A Prospective Study of Patients with Persistent Symptoms after SARS-CoV-2 Infection Referred to Physical Medicine and Rehabilitation.

INTRODUCTION: New evidence and extrapolated data from other coronaviruses suggest that symptoms and consequences of COVID-19 may persist beyond the cure. The aims of this study were to evaluate persistent symptoms after SARS-CoV-2 infection and its impact on physical condition, activities of daily living, and quality-of-life; establish whether symptom persistence is associated with higher disability; and document the evolution of the multiple domains after a home exercise program. METHODS: Prospective study with patients referred to a Physical and Rehabilitation Medicine clinic, after SARS-CoV-2 infection. Patient evaluations, including a symptom questionnaire, the 1-Min Sit-to-stand test (1-MSTS), the EQ-5D questionnaire and the London Chest Activity Daily Living (LCA-DL) questionnaire, were performed before and after a home exercise program. RESULTS: Seventy-four patients were included. The majority (n = 71) had been hospitalized (mean stay 19.66 ± 13.35 days), 51% required intensive care. At first evaluation, 54 days after symptom onset, a mean of 18.6 repetitions in the 1-MSTS were performed. The percentage of LCA-DL was above 28% in 23% of the patients. Impairments on EQ-5D were present in 44% for mobility and 44% for anxiety/depression. Mean EQ-5D VAS was 66.5 out of 100. Fifty-one (70%) had at least one persistent symptom (Symptomatic Group), while 22 (30%) were asymptomatic (Asymptomatic Group). The Symptomatic Group had statistically significantly worse mean results on 1-MSTS (16.8 vs 22.9; p < 0.001), % LCA-DL score, EQ-D5 (7.8 vs 5.7; p < 0.001) and EQ-D5-VAS. No patient characteristic, clinical background, comorbidity, or hospitalization characteristics was significantly different between groups. Every patient was given a home exercise program; 47 patients joined an additional rehabilitation program or were clinically discharged and were therefore excluded from the second evaluation. Twenty-seven patients participated in a second evaluation. In the matched analysis, mean 1-MSTS improved by 3.4 repetitions. Mean LCA-DL, mean EQ-5D score (7.1 to 6.6) and EQ-VAS score changed favourably and significantly. CONCLUSION: Two months after infection by SARS-CoV-2, persistent symptoms were frequent in patients referred to a Physical Medicine and Rehabilitation clinic. Additionally, the SARS-CoV-2 infection, as well as the persistence of symptoms, had a negative impact in the physical condition and functionality in ADL and quality-of-life. With a home exercise program in place, a statistically significant improvement was observed. Referral of patients with persistent symptoms to Physical and Rehabilitation Medicine may be warranted.

In vitro colonic fermentation and potential prebiotic properties of pre-digested jabuticaba (Myrciaria jaboticaba (Vell.) Berg) by-products.

Jabuticaba (Myrciaria jaboticaba (Vell.) Berg) by-products (JB) are rich sources of dietary fiber and phenolic compounds, which can be fermented by intestinal microbiota to promote health benefits. This study evaluated the effects of a 48 h-in vitro colonic fermentation of pre-digested JB on the contents of phenolic compounds and sugars, production of organic acids, and abundance (%) of bacterial groups found as part of the human intestinal microbiota. JB reduced the pH (4.35) and promoted changes on phenolic compounds (profile and contents) and sugars, as well as production of short-chain fatty acids during the fermentation. JB increased the abundance of Lactobacillus spp./Enterococcus spp. (4.32-6.25%) and Bifidobacterium spp. (4.60-10.03%) during the fermentation, and decreased the abundance of Bacteroides spp./Prevotella spp. (7.50-10.71%), Eubacterium rectale/Clostridium coccoides (1.37-3.70%), and C. histolyticum (0.91-2.30%), resulting in positive prebiotic indexes (8.61-11.92). JB should contribute to beneficial changes in the human intestinal microbiota, with effects compatible with prebiotic ingredients.

The aftermath of hip fragility fractures - are we missing out on osteoporosis treatment?"

