujeres que ya habían experimentado el puerperio.

Consideraciones para el manejo clínico ambulatorio del COVID-19 leve / Considerations for outpatient clinical management of mild COVID-19

La evidencia científica actual ha permitido el desarrollo de diversas guías y protocolos clínicos para el manejo de la enfermedad COVID-19, los cuales en general, no han desarrollado en profundidad las indicaciones para el manejo ambulatorio del cuadro clínico leve. La Organización Mundial de la Salud señala en estos casos, un tratamiento sintomático, incluyendo antipiréticos, analgésicos, además de nutrición y rehidratación adecuadas. Sumado a lo anterior, se debe realizar aislamiento inmediato, el que debe incluir el seguimiento sobre la evolución de síntomas y necesidad de atención médica. El cumplimiento de estas indicaciones es fundamental para una mejor evolución del cuadro; la correcta hidratación y nutrición permiten optimizar la respuesta inmunológica durante la fase aguda de la enfermedad. Se suma, además, la importancia de mantenerse activo y evitar el reposo absoluto en cama, considerando los efectos deletéreos que esto genera sobre diversos sistemas, incluyendo el cardiorrespiratorio. Es evidente que una persona deshidratada, malnutrida, y que genera complicaciones pulmonares asociadas al reposo en cama, tiene mayor riesgo de requerir hospitalización. Todo lo anterior implica que las personas con COVID-19 leve sean educadas respecto al manejo de la enfermedad en casa, haciéndolas parte activa de su tratamiento, considerando además el impacto sobre la salud mental que implica el diagnóstico. En este artículo se desarrollan los fundamentos del manejo sintomático no farmacológico de la enfermedad leve, visibilizando la importancia de su cumplimiento y haciendo responsable a las autoridades y al equipo de salud sobre la educación a la población en este ámbito.

Current scientific evidence has allowed the development of various clinical guidelines and protocols for the management of COVID-19, which in general has not in depth developed indications for ambulatory care of the mild clinic presentation. The World Health Organization indicates in these cases, a symptomatic treatment, including analgesic, antipyretics, as well an adequate nutrition and rehydration. Besides, immediate isolation must be performed, which must include monitoring the symptoms' evolution and the need of medical attention. The correct following of these indications is essential for a better disease evolution; correct hydration and nutrition allow optimizing the immune response during the acute phase of the disease. In addition, the importance of staying active and avoiding absolute bed rest is added, considering the deleterious effects that this generates on various systems, including the cardiorespiratory one. It is evident that a person who is dehydrated, malnourished, and those who generates pulmonary complications associated with bed rest, has a greater risk of requiring hospitalization. All of the above implies that people with mild COVID-19 must be educated about the management of the disease at home, making them an active part of their treatment, also considering the impact on mental health that the diagnosis implies. This article develops the foundations of a non-pharmacological symptomatic management of mild disease, making visible the importance of its achievement and making the authorities and the health team responsible for educating the population in this area.

Insuficiencia cervical y prolapso de bolsa amniótica "en reloj de arena"en gestante pretérmino / Cervical Insufficiency and Prolapse of an "Hourglass" Amniotic Sac in Preterm Pregnant Women

RESUMEN Introducción: La insuficiencia cervical se concibe hoy día como un proceso biológico continuo con grados progresivos de insuficiencia. La expresión más extrema de la insuficiencia cervical se conoce como "bolsa en reloj de arena". La mayoría de los autores están de acuerdo en recomendar el reposo en cama y realizar cerclaje cervical de emergencia. Objetivo: Presentar el caso de una gestante en la que se logró la reversión del prolapso de las membranas amnióticas en "reloj de arena" con buenos resultados perinatales. Presentación de caso: Paciente de 31 años con antecedentes de parto anterior a las 36,5 semanas, que en los momentos actuales cursa una gestación de 20,6 semanas. Acude a la consulta por dolor en hipogastrio y al examen físico se comprueba que la bolsa amniótica protruye por el orificio cervical externo y presenta una dilatación cervical de 2 cm. Se aplica tratamiento medicamentoso y se reduce el prolapso de la bolsa. Conclusiones: Con el tratamiento conservador se logró una buena evolución de la gestación, con parto eutócico y buenos resultados perinatales(AU)

