Changes in respiratory function and physical performance in middle-aged and old inpatients recovering from COVID-19 after a rehabilitation program

Степень изменений дыхательной функции и физической подготовленности у пациентов, выздоравливающих после COVID-19, представляет интерес для реабилитационных мер. 56 пациентов (67 % - женщины), средний возраст - 64±11 лет, перенесшие COVID-19, прошли курс комплексной реабилитации (16,9±3,8 дня). После курса реабилитации пациенты показали улучшение дыхательной функции: проба Штанге - на 19 % (p=0,006), проба Генчи - на 25 % (p=0,026), улучшение самочувствия по результатам КТ легких (p<0,001); повышение физической подготовленности: скорость привычной ходьбы - на 80 % (р=0,025); толерантности к физической нагрузке: пройденное расстояние до первых признаков утомления - на 227 % (р<0,001), ЧСС в покое - на 1 % (р=0,011). Темпы изменений дыхательной функции и физической подготовленности были значительными и превышали подобные изменения, приводимые в литературе для относительно здоровых пожилых людей, которые приступают к физическим занятиям. Однако абсолютные показатели функции дыхания и физической подготовленности после реабилитационной программы были ниже нормированных значений для данного возраста. Данные результаты могут быть полезны для клиницистов при составлении программы реабилитации пациентов, перенёсших COVID-19. Changes in respiratory and physical performance in geriatric inpatients recovering from COVID-19 are of interest for rehabilitation interventions. 56 inpatients (67 % women), average age 64±11 years recovering from COVID-19 underwent a comprehensive rehabilitation program (16,9±3,8 days). After the rehabilitation program, the patients showed an improvement in respiratory function: voluntary breath-holding after inhalation - by 19 % (p=0,006), breath-holding after exhalation - by 25 % (p=0,026), lungs computed tomography (p<0,001); physical performance: handgrip strength - by 14 % (p=0,083), preferred walking speed - by 80 % (p=0,025); exercise tolerance: distance walked until the first signs of fatigue - by 227 % (p<0,001), resting heart rate - by 1 % (p=0,011). The interaction of rehabilitation time and patient sex was statically nonsignificant across all variables of interest. The rates of changes in respiratory function and physical performance were significant and exceeded similar changes recorded in healthy old people who begin an exercise program. However, in absolute values, respiratory function and physical performance values after the rehabilitation were lower than reference values for this age group. These results can be valuable for clinicians when designing a rehabilitation program for geriatric patients recovering from COVID-19.

Use of intravenous lipid emulsion therapy as a novel treatment for brevetoxicosis in sea turtles

The southwest coast of Florida experiences annual red tides, a type of harmful algal bloom that results from high concentrations of Karenia brevis. These dinoflagellates release lipophilic neurotoxins, known as brevetoxins, that bind to sodium channels and inhibit their inactivation, resulting in a variety of symptoms that can lead to mass sea turtle strandings. Traditional therapies for brevetoxicosis include standard and supportive care (SSC) and/or dehydration therapy; however, these treatments are slow-acting and often ineffective. Because red tide events occur annually in Florida, our objective was to test intravenous lipid emulsion (ILE) as a rapid treatment for brevetoxicosis in sea turtles and examine potential impacts on toxin clearance rates, symptom reduction, rehabilitation time, and survival rates. Sea turtles exhibiting neurological symptoms related to brevetoxicosis were brought to rehabilitation from 2018–2019. Upon admission, blood samples were collected, followed by immediate administration of 25 mg ILE/kg body mass (Intralipid® 20%) at 1 mL/min using infusion pumps. Blood samples were collected at numerous intervals post-ILE delivery and analyzed for brevetoxins using enzyme-linked immunosorbent assays. In total, nine (four subadults, one adult female, four adult males) loggerheads (Caretta caretta), five (four juvenile, one adult female) Kemp’s ridleys (Lepidochelys kempii), and four juvenile green turtles (Chelonia mydas) were included in this study. We found that plasma brevetoxins declined faster compared to turtles that received only SSC. Additionally, survival rate of these patients was 94% (17/18), which is significantly higher than previous studies that used SSC and/or dehydration therapy (47%; 46/99). Nearly all symptoms were eliminated within 24–48 h, whereas using SSC, symptom elimination could take up to seven days or more. The dosage given here (25 mg/kg) was sufficient for turtles in this study, but the use of a higher dosage (50–100 mg/kg) for those animals experiencing severe symptoms may be considered. These types of fast-acting treatment plans are necessary for rehabilitation facilities that are already resource-limited. Intravenous lipid emulsion therapy has the potential to reduce rehabilitation time, save resources, and increase survival of sea turtles and other marine animals experiencing brevetoxicosis.