INTRODUCTION: Fragility fractures cause significant mortality and morbidity. Even though there are multiple guidelines for the management of fragility fractures, european countries still report treatment rates of less than 30%. Implementation of fracture liaison services can increase this percentage by 21%. Our goal is to describe the management of osteoporosis, in patients with hip fragility fracture treated in a portuguese hospital with no internal protocols in place. METHODS: A retrospective study was conducted. Patients treated surgically for hip fragility fracture in our hospital, during 2017, were included. Data until May 2020 was collected on osteoporosis recognition and pharmacological treatment prescription. RESULTS: A total of 102 patients were included, 87% female, with a mean age of 79.9±9.9 years at the time of the fracture. Pharmacological anti-osteoporotic treatment after the hip fragility fracture was prescribed in 35%. From those, 53% did not include bisphosphonates. General practice doctors were responsible for 44% of anti-osteoporotic prescriptions and "Osteoporosis" ICD10 codification in primary care was present in 10.7%. DISCUSSION/CONCLUSION: We found a gap in osteoporosis treatment after a hip fragility fracture, similar to literature reports when no fracture liaison service is in place. We believe that the lack of such protocols, the low rate of "osteoporosis" or "fragility fracture" mentioning at hospital discharge, together with the under recognition at primary care level, contribute to this reality. The implementation of new measures is crucial to improve prevention and management of fragility fractures.

Impact of Cashew (Anacardium occidentale L.) by-Product on Composition and Metabolic Activity of Human Colonic Microbiota In Vitro Indicates Prebiotic Properties.

Cashew apple by-product (CAB) is an important agro-industrial waste still underutilized, although it has been characterized as source of a variety of nutrients and bioactive compounds. This study evaluated the capability of freeze-dried CAB (FCAB) submitted to a simulated gastrointestinal digestion of inducing changes in relative abundance of distinct microbial groups found as part of human colonic microbiota, as well as in pH and short-chain fatty acid production during a 24-h in vitro fermentation using a pooled human fecal inocula. FCAB increased the relative abundance of Bifidobacterium and Lactobacillus/Enterococcus during colonic fermentation, besides to decrease the relative abundance of Bacteroides/Prevotella, Eubacterium rectale/Clostridium coccoides, and Clostridium histolyticum. FCAB increased the counts of lactic acid bacteria and decreased the counts of Enterobacteriaceae during colonic fermentation. Furthermore, FCAB decreased pH and increased the production of short-chain fatty acids in colonic fermentation media. These effects could be linked to contents of dietary fibers and the presence of fructans and different phenolic compounds found in FCAB. These results showed that FCAB induced positive alterations in composition and metabolic activity of human colonic microbiota in vitro, which indicate prebiotic properties.

In vitro evaluation of potential prebiotic effects of a freeze-dried juice from Pilosocereus gounellei (A. Weber ex K. Schum. Bly. Ex Rowl) cladodes, an unconventional edible plant from Caatinga biome.

This study evaluated in vitro the potential prebiotic effects of a freeze-dried juice extracted from cladodes of Pilosocereus gounellei (A. Weber ex K. Schum.) Bly. Ex Rowl, an unconventional edible plant from Brazilian Caatinga biome and popularly known as xique-xique. Prebiotic effects of freeze-dried xique-xique cladode juice (XCJ, 20 g/L) were evaluated by measurements of prebiotic activity scores and stimulatory effects on growth and metabolic activities of probiotic Lactobacillus acidophilus LA-05, L. casei L-26 and L. paracasei L-10, which are beneficial species found as part of human gut microbiota. XCJ showed positive prebiotic activity scores on all examined probiotics, indicating a selective stimulatory effect on these microorganisms in detriment to enteric pathogens. Examined probiotics had high viable counts (> 8 log CFU/mL) after 48 h of cultivation in media with XCJ (20 g/L), representing an increase of > 2 log CFU/mL when compared to viable counts found on time zero. Cultivation of probiotics in media with XCJ resulted in decreased pH during the 48 h-incubation. Contents of fructose and glucose decreased in media with XCJ inoculated with L. acidophilus LA-05, L. casei L-26 or L. paracasei L-10 during the 48 h-cultivation, in parallel with an increase in contents of acetic and lactic acids. Measured effects of XCJ on probiotics were overall similar to those exerted by fructoligosaccharides (20 g/L), a proven prebiotic ingredient. These results showed that XCJ could exert selective stimulatory effects on different Lactobacillus species, which are indicative of potential prebiotic properties.