ABSTRACT Introduction: Cervical insufficiency is conceived today as a continuous biological process with progressive degrees of insufficiency. The most extreme expression of cervical insufficiency is known as "hourglass bag". Most authors agree to recommend bed rest and perform emergency cervical cerclage. Objective: To report the case of a pregnant woman in whom the prolapse reversal of the amniotic membranes in hourglass was achieved with good perinatal results. Case report: A 31-year-old patient who is currently pregnant at 20.6 weeks and has history of childbirth prior to 36.5 weeks. She comes to the consultation complaining of pain in hypogastrium. The physical examination shows that the amniotic sac protrudes through the external cervical orifice and there is 2cm cervical dilation. Drug treatment is applied and the prolapse of the sac is reduced. Conclusions: The conservative treatment achieved good evolution of the gestation, with eutócico childbirth and good perinatal results(AU)

Discomfort and Bleeding in Relation to Bedrest Time after Bone Marrow Examination among Hemato-oncology Patients / 임상간호연구

PURPOSE: The purpose of this study was to investigate hemato-oncology patients' discomfort and bleeding in relation to the bedrest time after bone marrow examination. METHODS: A descriptive correlational study was conducted. The data were collected using self-report questionnaire from total of 131 patients who underwent bone marrow examination from January 2017 to September 2017. Data were analyzed with descriptive statistics, Wilcoxon Signed-rank test, McNemar's test and logistic regression. RESULTS: The level of discomfort after 4 hours of bedrest was significantly higher when compared to 2 hours of bedrest(p<.001). The occurrence of bleeding after 2 hours of bedrest was significantly higher than 4 hours of bedrest(p<.001), however the degree of bleeding was slight. No bleeding occurred in 84% of the patients after 2 hours of bedrest. CONCLUSION: The results of this study demonstrated that shortening the bed rest time after bone marrow examination was helpful in improving the patient's well-being. Bedrest time could be shortened according to the site of bone marrow examination and patient's condition.

Deleterious effects of prolonged bed rest on the body systems of the elderly - a review / Efeitos deletérios do tempo prolongado no leito nos sistemas corporais dos idosos - uma revisão

Abstract Objective: to describe the deleterious effects of prolonged bed rest on the body systems of the elderly. Method: an integrative-narrative review was carried out, with the following research question: What are the effects of prolonged bed rest on the body systems of the elderly? The PubMed and Virtual Health Library databases were searched with the following terms: "bed rest" and "elderly" with the Boolean operator "and". Results: a total of 1,639 articles were found. After application of the established criteria, nine articles remained, and 20 were added to maintain the citation of the primary source, giving a total of 29 articles. Conclusion: the immobility associated with prolonged bed rest is detrimental to the health of the elderly, as it affects several systems, such as the cardiovascular, pulmonary, gastrointestinal, musculoskeletal and urinary systems, which may lead to the onset of diseases in addition to those that led to bed rest. AU

Resumo Objetivo: descrever os efeitos deletérios do tempo prolongado nos sistemas corporais dos idosos. Método: foi realizada revisão integrativa-narrativa, com a seguinte pergunta de pesquisa: Quais os efeitos do tempo prolongado no leito nos sistemas corporais dos idosos? Foram pesquisadas as bases de dados PubMed e Biblioteca Virtual em Saúde (BVS) com os seguintes termos: bed rest e elderly com o boleador and. Resultados: foram encontrados um total de 1.639 artigos. Após aplicação dos critérios estabelecidos restaram nove artigos, sendo que foram acrescentados 20 para a manutenção da citação da fonte primária, totalizando 29 artigos. Conclusão: a imobilidade associada ao tempo prolongado no leito se mostra prejudicial à saúde do idoso por afetar diversos sistemas, tais como cardiovascular, pulmonar, gastrointestinal, musculoesquelético e urinário, podendo levar ao aparecimento de doenças adicionais àquelas que ocasionaram o repouso no leito. AU

Epidural blood patch treatment of diplopia that developed after headache resolution in a patient with spontaneous intracranial hypotension

Sudden headache onset may rarely be caused by spontaneous intracranial hypotension (SIH). Other associated symptoms in patients with SIH are nausea, vomiting, vertigo, hearing alteration, and visual disturbance. This case report describes a 43-year-old female diagnosed with SIH who developed diplopia after resolution of an abrupt-onset headache, which was managed with conservative treatments, including bed rest and hydration. She was also diagnosed with secondary right sixth cranial nerve palsy. Although conservative management relieved her headache, the diplopia was not fully relieved. Application of an autologous epidural blood patch successfully relieved her diplopia, even after 14 days from the onset of visual impairment.

