[Long-term consequences of COVID-19 in patients with functional bowel disorders, rehabilitation prospective of microbiocenosis-oriented therapy].

AIM: To analyze long-term consequences of the new coronavirus infection and rehabilitation prospective of microbiocenosis-oriented therapy in patients with functional bowel disorders. MATERIALS AND METHODS: The study enrolled 100 consecutive patients with various types of functional bowel disorders with recurrence of symptoms after the new coronavirus infection. The severity of abdominal pain was evaluated in points, and bowel movement disorders were assessed using the Bristol stool scale. A questionnaire was used as part of an in-depth clinical examination for COVID-19 survivors to identify the clinical symptoms typical for the post-COVID syndrome. The Hospital Anxiety and Depression Scale was used to identify and assess the severity of depression and anxiety, and the Asthenic State Scale was used to diagnose the asthenia. RESULTS: All patients in the study subjectively linked the recurrence of bowel disorders with the new coronavirus infection. The most common bowel disorder was irritable bowel syndrome with diarrhea. A distinctive feature of exacerbations of intestinal symptoms in the post-COVID period is their association with depression/anxiety and asthenic states. The addition of Zakofalk® metaprebiotic to the treatment regimen was associated with significant regression of abdominal pain and normalization of bowel movement, an improvement of asthenia, anxiety, and depression. CONCLUSION: The addition of Zakofalk® to treatment regimens for exacerbations of functional bowel disorders after the new coronavirus infection significantly improves the effectiveness of therapy.

Estudio aleatorizado sobre la influencia de un programa de rehabilitación integral funcional en el control de la astenia relacionada con la enfermedad oncológica / Randomised study on the influence of a comprehensive rehabilitation programme on control of cancer-related asthenia

FUNDAMENTO Y OBJETIVO: La astenia debida a la enfermedad oncológica es un fenómeno multifactorial, tratado habitualmente mediante fármacos. Estos tratamientos suelen controlar el síntoma, pero no consiguen mejorar la funcionalidad de los pacientes. En algunos pacientes pueden inducir o incluso aumentar los niveles de astenia. El objetivo principal de nuestro estudio ha sido comprobar la eficacia de un programa de rehabilitación integral funcional en el control de la astenia relacionada con la enfermedad oncológica. PACIENTES Y MÉTODOS: Este es un estudio experimental, prospectivo, longitudinal, aleatorizado mediante un esquema paralelo de asignación fija con grupo experimental y grupo control, realizado con 192 pacientes del Servicio de Oncología del Hospital Universitario de Salamanca. El grupo de intervención, además de recibir tratamiento farmacológico, participó en un programa de rehabilitación integral funcional. El grupo control solo recibió el tratamiento farmacológico habitual. Los resultados principales medidos fueron los niveles de astenia y la realización de actividades de la vida diaria mediante el cuestionario Perform y la escala triple EVA. RESULTADOS: Los pacientes del grupo experimental obtuvieron después de la intervención una importante disminución en los niveles de astenia evaluada con el cuestionario PERFORM (puntuación inicial del grupo experimental: 19,19; puntuación inicial del grupo control: 20,98. Puntuación final del grupo experimental: 36,12; puntuación final del grupo control: 22,48). Estos resultados son estadísticamente significativos con respecto a los obtenidos por el grupo control (p < 0,001; IC 95%). Los pacientes del grupo de intervención obtuvieron también una mejora estadísticamente significativa (p < 0,001; IC 95%) comparada con la obtenida por los sujetos del grupo control en los ítems de niveles de energía, actividades diarias y calidad de vida evaluados con la escala triple EVA. CONCLUSIONES: Las intervenciones no farmacológicas de un programa de rehabilitación integral funcional mejoran los niveles de astenia debida a la enfermedad oncológica: esto supone un incremento importante de sus actividades de la vida diaria