Depression a common condition in older hospitalized chronic patients-a transversal study

Objective: To examine the prevalence of depression among older hospitalized patients and its relation to chronic diseases. Method: A transversal study was conducted in a Regional Hospital in South Albania which included a total of 100 hospitalized chronic patients. The study lasted one month and the Patient Health Questionnaire (PHQ-9) was used for the data collection. Each participant completed a validated Albanian version of the questionnaire. Patients diagnosed with various pathologies who presented for examination but were not admitted to the hospital were excluded from the study. For the data analyses were used descriptive statistics. Results: Participants’ mean age was 55.9 ± 18.45. 46 % of patients were female and 54% were male. The results of variables assessing the depression were as follows: 24% of female patients report “Little interest or pleasure in doing things” nearly every day; 15% of female and 11% of male patients report “Feeling down, depressed, or hopeless”; 39% of female and 24% of male patients feel “tired or have little energy”. The diagnosis was significantly associated with the trend for depression, p<0.05. The most frequent diagnoses diagnosis were hypertension, diabetes, and stroke respectively 23.00%, 14.00%, and 10.00%. Conclusion: Depressive symptoms occur more commonly in older hospitalized patients with chronic diseases. They require a longer rehabilitation time, which influences the day hospital stay. For improving the quality of care and life of this patient a routine depression screening and more support from nurses are recommended.

Relationship between average daily rehabilitation time and decline in instrumental activity of daily living among older patients with heart failure: A preliminary analysis of a multicenter cohort study, SURUGA-CARE

Background Limitation of instrumental activity of daily living (IADL) is independently associated with an adverse prognosis in older heart failure (HF) patients. Aims This multicenter study aims to examine the relationship between average daily rehabilitation time (ADRT) and risk of IADL decline during acute hospitalization in older patients with HF. Methods Four hundred eleven older patients who were hospitalized due to acute HF and underwent rehabilitation were divided into three groups based on the tertile of the ADRT: short, intermediate, and long groups. IADL was assessed by the National Center for Geriatrics and Gerontology Activities of Daily Living (NCGG-ADL) scale. Change in NCGG-ADL (Δ NCGG-ADL) was calculated by subtracting the pre-hospitalization score from the at-discharge score and IADL decline was defined as Δ NCGG-ADL < = −1 point. Logistic regression analysis was carried out examining the association between ADRT and occurrence of IADL decline. Results The ADRT was 23.9, 32.0, and 38.6 minutes in short, intermediate, and long group, respectively. The proportion of patients with IADL decline during hospitalization was 21% among all subjects and short group had the highest proportion of IADL decline (33%) and long group had the lowest proportion (14%). The long group had significantly lower odds of IADL decline compared with the short group (OR:0.475, 95% CI:0.231–0.975, P = 0.042). Among the items of NCGG-ADL scale, significant decreases in the “go out by oneself”, “travel using a bus or train”, “shop for necessities”, “vacuum”, and “manage medication” were observed at discharge compared to pre-hospitalization in the short group (p<0.01, p<0.01, p<0.01, p<0.05, and p<0.05). Conclusions The present study demonstrated that short of ADRT may be associated with the risk of IADL decline during hospitalization in older patients with HF.

