ABSTRACT
El objetivo fue analizar la percepción que tienen las personas amputadas de los efectos que el aislamiento social, consecuente a la pandemia de la COVID 19, ha provocado en su movilidad. Es un estudio cualitativo realizado a través de un formulario electrónico con dos ejes temáticos: movilidad física y las preocupaciones y soluciones relacionadas con ésta, antes y después de la pandemia. El proceso de análisis consistió en la organización de los testimonios, separación por ejes temáticos e identificación de las palabras clave. La representación del análisis de datos se realizó utilizando la metodología descriptiva de construcción del diagrama lógico de Ishikawa. Se incluyeron 10 participantes, 9 no estaban infectados por el virus SARS-CoV-2. Las palabras clave que más impactaron en la movilidad física: movimiento, actividad física, ayuda para salir y dolor. Entre los términos secundarios, destacaron: fisioterapia y actividades realizadas en el hogar. Las principales repercusiones del aislamiento fueron la disminución de la movilidad y la resistencia a caminar con más agarrotamiento y problemas musculares, dificultad en los movimientos y en las actividades diarias. También revelaron reducción de la actividad física, estilo de vida sedentario, aumento del peso, falta de ayuda externa para salir y desplazarse y aumento del dolor. Las soluciones para los problemas de movilidad fueron volver a la fisioterapia y la actividad física y adelgazar. Se señala la idoneidad, para las personas amputadas aisladas, de intervenciones a distancia que les permitan recibir de forma integral una atención completa, rehabilitando tanto la salud física como la psicológica. (AU)
The objective was to analyze the perception that people with amputation have of the effects of social isolation caused by the COVID-19 pandemic on physical mobility. It is qualitative research was obtained through an electronic form that contained two thematic axes: physical mobility, concerns, and solutions related to physical mobility before and after the pandemic. The analysis process consisted of the organization of the testimonies, separation by thematic axes, and identification of the content keywords. The representation of the data analysis was carried out using the descriptive methodology of construction of the Ishikawa logic diagram. 10 participants were included, being 9 declared had not yet been infected with the SARS-CoV-2. The keywords that most impacted physical mobility were movement; physical activity, help getting out, and pain. Regarding the secondary keywords physiotherapy and activities performed at home stood out. The greatest repercussions of social isolation were decreased mobility and resistance to walking more stiffness and muscle problems, and difficulty in movements and daily activities. They also revealed stopping physical activities and a sedentary lifestyle, weight gain, no outside help to get out and move, and increased pain. The solutions for the mobility problems were to return to physiotherapy and physical activity and lose weight. Importance is given to remote intervention in people isolated with amputations in a comprehensive way to receive complete care rehabilitating both the physical and psychological health condition. (AU)
O objetivo deste estudo foi analisar a percepção das pessoas com amputação sobre os efeitos do isolamento social causado pela pandemia COVID-19 na mobilidade física. Foi um estudo qualitativo, realizado por meio de formulario eletrônico contendo dois eixos temáticos: mobilidade física e preocupações e soluções relacionadas antes e depois da pandemia. O processo de análise consistiu na organização dos testemunhos, separação por eixos temáticos e identificação de palavras-chave. A representação da análise dos dados foi realizada por meio da metodologia descritiva de construção do diagrama lógico de Ishikawa. Foram incluídos 10 participantes, 9 não infectados pelo vírus SARS-CoV-2. As palavras-chave que mais impactaram na mobilidade física foram movimento, atividade física, ajuda para sair e a dor. Em relação às palavras-chave secundárias destacaram fisioterapia e atividades realizadas em casa. As maiores repercussões do isolamento foram a diminuição da mobilidade e resistência à marcha, maior rigidez e problemas musculares, dificuldade de movimentos e atividades diárias. Também destacaram a interrupção da atividade física e estilo de vida sedentário, ganho de peso, nenhuma ajuda externa para sair e o aumento da dor. As soluções para os problemas de mobilidade foram retornar à fisioterapia e a atividade física, bem como perder peso. É importante a intervenção de forma remota de maneira integral em pessoas com amputações em isolamento para receber cuidados completos, reabilitando a sua saúde física e psicológica. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pandemics , Coronavirus Infections/epidemiology , Amputation, Surgical/psychology , Mental Health , Severe acute respiratory syndrome-related coronavirus , Spain , Mobility LimitationABSTRACT
BACKGROUND: Systemic sclerosis (SSc) is an autoimmune rheumatic disease. Individuals with a diagnosis of SSc describe repercussions on their activities of daily living and instrumental activities of daily living that affect their everyday functional capacity. The objective of this systematic review was to explore the effectiveness of non-pharmacological interventions to improve hand function and the ability to perform activities of daily living. METHODS: A systematic review was conducted on the Cochrane Library, Medline/PubMed, OTseeker, PEDro, Scopus, Web of Science up to September 10, 2022. Inclusion criteria were defined following PICOS recommendations (Populations, Intervention, Comparison and Outcome measures). Methodological quality was assessed with the Downs and Black Scale and risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). A meta-analysis of each outcome was performed. RESULTS: A total of 8 studies met the inclusion criteria, providing data on 487 individuals with SSc. The non-pharmacological intervention applied the most was exercise. The effects of non-pharmacological interventions were better than those of the waiting list or no treatment control conditions in both outcomes - hand function (mean difference [MD] = -6.98; 95% CI [-11.45, - 2.50], P = 0.002, I2 = 0%) and performance of daily activities (MD = -0.19; 95% CI [-0.33, - 0.04], P = 0.01, I2 = 0%). Moderate risk of bias was found in the majority of the studies included. CONCLUSION: There is emerging evidence that non-pharmacological interventions can improve hand function and performance of daily activities in individuals with a diagnosis of SSc. Given the moderate risk of bias found in the studies included, the results should be considered with caution.