BACKGROUND AND OBJECTIVE: Cancer-related fatigue is a multifactorial phenomenon, which is usually treated exclusively with medication. These treatments usually only achieve control of symptoms but do not improve the functionality of PATIENTS: In some patients they can induce or increase fatigue levels. Our aim is to test the effectiveness of a «comprehensive functional rehabilitation programme» in controlling fatigue-related cancer. PATIENTS AND METHOD: This is an experimental, prospective, longitudinal, randomized study using a parallel fixed allocation scheme with experimental and control group with 192 patients from the Oncology Service of Salamanca University Hospital. The intervention group received pharmacological treatment and then participated in a «comprehensive functional rehabilitation programme»; the control group received only pharmacological treatment. The main outcomes measured were asthenia levels and daily activities through the PERFORMA questionnaire and triple VAS. RESULTS: Patients in the experimental group decrease fatigue levels in PERFORM Questionnaire (Initial score group, 19.19, initial score, control group, 20.98, final score, 36.12, final score, control group, 22.48). We found significant differences (p < 0.001, IC 95%) with patients of CONTROL GROUP: Patients of intervention group improve the energy levels, daily activities and quality of life assessed with the EVA triple scale and also we found again significant differences (p < 0.001, IC 95%) with patients of CONTROL GROUP: CONCLUSIONS: The non- pharmacological interventions of functional rehabilitation program comprehensive decrease fatigue related cancer, therefore patients participating in this program better perform their daily activities

Exposició a tuberculosi pulmonar en una unitat neonatal: decisions diagnòstiques i terapèutiques / Exposición a tuberculosis pulmonar en una unidad neonatal: decisiones diagnósticas y terapéuticas / Exposure to pulmonary tuberculosis in a neonatal unit: diagnostic and therapeutic decisions

Fonament: els nounats tenen un risc incrementat de patir malaltia tuberculosa greu a causa de la seva condició d'immunosupressió. Objectiu: avaluar la incidència d'infecció tuberculosa o malaltia latent en una cohort de nounats exposats a un treballador sanitari d'una unitat neonatal diagnosticat de malaltia tuberculosa pulmonar, així com descriure les estratègies per al seu diagnòstic i tractament. Mètode: per al cribratge inicial es va fer una prova de tuberculina (PT) i una radiografia (Rx) toràcica. En cas de dubte, es practicaria una tomografia axial computada (TC) i un QuantiFERON(R)-TB Gold test. Descartada la infecció, es va iniciar tractament amb isoniazida fins als 6 mesos. A aquesta edat, es va fer una segona PT. Resultats: seixanta nounats van estar exposats al cas índex. La PT va ser negativa tant a l'inici com als 6 mesos. Un nadó presentava una imatge dubtosa en la radiografia toràcica, però la TC i el QuantiFERON(R)-TB Gold test van ser normals. El 88,6% dels nounats van iniciar profilaxi, es va contraindicar en el 3% i hi va haver negativa dels pares en el 8%. Tan sols un pacient va presentar efectes secundaris per isoniazida. El 78% dels casos va completar la profilaxi. Als 12 mesos no es va detectar cap cas de tuberculosi. Conclusions: la incidència d'infecció tuberculosa en nounats hospitalitzats exposats és baixa, però, a causa de la gravetat potencial, la profilaxi amb isoniazida fins als 6 mesos i un cribratge precoç amb una PT i una Rx toràcica poden ser una estratègia vàlida per minimitzar el risc