Postdural Puncture Headache after Cervical Medial Branch Block

Cervical medial branch block (MBB) is a frequently performed procedure for management of neck pain that rarely has complications. With fluoroscopic guidance, the procedure is considered a relatively safer procedure than epidural block. We report a case of a 27-year-old woman presenting with postural headache after cervical MBB. Dural penetration by inappropriate needle placement was suspected after reviewing fluoroscopic images of the procedure. After conservative treatment, including bed rest and analgesic treatment, the patient completely recovered without any neurological complications. Complications associated with MBB are rare and previous case reports have focused only on infection or vascular injection as etiologies. This is the first report of complications related to dural puncture after cervical MBB. Our findings suggest that misplacement of the block needle by inaccurate alignment of both sides of the cervical articular pillar, assessed by fluoroscopic view during the procedure, can result in dural injury.

The Influence of Initial Magnetic Resonance Imaging Findings on the Compression Rate of Thoracolumbar Osteoporotic Vertebral Compression Fracture / 대한정형외과학회잡지

PURPOSE: To investigate the influence of the size of low intensity zone (LIZ) (T1 image) on the vertebral body and the increase in the compression rate in patients with osteoporotic vertebral compression fracture. MATERIALS AND METHODS: In a retrospective study, 187 patients (198 segments) who were followed-up for at least 3 months and diagnosed with thoracolumbar vertebral compression fracture between October 2011 and October 2016, and treated with conservative therapies, such as bed rest and thoraco-lumbar-sacral orthosis. We measured the size of the vertebral LIZ, and fractures on the upper and lower endplates were observed on the initial magnetic resonance imaging. We analyzed the correlation with the increase in compression rate at the last follow-up. Comparisons of the increase in the compression rate were analyzed through a correlation analysis. RESULTS: The larger the size of the LIZ the greater the difference in the increase of the compression rate. The group with the initially LIZ (80%–100%) was significantly increased to 23.87%±17.90% (p=0.007). In case of fracture of upper and lower endplates, an increase in the compression rate was 19.39%±12.59% in the upper endplate fracture, which was significantly higher than that in the absence of endplate fracture (p=0.002). CONCLUSION: The larger the size of the LIZ (T1 image) and superior endplate fracture observed on the initial magnetic resonance imaging after fracture, the greater the increase in the compression rate. In particular, when the size of the LIZ is greater than 80%, the compression rate was significantly increased.

Effect of Structured Bed Exercise on Uterine Contractions, Fetal Heart Rate Patterns, and Maternal Psychophysical Symptoms of Hospitalized High-Risk Pregnant Women: A Randomized Control Trial

PURPOSE: This study examined the effect on uterine contraction frequency (UCF), blood pressure (BP), heart rate (HR), fetal heart rate (FHR) patterns and psychophysical symptoms (physical discomfort, anxiety, and depression) of structured bed exercise (SBE) in hospitalized high-risk pregnant women prescribed bed rest. METHODS: Forty-five hospitalized high risk pregnant women at >24 weeks of pregnancy prescribed bed rest were randomly assigned to the experimental or control group. From January to May 2014, data were collected using electronic fetal monitoring and patient monitoring of UCF, BP, HR and FHR patterns, and psychophysical symptoms were measured using the antenatal physical discomfort scale, state-trait anxiety scale, and Edinburgh postnatal depression scale. RESULTS: UCF, BP, HR, and FHR patterns (rate, variability, acceleration, and deceleration) did not differ significantly between the experimental and control groups. The experimental group showed a significant increase in baseline FHR after SBE within the normal range, and after SBE, it reduced to the FHR before SBE. The variability, acceleration and deceleration of FHR before and after SBE did not differ significantly between two groups. Moreover, there was no statistically significant difference before and after SBE in the experimental group. Also, the experimental group showed statistically significant decreases in physical discomfort score. However, there were no significant differences in depression and anxiety score between two groups. CONCLUSIONS: SBE in hospitalized high-risk pregnant women under bed rest did not increase the risk to the fetus, and relieved physical discomfort and anxiety. Therefore, SBE should be considered as a nursing intervention in hospitalized high-risk pregnant women.