Subject(s)
Activities of Daily Living , Scleroderma, Systemic , Humans , Exercise , Quality of LifeABSTRACT
BACKGROUND: Neuropsychiatric symptoms (NPS) in patients with Alzheimer's disease (AD) worsened during the COVID-19 lockdowns, but their progression thereafter is unknown. We present the first longitudinal study tracking them before, during, and after restrictions. OBJECTIVES: To describe the effect of the COVID-19 mandatory lockdowns on Cognitive and Neuropsychiatric symptoms in patients with Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD). METHODS: Cohort of 48 patients with amnestic MCI and 38 with AD in Lima, Peru. They received three rounds of cognitive (RUDAS, CDR, M@T), behavioral (NPI), and functional (ADCS-ADL) assessments. We assessed the change in score means across the time points and for each domain of NPS and tracked the changes in individual patients. RESULTS: RUDAS declined 0.9 (SD 1.0) from baseline to lockdown and 0.7 (SD 1.0) after restrictions. M@T declined 1.0 (SD 1.5) from baseline to lockdown and 1.4 (SD 2.0) after restrictions. CDR worsened in 72 patients (83.72%) from baseline to post-lockdown. NPI worsened by 10 (SD 8.3) from baseline to lockdown but improved by 4.8 (SD 6.4) after restrictions. Proportionally, 81.3% of all patients had worsened NPS during the lockdowns, but only 10.7% saw an increase thereafter. Improvement was statistically significant for specific NPS domains except hallucinations, delusions, and appetite changes. Anxiety, irritability, apathy, and disinhibition returned to baseline levels. CONCLUSION: Following confinement, cognition continued to decline, but NPS demonstrated either stability or improvement. This highlights the role modifiable risk factors may have on the progression of NPS.
Subject(s)
Alzheimer Disease , COVID-19 , Cognitive Dysfunction , Humans , Alzheimer Disease/diagnosis , Longitudinal Studies , Peru/epidemiology , Neuropsychological Tests , Communicable Disease Control , Cognitive Dysfunction/diagnosis , CognitionABSTRACT
La Esclerosis Múltiple (EM) es una enfermedad crónica del sistema nervioso central, para la cual aún no hay una cura definitiva; sin embargo, existe una diversa variedad de terapias con el objetivo de modificar el curso natural de la enfermedad, que promueve la inclusión constante de nuevas estrategias terapéuticas. Objetivo: La Sociedad Peruana de Neurología, por encargo del Ministerio de Salud, convocó a un comité de expertos con el objetivo de elaborar una guía de práctica clínica para el diagnóstico y tratamiento de EM. Método: Se realizó una búsqueda y evaluación de guías de práctica clínica bajo la metodología AGREE II, escogiendo como modelo la Guía de Práctica Clínica Catalana. Las preguntas clínicas no concernientes al tratamiento fueron resueltas a través de revisión sistemática. Las preguntas clínicas de tratamiento se diseñaron bajo el formato PICO y se resolvieron con un meta-análisis de ensayos clínicos disponibles hasta agosto del 2017, tomando en consideración las terapias aprobadas por DIGEMID hasta enero del 2017. Las recomendaciones finales fueron elaboradas mediante el método Delphi modificado con un consenso de al menos 80% de los miembros de su comité. Finalmente se realizó una revisión externa del manuscrito por expertos internacionales en EM. Resultados: Se formularon 18 preguntas clínicas y 21 recomendaciones para el manejo, incluyendo algoritmos terapéuticos.