Fundamento. Los neonatos tienen un riesgo incrementado de sufrir enfermedad tuberculosa grave dada su condición de inmunosupresión. Objetivo. Evaluar la incidencia de infección tuberculosa o enfermedad latente en una cohorte de neonatos expuestos a un trabajador sanitario de una unidad neonatal diagnosticado de enfermedad tuberculosa pulmonar, así como describir las estrategias para su diagnóstico y tratamiento. Método. Para el cribado inicial se realizó una prueba de tuberculina (PT) yuna radiografía (Rx) torácica. En caso de duda, se practicaría tomografía axial computerizada (TC) y prueba del QuantiFERON®-TB Gold test. Descartada la infección, se inició tratamiento con isoniazida hasta los 6 meses. A esta edad se practicó una segunda PT. Resultados. Sesenta neonatos fueron expuestos. La PT fue negativa tanto al inicio como a los 6 meses. Un neonato presentaba una imagen dudosa en la radiografía torácica, pero la TC y el QuantiFERON®-TB Gold test fueron normales. El 88,6% de los neonatos iniciaron profilaxis, se contraindicó en el 3% y hubo negativa de los padres en el 8%. Tan sólo un paciente presentó efectos secundarios por isoniazida. El 78% de los casos completó la profilaxis. A los 12 meses no se detectó ningún caso de tuberculosis. Conclusiones. La incidencia de infección tuberculosa en neonatos hospitalizados expuestos es baja, pero, debido a la potencial gravedad, la profilaxis con isoniazida hasta los 6 meses y un cribado precoz con una PT y una Rx torácica pueden ser una estrategia válida para minimizar el riesgo (AU)

Background. Neonates have an increased risk to suffer severe tuber culosis due to their immunosuppressed condition. Objective. To assess the incidence of tuberculosis infection or latent disease in a cohort of newborns exposed to a healthcare worker of the neonatal unit, diagnosed with pulmonary tuberculosis disease, as well as describe diagnostic and treatment strategies. Method. Tuberculin skin test (TST) and chest X-rays were performed at the initial screening. Chest computed tomography (CT) and QuantiFERON®-TB Gold test were performed on cases where chest X-ray was not clear. Once all diagnostic tests were negative, infants were treated with isoniazid up to 6 months of age. At this age, a second TST was performed. Results. 60 newborns were exposed. TST were negative at baseline and at 6 months. One infant had an abnormal chest X-ray, with normal findings on CT and QuantiFERON®-TB Gold test. 88.6% neonates started with prophylaxis, it was contraindicated in 3% and was refused by the parents in 8%. Isoniazid was withdrawn due to side effects in only 1 infant. Prophylaxis was completed by 78% of patients. At 12 months, no cases of tuberculosis were reported. Conclusions. The tuberculous infection incidence in hospitalized neonates exposed is low but, due to the potential severity, prophylaxis with isoniazid until 6 months and an early screening with TST and chest X-ray is a valid strategy to minimized risks (AU)

Inpatient rehabilitation improved functional status in asthenic patients with solid and hematologic malignancies.

OBJECTIVE: The aim of this study was to compare functional outcomes in asthenic patients with hematologic malignancies with those of asthenic patients with solid tumors after inpatient rehabilitation. We hypothesized that asthenic patients with hematologic malignancies are less likely than patients with solid tumors to make functional improvement after rehabilitation. DESIGN: The records of 60 asthenic cancer patients (30 consecutive patients with solid tumors and 30 consecutive patients with hematologic malignancies) who underwent inpatient rehabilitation at a comprehensive cancer center between October 2005 and October 2007 were retrospectively reviewed. Patients with focal neurologic deficits were excluded. All patients admitted to the inpatient rehabilitation unit received 3 hrs of more of therapy per weekday. The main outcomes included total, motor, and cognitive Functional Independence Measure (FIM) scores, hospital and rehabilitation length of stay, and FIM efficiency. RESULTS: The mean total FIM score significantly improved in patients with solid tumors (mean, 15; range, -6 to 38) and in patients with hematologic malignancies (mean, 17; range, -3 to 27); however, between-group differences in FIM scores were not significant (P = 0.31). The solid tumor patients were significantly older than the hematologic malignancy patients (71 ± 11 vs. 64 ± 12 yrs; P = 0.02), but the mean rehabilitation lengths of stay were the same for each group (9.5 days; P = 0.82). The mean FIM efficiency in the hematologic malignancy group was higher than that of the solid tumor group (1.9 vs.1.4; P = 0.049). CONCLUSIONS: Asthenic patients with solid tumors or hematologic malignancies could benefit from inpatient rehabilitation and make significant functional gain.