A Case of Spontaneous Intracranial Hypotension Accompanied by Acute Kidney Injury in a Child / 대한소아신경학회지

Spontaneous intracranial hypotension in childhood is rare, and a few cases have been reported as a cause of headache in children. A 9-year-old boy was admitted to our hospital with a 3-day history of new-onset headache that worsened upon standing or walking, and aggravating low back pain. No medical history of injury, connective tissue disorder or migraine was detected. A neurological examination revealed neck stiffness. His initial blood tests suggested acute kidney injury by increased blood urea nitrogen (BUN) and creatinine. Brain computed tomography (CT) and cerebral spinal fluid (CSF) analysis were normal: however, opening pressure was low (< 60 mm H₂O). Magnetic resonance imaging (MRI) of the spine showed a collection of cerebral spinal fluid in the dorsal extradural space throughout the entire thoracic and lumbar spine level. The patient was diagnosed as having spontaneous intracranial hypotension accompanied by acute kidney injury. Magnetic resonance myelography and spinal MRI performed 14 days later did not show any cerebrospinal fluid leak. The headache and back pain were alleviated with strict bed rest and hydration. He remained free of headache and back pain at the 2-month follow-up. Here, we report a case of a 9-year-old boy with spontaneous intracranial hypotension.

Rehabilitation in Intensive Care Unit

In the past, critically ill patients in intensive care units have often been managed with bed rest and sedation. On the other hand, prolonged bed rest results in deconditioning and many survivors from the intensive care unit suffer from physical and mental sequelae. Therefore, rehabilitation in intensive care units has been started to prevent them. Recently, many positive results about the effectiveness and safety of rehabilitation in intensive care units were published. In this review, the evidence and the practical point of rehabilitation in intensive care units are discussed.

Vantagens do uso da Rede de dormir: contribuições da enfermagem para a vida / Ventajas del uso de la hamaca: aportes de la enfermería para la vida / Advantages of the use of the hammock: contributions of the nursing for the life

Introdução: a Rede de dormir é uma cama de origem indígena brasileira, usada, principalmente, por população de regiões da Amazônia e Nordeste do Brasil para deitar, repousar e dormir, demonstrando potencialidades para uso em pessoas acamadas. Objetivo: descrever a utilidade da Rd na condição de cama e refletir sobre as suas vantagens para a saúde. Métodos: estudo qualitativo com 66 participantes que habitualmente dormem na cama e na Rd. A produção de dados foi realizada em duas etapas: imagem fotográfica e preenchimento de inquérito de pesquisa. Os dados foram tabulados com estatística descritiva e discutidos por análise discursiva e semiótica de imagens paradas. Resultados: A Rd é preferível em relação à cama para dormir nas noites quentes, fora de casa, sozinho e descansar. A lateralização do corpo no repouso não difere à da cama. Conclusão: o uso da Rd para repousar e ou dormir demonstrou ser vantajosa em relação à cama, por dispensar uso de apoios anatômicos e ser considerada mais aerada e confortável(AU)

Introducción: la hamaca es una cama de origen indígena, usada principalmente por la población de regiones de la Amazonia y Nordeste del Brasil, para recostarse, reposar y dormir. Su uso con enfermos en casa (personas encamadas) ha demostrado potencialidades. Objetivo: describir el uso de la hamaca y sus ventajas para la salud. Métodos: estudio cualitativo con 66 participantes que habitualmente duermen en la cama y en la hamaca. La producción de datos fue realizada en dos etapas: a través de imágenes fotográficas e interrogatorio. En el análisis de datos se utilizó la estadística descriptiva y el análisis discursivo y semiótico de imágenes fijas. Resultados: la hamaca es preferida en relación a la cama para dormir en noches de calor, fuera de casa, solo y para descansar. La lateralización del cuerpo en reposo no difiere a la de la cama. Conclusión: el uso de la hamaca para reposar o dormir demostró tener ventajas en relación a la cama, por proporcionar apoyos anatómicos, ser más fresca y confortable(AU)