Multiple Sclerosis (MS) is a chronic disease of the central nervous system, for which there is still no definitive cure; but there is a diverse variety of therapies with the objective of modifying the course of the disease, which promotes the constant inclusion of new therapeutic strategies. Objective: The Peruvian Society of Neurology, as requested by the Peruvian Health Ministry, convened a committee of experts with the purpose of elaborating a clinical practice guideline for the diagnosis and treatment of MS. Method: Clinical practice guidelines were searched and evaluated according to the AGREE II methodology, choosing the Catalan Clinical Practice Guide as a model. The clinical questions not related to treatment were solved through a systematic review. The clinical treatment questions were assessed under the PICO format and were solved with a meta-analysis of clinical trials available until August 2017, considering the therapies approved by DIGEMID until January 2017. The final recommendations were elaborated using the modified Delphi method with a consensus of at least 80% of the members of its committee. Finally, an external revision of the manuscript was made by international experts in MS. Results: Eighteen clinical questions and twenty-one recommendations for management were developed, including therapeutic algorithms.
ABSTRACT
BACKGROUND: Little is known about the influence of ongoing barriers to care in the persistence of hepatitis C virus (HCV) viremia after treatment with direct-acting antivirals (DAAs) among people living with human immunodeficiency virus (PLWH). METHODS: We conducted a retrospective cohort analysis of PLWH treated through the standard of care in 3 Western countries, to investigate the predictors of HCV treatment failure (clinical or virologic), defined as having a detectable serum HCV ribonucleic acid within 12 weeks after DAA discontinuation. In addition to HCV and liver-related predictors, we collected data on ongoing illicit drug use, alcohol abuse, mental illness, and unstable housing. Logistic regression analyses were used to identify predictors of HCV treatment failure. RESULTS: Between January 2014 and December 2017, 784 PLWH were treated with DAA, 7% (n = 55) of whom failed HCV therapy: 50.9% (n = 28) had a clinical failure (discontinued DAA therapy prematurely, died, or were lost to follow-up), 47.3% (n = 26) had an HCV virologic failure, and 1 (1.8%) was reinfected with HCV. Ongoing drug use (odds ratio [OR] = 2.60) and mental illness (OR = 2.85) were independent predictors of any HCV treatment failure. Having both present explained 20% of the risk of any HCV treatment failure due to their interaction (OR = 7.47; P < .0001). Predictors of HCV virologic failure were ongoing illicit drug use (OR = 2.75) and advanced liver fibrosis (OR = 2.29). CONCLUSIONS: People living with human immunodeficiency virus with ongoing illicit drug use, mental illness, and advanced liver fibrosis might benefit from enhanced DAA treatment strategies to reduce the risk of HCV treatment failure.
ABSTRACT
Introduction: Viral load (VL) monitoring for people on antiretroviral therapy (ART) is extremely challenging in resource-limited settings. We assessed the VL testing scale-up in six Médecins Sans Frontières supported health centres in Maputo, Mozambique, during 2014-15. Methods: In a retrospective cohort study, routine programme data were used to describe VL testing uptake and results, and multi-variate logistical regression to estimate predictors of VL testing uptake and suppression. Results: Uptake of a first VL test was 40% (17 236/43 579). Uptake of a follow-up VL test for patients with a high first VL result was 35% (1095/3100). Factors associated with a higher uptake included: age below 15 years, longer time on ART and attending tailored service delivery platforms. Virological suppression was higher in pregnant/breastfeeding women and in community ART Group members. Patients with a high first VL result (18%; 3100/17 236) were mostly younger, had been on ART longer or had tuberculosis. Out of 1095 attending for a follow-up VL test, 678 (62%) had virological failure. Of those, less than one-third had started second line ART. Conclusion: This was the first study describing the uptake and results of VL testing scale-up in Mozambique. Identified gaps show patient and programmatic challenges. Where service delivery was customized to patient needs, VL monitoring was more successful.
Subject(s)
Anti-HIV Agents/therapeutic use , Drug Monitoring/statistics & numerical data , HIV Infections/drug therapy , Viral Load/statistics & numerical data , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Mozambique , Pregnancy , Program Evaluation , Retrospective Studies , Viral Load/drug effects , Young AdultABSTRACT
As fraturas de mandíbulas são lesões que frequentemente acometem o esqueleto facial. Neste artigo, um caso não usual de fratura mandibular por projetil de arma de fogo é descrito