Prebiotic activity of monofloral honeys produced by stingless bees in the semi-arid region of Brazilian Northeastern toward Lactobacillus acidophilus LA-05 and Bifidobacterium lactis BB-12.

This study assessed the in vitro prebiotic effects of honeys from Ziziphus joazeiro Mart. (juazeiro; J) and Mimosa arenosa Willd Poir (jurema branca; JB) produced by native stingless bees, namely Melipona subnitida Ducke (jandaíra; J) and M. scutellaris Latrelle (uruçu; U), in the Brazilian Northeastern semi-arid region toward the probiotics Lactobacillus acidophilus LA-05 and Bifidobacterium animalis subsp. lactis BB-12. Cells of the probiotic strains were enumerated over 48 h of cultivation in broths containing each honey (JJ, JU, JBJ or JBU) as a sole carbon source. The metabolic activities of probiotic strains in these media were assessed by measuring changes in pH values and sugars, organic acids and phenolics contents. All honeys (20 or 30 g/L) exerted growth promoting effects and displayed positive prebiotic activity scores (0.94-1.22) on tested probiotics. JJ showed the highest (p < 0.05) stimulatory effects on probiotics growth and prebiotic scores. At the end of the cultivation period, counts of L. acidophilus LA-05 and B. lactis BB-12 increased (p < 0.05) more than 2 log in broths regardless the monofloral honey added. The pH values and sugars contents decreased (p < 0.05), while the organic acids contents increased (p < 0.05) during cultivation of probiotics in broths containing JJ, JU, JBJ or JBU as carbon source. After 48 h of cultivation, contents of gallic, caftaric and caffeic acid, catechin and procyanidins (B1 and B2) decreased (p < 0.05) in media containing JJ, JU, JBJ or JBU despite of the inoculated probiotic. JJ honey presented overall the better stimulatory effects on the growth and metabolism of L. acidophilus LA-05 and B. lactis BB-12. These results showed for the first time the potential prebiotic properties of four monofloral honeys produced by stingless bees in the Brazilian Northeastern semi-arid region.

Protective Effects of Tropical Fruit Processing Coproducts on Probiotic Lactobacillus Strains during Freeze-Drying and Storage.

This study evaluated the protective effects of coproducts from agroindustrial processing of the tropical fruits acerola (Malpighia glabra L., ACE), cashew (Anacardium occidentale L., CAS), and guava (Psidium guayaba L., GUA) on the probiotics Lactobacillus paracasei L-10, Lactobacillus casei L-26, and Lactobacillus acidophilus LA-05 during freeze-drying and storage. The occurrence of damage to membrane integrity, membrane potential, and efflux activity of Lactobacillus cells after freeze-drying was evaluated by flow cytometry, and viable counts were measured immediately after freeze-drying and during 90 days of storage under refrigerated or room temperature conditions. Probiotic strains freeze-dried without substrate had the overall highest count reductions (0.5 ± 0.1 to 2.9 ± 0.3 log cycles) after freeze-drying. Probiotics freeze-dried with fruit processing coproducts had small cell subpopulations with damaged efflux activity and membrane potential. Average counts of probiotics freeze-dried with ACE, CAS, or GUA after 90 days of storage under refrigerated or room temperature were in the range of 4.2 ± 0.1 to 5.3 ± 0.2 and 2.6 ± 0.3 to 4.9 ± 0.2 log CFU/g, respectively, which were higher than those observed for strains freeze-dried without substrate. The greatest protective effects on freeze-dried probiotics were overall presented by ACE. These results revealed that ACE, CAS, and GUA can exert protective effects and increase the stability of probiotic lactobacilli during freeze-drying and storage, in addition to supporting a possible added-value destination for these agroindustrial coproducts as vehicles for probiotics and for the development of novel functional foods.

Comparative study of impulsiveness and risk behaviors among infected individuals with hepatitis C virus and human T-cell lymphotropic virus type 1.