Malnutrition associated with Wallenberg Syndrome: Case report

Introduction: Wallenberg Syndrome (SW) is characterized by the condition of swallowing impairment, and nutritional assessment is essential to prevent weight loss. Objective: To report a case of malnutrition associated with SW. Methods: Report of malnutrition in a patient diagnosed with SW in a public hospital in Santa Catarina-Brazil. Results: Elderly, 67 years old, male, retiring, systemic arterial hypertension story and ischemic stroke (without sequelae). He sought assistance on 03/17/2020 in a public hospital in Joinville/SC reporting dysphagia and vertigo, being admitted for investigation of a new vascular event. During hospitalization, he presented: constipation, vertigo, hoarseness, odynophagia, hiccups, regurgitation, emesis, heartburn and drooling. He underwent cranial magnetic resonance imaging confirming infarction in a left posterior-lateral bulb, with a vertebral lesion in the V4 portion, characterizing the SW. He underwent a videodeglutogram, showing a risk of silent bronchoaspiration and with prolonged rehabilitation time, making it necessary to choose an alternative feeding route, initially a nasoenteral tube. Initial anthropometric assessment (03/17/2020): BMI 27.47 kg/m² (height: 163 cm, weight: 73 kg). During hospitalization there was a reduction of -7.9 kg (final weight 65.1 kg; BMI 24.3 kg/m², totaling 10.82% loss (04/23/2020) in 1 month (considered severe). Brachial circumference decreased from 31 (03/24) to 28 cm (04/10). On physical examination: distended abdomen, loss of muscle mass at the temples and subcutaneous fat (biceps). This abrupt nutritional loss was associated with low diet tolerance gastrointestinal night infusion and volumes above 85 ml/h, making it impossible to reach a nutritional goal, he was discharged with gastrostomy, continued to undergo rehabilitation with a speech therapist at home and after 3 months he returned to exclusive oral feeding. Conclusion: Patients diagnosed with SW should be monitored about diet tolerance and to avoid risk of complications associated with weight loss and risk of bronchoaspiration.

Stress Fracture Tibia among Military Recruits Management by Patellar Tendon Bearing Cast

Introduction: Lower limb overuse injuries are common features of military training. Female recruits have significantly higher incidence of fracture than male recruits. In addition to the cost and time of rehabilitation, injury leads to disillusionment among recruits. Conventionally stress fracture tibia is treated with long leg posterior cast for 6-8 weeks but little is known about the length of time required for rehabilitation and to return to pre-injury level. Objectives: To see the outcome of management of stress fracture tibia among military recruits treated with Patellar Tendon Bearing (PTB) cast for 8 weeks and to find out the rehabilitation time to return to pre-injury level. Materials and Methods: This prospective study was conducted in Combined Military Hospital, Bogura, Bangladesh, from January 2015 to December 2016. Out of 2600 recruits 74 (male 60 females 14) were diagnosed as case of stress fracture tibia during the period. They were treated by PTB cast for 08 weeks and their treatment and rehabilitation to pre-injury level (follow-up) were recorded prospectively. Results: Total 85 patients were clinically suspected to have stress fracture tibia, out of them 74(87.06%) patients were finally diagnosed as case of stress fracture. Of these 74 patients 44(59.46%) were diagnosed by initial x-ray and 30(40.54%) were diagnosed by MRI scan. Prevalence of stress fracture in male was 2.45% and in female recruits 9.33%, overall prevalence was 2.85%.About 56(75.67%) patients developed stress fracture in 0-8 weeks of training, mean rehabilitation time to return to pre-injury level was 15.51 weeks, there was no recurrence of stress fracture and all the patients completed 12 months training, none of them was relegated or withdrawn from training on medical ground. Conclusion:Patellar tendon bearing cast is an effective, technically simple method for treating stress fracture of tibia in military recruits with excellent outcome. This method not only treats the fracture but also prevents depressive disorders. JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 196-199

Teleoperated Motorized Functional Electric Stimulation Actuated Rehabilitative Cycling

Many people are affected by a wide range of neuromuscular disorders, many of which can be improved through the use of Functional Electrical Stimulation (FES) rehabilitative cycling. Recent improvements in nonlinear, Lyapunov-based FES muscle control with motor assistance in unstimulated regions of the cycle-crank rotation have led to a reduction in muscle fatigue, allowing rehabilitation time to be extended. Studies in rehabilitation have shown that the addition of coordinated movement between the upper limbs and lower limbs can have a positive effect on neural plasticity leading to faster restoration of walking in those who have some neurological disorders. In this paper, to implement coordinated motion during rehabilitation, a strongly coupled bilateral telerobotic system is developed between a hand-cycle system driven by the participant’s volitional efforts and a split-crank leg-cycle system driven by the switched application of FES with motor assistance. A variable operator is applied to the leg-cycle’s motor input during the FES stimulation regions to provide assistance as required. Lyapunov-based analysis methods are used on the combined leg and hand-cycle system to prove global exponential stability. Analysis further proves that all switched system inputs are bounded, thus the states of the telerobotic master (i.e., hand-cycle system) are bounded, therefore, the telerobotic system is stable.