Redefining cancer-related asthenia-fatigue syndrome.

BACKGROUND: Asthenia fatigue syndrome (AFS) is a common symptom perceived by patients with cancer and consists of reported pathologic fatigue, poor endurance, and impaired motor and cognitive function. OBJECTIVE: The purpose of this study was to examine the relationship between a traditional measure of AFS, visual analogue scale (VAS) fatigue ratings, and a set of more objective functional and physiologic measures (Dietz oncology classification, C-reactive protein, serum albumin, hemoglobin, body mass index [BMI]), Motor Functional Independence Measure (FIM) Score, Cognitive FIM Score. We hypothesized a relationship could suggest the utility of alternative means of assessing and addressing AFS. METHODS: We retrospectively examined the records of 131 patients admitted to our facility for inpatient rehabilitation because of disability-causing cancer or its treatment. RESULTS: Of our sample, 94.7% (124 cases) indicated at least mild fatigue and 97.7% (128 cases) showed abnormal serum albumin, C-reactive protein, hemoglobin, or BMI. We used multiple regression analysis to examine the relationship between VAS fatigue ratings and the aforementioned set of functional and physiologic variables. The regression explained a significant proportion of the variability in VAS fatigue ratings (F = 2.25, df = 7,123, p = 0.03, R = 0.34, R(2) = 0.11). However, only Motor FIM Score accounted for a significant independent contribution to the variability in VAS fatigue ratings. CONCLUSION: The data indicate physiologic and functional variables may provide an alternative, objective, and reliable operational definition of AFS. Specifically, using Motor FIM Score, as a surrogate for VAS fatigue ratings may be used to measure the efficacy of AFS treatment.

The role of rehabilitation medicine and palliative care in the treatment of patients with end-stage disease.

Rehabilitation medicine and palliative care share many common goals. They strive to maximize physical function and emotional well-being to the highest extent possible given the nature of the underlying disease process. Many patients with end-stage disease experience symptoms and functional losses that diminish their quality of life. This article outlines the benefits that active rehabilitation therapy can provide to patients in the terminal stages of their disease and some of the ethical and practical issues faced in the planning and provision of this care.

[Changes in poststroke asthenia in the course of rehabilitation]. / Dinamika postinsul'tnoi astenii v protsesse vosstanovitel'nogo lecheniia.

Questionnaire (asthenia MFI) survey of 2043 patients early in rehabilitation after ischemic stroke in the territory of the carotid arteries was made. Asthenia was detected in 81% patients with elevated total score, physical, psychic asthenia, hypoactivity and low motivation. Asthenia was secondary and correlated with social maladaptation. Rehabilitation in a specialized neurological department of health resort Ust-Kachka leads to positive changes in the above indices.

Psychoneurophysiological assessment of recovery of cognitive function in patients with asthenia during rehabilitation.

Forty patients with severe asthenia were subjected to clinical, neurological, psychometric, and neurophysiologic examination before and after Enerion therapy. Psychoneurophysiological assessment with cognitive evoked potentials P300 and psychometric tests revealed serious impairment of cognitive functions in patients before therapy (compared to healthy individuals). Enerion therapy decreased the degree of psychoautonomic syndrome and asthenia and improved cognitive functions.

Rehabilitation for elderly patients with cancer asthenia: making a transition to palliative care.

The transition from curative to palliative care for elderly patients with cancer-related asthenia presents complex challenges to oncologists. A result of this complexity is a lack of regard for the maintenance of physical and mental function. This study examined the effects of comprehensive, multidisciplinary, inpatient rehabilitation on the physical and mental function of elderly cancer patients with asthenia. We found that both physical and mental function improved following inpatient rehabilitation. However, it is difficult to predict which patients benefit most from rehabilitation. Nevertheless, functional improvement following rehabilitation may allow medical caregivers to better distribute the type and intensity of care, and reduce the caregiver burden experienced by family members in the home.

Functional recovery in cancer rehabilitation.