INTRODUCTION AND OBJECTIVES: Hepatitis C virus (HCV) and human T-cell lymphotropic virus type 1 (HTLV-1) infections have chronic courses. HCV is primarily transmitted via the hematogenous route, whereas HTLV-1 is primarily transmitted sexually, although it can also be transmitted by blood. Individuals chronically infected with either HTLV-1 or HCV can differ in terms of behavioral characteristics and personality traits. This study compared the occurrence of risk behaviors and impulsivity aspects between HCV and HTLV-1 carriers. MATERIALS AND METHODS: Observational, comparative and cross-sectional study that involved a sample of outpatients who had HCV or HLTV-1, by way of a sociodemographic and behavioral questionnaire and the Barratt Impulsiveness Scale - BIS-11. 143 individuals with HCV and 113 individuals with HTLV-1 were evaluated. RESULTS: There was a difference with regards to gender among patients, with mostly males affected in the HCV group. Risk behaviors commonly mediated by impulsiveness were significantly more frequent in the HCV group. Similarly, overall impulsiveness and domain nonplanning were higher in the HCV group. Multivariate analysis showed that increased age, male gender, higher nonplanning scores and HCV infection were independent factors for the occurrence of risk behaviors. Both groups presented high rates of other sexually transmitted diseases and a low rate of condom use in sexual relations. CONCLUSIONS: This study confirms the higher rate of risk behaviors and the levels of impulsiveness commonly observed in patients with HCV, along with comparisons to patients with HTLV-1.

Quality of life, risk behaviors and depression among carriers of hepatitis C virus and human T-cell lymphotropic virus type 1: a comparative study

Abstract Human T-cell lymphotropic virus type 1 (HTLV-1) has low prevalence rates, but is endemic in some regions of the world. It is usually a chronic asymptomatic infection, but it can be associated with serious neurologic and urinary conditions. Hepatitis C virus (HCV) is broadly spread out worldwide. The majority of these infections have a chronic course that may progress to cirrhosis and hepatocellular carcinoma. Objectives: To compare sociodemographic and mental health (risk behaviors, depression, and suicide) aspects, and quality of life among patients with HCV or HTLV-1. Methods: Observational, comparative and cross-sectional study involving outpatients with HCV or HLTV-1 infection. Sociodemographic characteristics, risk behaviors and quality of life were assessed through the questionnaires Mini International Neuropsychiatric Interview - MINI Plus (depression and suicide) and Medical Outcomes Study 36-Item Short-Form Health Survey (quality of life). Univariate and multivariate statistical analyses (hierarchical logistic regression) were conducted. Results: 143 individuals with HCV and 113 individuals with HTLV-1 infection were included. Males were predominant in the HCV group (68.8%) and females in the HTLV-1 group (71.7%). The frequency of risk behaviors (sexual and drug use) was greater in those with HCV (p < 0.05). A past depressive episode was more common in the HTLV-1 group (p = 0.037). Quality of life was significantly worse in the physical functioning, vitality, mental health, and social functioning domains in those with HTLV-1 (p < 0.05). HTLV-1 infection remained independently associated with worse quality of life in multivariate analysis. Conclusions: Risk behaviors are frequent among those infected with HCV. Additionally, despite HTLV-1 being considered an infection with low morbidity, issues related to mental health (depressive episode) and decreased quality of life are relevant.

Quality of life, risk behaviors and depression among carriers of hepatitis C virus and human T-cell lymphotropic virus type 1: a comparative study.

Human T-cell lymphotropic virus type 1 (HTLV-1) has low prevalence rates, but is endemic in some regions of the world. It is usually a chronic asymptomatic infection, but it can be associated with serious neurologic and urinary conditions. Hepatitis C virus (HCV) is broadly spread out worldwide. The majority of these infections have a chronic course that may progress to cirrhosis and hepatocellular carcinoma. OBJECTIVES: To compare sociodemographic and mental health (risk behaviors, depression, and suicide) aspects, and quality of life among patients with HCV or HTLV-1. METHODS: Observational, comparative and cross-sectional study involving outpatients with HCV or HLTV-1 infection. Sociodemographic characteristics, risk behaviors and quality of life were assessed through the questionnaires Mini International Neuropsychiatric Interview - MINI Plus (depression and suicide) and Medical Outcomes Study 36-Item Short-Form Health Survey (quality of life). Univariate and multivariate statistical analyses (hierarchical logistic regression) were conducted. RESULTS: 143 individuals with HCV and 113 individuals with HTLV-1 infection were included. Males were predominant in the HCV group (68.8%) and females in the HTLV-1 group (71.7%). The frequency of risk behaviors (sexual and drug use) was greater in those with HCV (p < 0.05). A past depressive episode was more common in the HTLV-1 group (p = 0.037). Quality of life was significantly worse in the physical functioning, vitality, mental health, and social functioning domains in those with HTLV-1 (p < 0.05). HTLV-1 infection remained independently associated with worse quality of life in multivariate analysis. CONCLUSIONS: Risk behaviors are frequent among those infected with HCV. Additionally, despite HTLV-1 being considered an infection with low morbidity, issues related to mental health (depressive episode) and decreased quality of life are relevant.