Introduction: The hammock is a bed of Brazilian indigenous origin, used mainly by people of the Amazon and Northeast Brazil to lie down, rest and sleep, demonstrating potential for use in bedridden people. Objective: To describe the hammock utility in bed condition and reflect on their health advantages. Methods: qualitative study with 66 participants who habitually sleep in bed and hammock. The production data was performed in two stages: photographic image and research survey fill. Data were tabulated using descriptive statistics and discussed by discursive analysis and semiotics of still images. Results: The hammock is preferred over the bed to sleep on hot nights away from home, alone and rest. The body lateralization at home does not differ to the bed. Conclusion: The use of the hammock to rest or sleep proved to be advantageous in relation to the bed, for taking use of anatomical support and be considered more aerated and comfortable(AU)

A Rare Complication of Lumbar Spinal Surgery: Pneumocephalus / 대한신경손상학회지

A 25-year-old male patient with severe thigh and right side pain was presented. In the lumbar magnetic resonance images, there was a contrasting spinal cord tumor image with 1 cm in diameter at the level of the L3 vertebra. The patient was operated and the tumor was totally removed. All the pain of the patient recovered. The patient's postoperative two days were very comfortable and the patient was early mobilized. On the third postoperative day, the patient complained of severe headache, nausea and vomiting. Immediate cranial computed tomography (CT) images was performed. Cerebral pneumocephalus was present in CT. The patient was treated with definite bed rest and plenty of fluid replacement. After three days, the patient's complaints were completely improved. This improvement was confirmed by performing a cerebral CT scan. In the formation of pneumocephalus, air is compressed into the intradural space during operation and this passes to the cerebral space. Definite bed rest, abundant fluid replacement and, in addition, highly inspired oxygen therapy are sufficient to correct the condition.

Lumbar herniated disc: spontaneous regression

BACKGROUND: Low back pain is a frequent condition that results in substantial disability and causes admission of patients to neurosurgery clinics. To evaluate and present the therapeutic outcomes in lumbar disc hernia (LDH) patients treated by means of a conservative approach, consisting of bed rest and medical therapy. METHODS: This retrospective cohort was carried out in the neurosurgery departments of hospitals in Kahramanmaraş city and 23 patients diagnosed with LDH at the levels of L3−L4, L4−L5 or L5−S1 were enrolled. RESULTS: The average age was 38.4 ± 8.0 and the chief complaint was low back pain and sciatica radiating to one or both lower extremities. Conservative treatment was administered. Neurological examination findings, durations of treatment and intervals until symptomatic recovery were recorded. Laségue tests and neurosensory examination revealed that mild neurological deficits existed in 16 of our patients. Previously, 5 patients had received physiotherapy and 7 patients had been on medical treatment. The number of patients with LDH at the level of L3−L4, L4−L5, and L5−S1 were 1, 13, and 9, respectively. All patients reported that they had benefit from medical treatment and bed rest, and radiologic improvement was observed simultaneously on MRI scans. The average duration until symptomatic recovery and/or regression of LDH symptoms was 13.6 ± 5.4 months (range: 5−22). CONCLUSIONS: It should be kept in mind that lumbar disc hernias could regress with medical treatment and rest without surgery, and there should be an awareness that these patients could recover radiologically. This condition must be taken into account during decision making for surgical intervention in LDH patients devoid of indications for emergent surgery.

Effects of Bed Angles and Bed Rest Time Combined with Hemostatic Methods on Discomfort and the Occurrence of Hemorrhagic Complications in Patients after Transfemoral Cerebral Angiography / 임상간호연구

PURPOSE: The purpose of this study was to examine the effects of bed angles and bed rest time combined with hemostatic methods on discomfort and hemorrhagic complications in patients after transfemoral cerebral angiography. METHODS: Data were collected from 93 inpatients following transfemoral cerebral angiography, from April 20 to September 23, 2016. Patients were grouped according to bed angle (0° vs. 30°) and bed rest time combined with hemostatic methods (4-hour bed rest after manual compression vs. 2-hour bed rest after applying vascular closure device). RESULTS: There was a significant group differences on discomfort (F=46.44, p<.001). The post-hoc analysis showed the lowest score of discomfort in those with bed angle 30o and 2-hour bed rest. There was no difference in hemorrhagic complications among 4 groups. CONCLUSION: The postangiograpy discomfort can be effectively reduced with the least hemorrhagic complications by bed angle 30° elevation and 2-hour bed rest after applying vascular closure device for those underwent transfemoral cerebral angiography.