OBJECTIVE: To assess the impact of inpatient rehabilitation on the motor and cognitive functional status of cancer patients, and to determine whether cancer diagnosis, rehabilitation impairment, physician-determined rehabilitation goals, and active cytotoxic treatment affect the magnitude of functional improvement. DESIGN AND SETTING: A retrospective, case series of patients with an oncology diagnosis undergoing inpatient rehabilitation at a rehabilitation hospital. PARTICIPANTS: A sample of 200 patients admitted for rehabilitation services due to disability resulting from impairments caused by cancer or its treatment. INTERVENTION: Comprehensive multidisciplinary inpatient rehabilitation. OUTCOME MEASURES: Function status was measured using the motor and cognitive measures of the Functional Independence Measure. RESULTS: All patients made significant gains in motor function regardless of diagnostic group, rehabilitation impairment group, rehabilitation goal group, and cytotoxic treatment status. The magnitude of motor function gain was not equivalent across all impairments and rehabilitation goals. Significant gains in cognitive function were made by all patients except those with intracranial neoplasms, central nervous system dysfunction, and palliative rehabilitation goals. CONCLUSION: Inpatient rehabilitation can improve both motor and cognitive function in patients with disability resulting from impairments caused by cancer or its treatment.

Persons found in their homes helpless or dead.

BACKGROUND: Health care providers and providers of emergency services are sometimes called to help with people who are found alone in their homes either helpless or dead. It is not known who is at risk for being found helpless or dead, what the mortality rates are among those found alive, or how frequently this situation occurs. METHODS: We conducted a population-based study of patients who were found in their homes either helpless or dead. Over 12 weeks, paramedics employed by the city of San Francisco identified 387 such events involving 367 persons. We obtained information on these patients from the emergency-medical-services department or the hospitals to which they were taken and determined their outcomes. RESULTS: The median age of the persons found helpless or dead was 73 years; 51 percent were women. The frequency of such incidents increased sharply with age, from a rate of 3 per 1000 per year among those 60 to 64 years of age to 27 per 1000 per year among those 85 years of age or older. The highest rate was among men 85 years and older who were living alone (123 per 1000 per year). In 23 percent of the cases, the person was found dead; an additional 5 percent died in the hospital. Thus, total mortality was 28 percent. Of the patients found alive, 62 percent were admitted to the hospital. The average hospital stay was eight days, and 52 percent of those admitted required intensive care. Of the survivors, 62 percent were unable to return to living independently. The total mortality was 67 percent for patients who were estimated to have been helpless for more than 72 hours, as compared with 12 percent for those who had been helpless for less than 1 hour. CONCLUSIONS: For elderly people who live alone, becoming incapacitated and unable to get help is a common event, which usually marks the end of their ability to live independently.

[The importance of individualized physical training in the rehabilitation of patients with arterial hypotension]. / Znachenie individualizirovannykh fizicheskikh trenirovok v reabilitatsii bol'nykh arterial'noi gipotenziei.

Essential hypotension patients whose 2-year program of rehabilitation included continuous physical training according to individual multifactorial programs or relevant training combined with drug therapy showed more favourable clinical response. Threshold muscular load and everyday motor activity rose more significantly when compared to those in patients who received chemotherapy alone.

[The dynamics of neurotic disorders with autonomic paroxysms]. / Dinamika nevroticheskikh rasstroistv s vegetativnymi paroksizmami.

Multi-dimensional investigation in the peculiarities, clinical course and possible mechanisms of neurotic disorders was performed in 115 patients. In order to study the further course of neurotic disorders and their determinants, as well as the issues of social rehabilitation and psychoprophylactic interferences, 56 patients were studied again after 6 to 8 years. For each of the symptom complexes investigated, the course had distinct features determined primarily by adaptation-compensatory capabilities of personality, and the "system of psychological defense". Most unfavorable was the course of hysterical disorders. Therapeutic policy in these patients should be grounded upon the psychotherapeutic measures aimed at finding the ways that would be psychologically adequate for changing the patients' attitudes and restoring their adaptation.