The Portuguese Version of the Immunosuppressant Therapy Adherence Scale (ITAS) among Liver Transplant Recipient Patients: Translation and Psychometric Properties.

INTRODUCTION AND AIM: Transplant recipients are chronically ill patients who rely on medical treatment throughout life to achieve positive results. Despite that, medication nonadherence after liver transplantation is extremely common. The self-report, one of several methods for measuring adherence, is easy to apply and low cost. Thus, this study aims to translate and validate the Immunosuppressant Therapy Adherence Instrument (ITAS) in Brazilian Portuguese for liver transplant recipients. MATERIAL AND METHODS: A total of 139 liver transplant recipients were selected from a general hospital, who were assessed by using the Portuguese version of ITAS. The scale was translated based on the model proposed by Wild, et al. and its psychometric properties were assessed. RESULTS: The average Cronbach's α coefficient was 0.830. ITAS and Basel Assessment of Adherence with Immunosuppressive Medications Scale (BAASIS) presented significant correlation, with a Spearman's ρ coefficient = 0.300 (S = 309,580; p < 0.001). The area under the receiver operating characteristics (ROC) curve was 0.638 (95% CI: 0.557 - 0.715). Factor analysis results indicated that the carelessness factor model was the optimal model, and the factor "feeling worse" was the lowest. CONCLUSION: The Portuguese version of ITAS has adequate psychometric properties to measure adherence to immunosuppressant therapy.

Predicting and Modelling the Growth of Potentially Pathogenic Bacteria in Coalho Cheese.

Coalho is a semihard medium- to high-moisture cheese produced in various states in the northeastern region of Brazil. This study was conducted to predict the growth kinetics (maximum growth rate, Grmax) of Escherichia coli, Listeria monocytogenes, Salmonella, and Staphylococcus aureus using the ComBase predictor with various combinations of temperature, pH, and water activity (aw) in commercial Coalho cheese samples. The growth of two antibiotic-resistant derivative strains of L. monocytogenes (parental strains ATCC 19115 and ATCC 7644) and S. aureus (parental strains ATCC 13565 and ATCC 19095) was measured in commercial Coalho cheese samples during 14 days of storage as a function of the initial contamination level (3 and 5 log CFU/g) and storage temperature (7.5 and 12°C). The highest Grmax values predicted by ComBase under the various conditions of temperature, pH, and aw were for L. monocytogenes (0.006 to 0.065 log CFU/g/h) and S. aureus (0.003 to 0.048 log CFU/g/h). The Grmax values predicted by ComBase for E. coli and Salmonella were 0.007 to 0.026 and 0.008 to 0.041 log CFU/g/h, respectively. An experimental challenge in Coalho cheese revealed that the populations of all tested antibiotic-resistant derivative strains of L. monocytogenes and S. aureus increased (>0.5 log CFU/g) by day 14 of storage at 7.5 or 12°C. L. monocytogenes and S. aureus had higher Grmax values in cheese samples stored at 12°C than those stored at 7.5°C. The ComBase growth predictions under the temperature, pH, and aw conditions in commercial Coalho cheese samples were generally fail-safe for predicting the growth of L. monocytogenes and S. aureus in the actual product. These results indicate that Coalho cheese has pH and aw characteristics that allow the growth of E. coli, L. monocytogenes, Salmonella, and S. aureus. These cheeses are typically stored at temperatures that do not prevent the growth of these bacteria.

Risk-taking behavior and impulsivity among HCV-infected patients.