Surgical techniques and clinical evidence of vertebroplasty and kyphoplasty for osteoporotic vertebral fractures

Osteoporotic vertebral fracture is a disease condition with high morbidity and mortality, whose prevalence rises with mean increase in the life span. Conventional treatments for an osteoporotic vertebral fracture include bed rest, pain medication and brace implementation, but if the patient's pain is severe, cement augmentation procedures, including vertebroplasty and kyphoplasty, are performed. Vertebroplasty and kyphoplasty are relatively easy procedures that have been reported to be effective in controlling acute pain. But, the risk of complication and additional adjacent segment fracture and their superiority over conventional treatment remain debatable. Therefore, the authors have summarized the procedures, complications, and clinical evidence of vertebroplasty and kyphoplasty in this review.

Postdural puncture headache / 대한마취과학회지

Postdural puncture headache (PDPH) is a common complication after inadvertent dural puncture. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and being a non-smoker. Needle size, design, and the technique used also affect the risk. Because PDPH can be incapacitating, prompt diagnosis and treatment are mandatory. A diagnostic hallmark of PDPH is a postural headache that worsens with sitting or standing, and improves with lying down. Conservative therapies such as bed rest, hydration, and caffeine are commonly used as prophylaxis and treatment for this condition; however, no substantial evidence supports routine bed rest and aggressive hydration. An epidural blood patch is the most effective treatment option for patients with unsuccessful conservative management. Various other prophylactic and treatment interventions have been suggested. However, due to a lack of conclusive evidence supporting their use, the potential benefits of such interventions should be weighed carefully against the risks. This article reviews the current literature on the diagnosis, risk factors, pathophysiology, prevention, and treatment of PDPH.

Rate of spontaneous voiding recovery after acute urinary retention due to bed rest in the hospital setting in a non-urological population clinical study of the relationship between lower limbs and bladder function

Abstract Objectives To understand the clinical relationship between lower limbs functions and the recovery of spontaneous voiding after an acute urinary retention (AUR) in older patients admitted to hospitals for non-urological causes using clinical parameters. Materials and Methods 56 adult patients (32 men; mean age: 77.9 ± 8.3 and 24 women; mean age 82.1 ± 4.6) with AUR were prospectively followed with validated Physical Performance Mobility Exam (PPME) instrument to evaluate the relationship between the recovery of mobility capacity and spontaneous voiding. After a short period of permanent bladder drainage patients started CIC along evaluation by PPME during hospitalization and at 7, 15, 30 60, 90, and 180 days of discharge. Mann-Whitney U, chi-square test and ANOVA tests were used. Results All patients were hospitalized for at least 15 days (Median 26.3 ± 4.1 days). Progressive improvement on mobility scale measured by PPME was observed after leaving ICU and along the initial 7 days of hospitalization but with a deterioration if hospitalization extends beyond 15 days (p<0.03). Prolonged hospital stay impairs mobility in all domains (p<0.05) except step-up and transfer skills (p<0.02) although a recovery rate on spontaneous voiding persistented. Restoration of spontaneous voiding was accompanied by improvement on mobility scale (p<0.02). Recovery of spontaneous voiding was markedly observed after discharging the hospital. All patients recovered spontaneous voiding until 6 months of follow-up. Conclusions Recovery to spontaneous voiding after acute urinary retention in the hospital setting may be anticipated by evaluation of lower limbs function measured by validated instruments.

A Case of Severe Epistaxis during Pregnancy Treated by Sphenopalatine Artery Ligation / 대한이비인후과학회지

Epistaxis is a common disease encountrered in Otorhinolaryngology; however, life-threatening epistaxis during pregnancy is rare, and there are no specific guidelines regarding the management of such patients. We encountered a 38-year-old female patient in the second trimester of her pregnancy, who presented with nosebleeds. No definite focus of bleeding was identified by nasal endoscopy, thus several conservative measures were used to stop nosebleeds including bed rest with head elevation, ice pack application, and nasal packing. Despite such treatments, nosebleeding continued. Endoscopic sphenopalatine artery ligation was conducted under general anesthesia and the results were successful. In obstetric assessment, there was no evidence of fetal distress. The patient delivered a healthy baby at 40 weeks, and there was no recurrence of epistaxis through postoperative 18 months.