The association between risk behaviors and hepatitis C virus (HCV) has been extensively studied. It is also proved that impulsivity is associated with risk behaviors. However, there is a lack of studies investigating the association between HCV and impulsivity, a characteristic that can contribute directly to these risk behaviors. This study aimed to investigate HCV-infected individuals' impulsivity and whether this feature mediates risk behavior. Adult patients with liver diseases (n=269) were divided into two groups: viral group (n=157) - patients with HCV and nonviral group (n=112). Risk behaviors were evaluated by a sociodemographic questionnaire. Impulsivity was assessed through Barratt Impulsiveness Scale - BIS-11. Psychiatric comorbidities were investigated by the Mini International Neuropsychiatric Interview 5.0.0. The viral group patients had higher impulsivity than the nonviral group in all domains: attentional impulsivity, motor impulsivity, and nonplanning. Risk behaviors were also shown to be associated with impulsivity levels. Our results suggest that HCV-infected patients are more impulsive than individuals with other liver diseases, even when analyses are controlled for the presence of comorbid mental disorders. In addition, at-risk behavior was significantly mediated by impulsivity.

The fatigue impact scale for daily use in patients with hepatitis B virus and hepatitis C virus chronic infections.

INTRODUCTION: Fatigue is an important clinical finding in the hepatitis virus chronic infection. However, the absence of scales to measure fatigue, translated and validated for Brazilian Portuguese, prevents access to information essential in clarifying specific clinical conditions in this population. AIM: The aim of this study was to determine the psychometric properties of the fatigue impact scale for daily use (D-FIS), in Brazilian Portuguese, for patients with the hepatitis C virus (HCV) and hepatitis B virus (HBV) chronic infection. MATERIAL AND METHODS: In this cross-sectional study, the authors evaluated the D-FIS in 101 outpatients, followed at the reference hospital. The Mini International Neuropsychiatric Interview Brazilian (MINI PLUS) was used to identify psychiatric disorders, and the Short Form Health Survey 36-item (SF-36) to evaluate the self-reported quality of life. We also examined the impact of fatigue on the quality of life of this group of patients. RESULTS: Relevant psychometric D-FIS results were: floor effect proved to be 1%; skewness was 0.46; item homogeneity was 0.59 and SEM (SD = 8.51) was 2.4. The Cronbach's alpha was 0.920 and item total correlation yielded coefficients ranging from 0.65 (item 1) to 0.85 (item 3). In a linear regression model, fatigue and depression influenced the self-reported quality of life. CONCLUSION: This study presents that the fatigue scale for daily use in Brazilian Portuguese can be considered a useful tool to verify the presence of fatigue in patients with the hepatitis viruses B and C.

Hepatitis C virus infection as a traumatic experience.

OBJECTIVE: The purpose of this study was to evaluate whether individuals consider their HCV infection to be a potentially traumatic experience. Additionally, we investigated its association with Post-Traumatic Stress Disorder (PTSD) and the impact of PTSD diagnosis on health-related quality of life (HRQoL) in HCV infected subjects. METHODS: We conducted a cross-sectional survey of 127 HCV-infected outpatients recruited at a University Hospital in Salvador, Brazil. All subjects answered an orally-administered questionnaire to gather clinical and socio-demographic data. We investigated traumatic experiences and the subject's perception of the disease using the Trauma History Questionnaire. PTSD and other psychiatric diagnoses were assessed through the Mini International Neuropsychiatric Interview-Brazilian Version 5.0.0 (M.I.N.I. PLUS). HRQoL was assessed using Short-Form 36 (SF-36). RESULTS: Approximately 38.6% of the patients considered hepatitis C to be a traumatic experience. Of these, 60.7% had a PTSD diagnosis. PTSD was associated with significant impairment in quality of life for individuals in seven SF-36 domains as shown bymultivariate analysis: Role-Physical (ß: -24.85; 95% CI: -42.08; -7.61), Bodily Pain (ß: -19.36; 95% CI: -31.28; -7.45), General Health (ß: -20.79; 95% CI: -29.65; -11.92), Vitality (ß: -11.92; 95% CI: -20.74; -3.1), Social Functioning (ß: -34.73; 95% CI: -46.79; -22.68), Role-Emotional (ß: -26.07; 95% CI: -44.61; -7.53), Mental Health (ß: -17.46; 95% CI: -24.38; -10.54). CONCLUSION: HCV is frequently a traumatic experience and it is strongly associated with PTSD diagnosis. PTSD significantly impaired HRQoL.