The Effects of an Intensive Rehabilitation Program on the Nutritional and Functional Status of Post-COVID-19 Pneumonia Patients.

Most hospitalized COVID-19 pneumonia patients are older adults and/or have nutrition-related issues. Many are bedridden in intensive care units (ICU), a well-documented cause of malnutrition, muscle wasting, and functional impairment. Objectives: To assess the effectiveness of an intensive rehabilitation program over the nutritional/functional status of patients recovering from COVID-19 pneumonia. Post-COVID-19 pneumonia patients underwent a 30-day intensive interdisciplinary rehabilitation program including a personalized nutritional intervention designed to achieve a minimum intake of 30 kcal/kg/day and 1 g protein/kg/day. The nutritional and functional status was assessed in each patient at three different moments. Each assessment included Body Mass Index (BMI), Mid Upper Arm Circumference (MUAC), Mid Arm Muscle Circumference (MAMC), Tricipital Skinfold (TSF), Hand Grip Strength (HGS), and Mini Nutritional Assessment (MNA®). The study included 118 patients, with ages in the range 41−90 years old. BMI increased linearly over time (0.642 units, F-test = 26.458, p < 0.001). MUAC (0.322 units, F-test = 0.515, p = 0.474) and MAMC status (F-test = 1.089, p = 0.299) improved slightly, whereas TSF decreased (F-test = 1.885, p = 0.172), but all these arm anthropometry trends did not show significant variations, while HGS (4.131 units, F-test = 82.540, p < 0.001) and MNA® (1.483 units, F-test = 217.726, p < 0.001) reported a meaningful improvement. Post-COVID-19 pneumonia patients presented malnutrition and functional impairment. An interdisciplinary rehabilitation program, including personalized nutritional intervention, was effective for post-hospital COVID-19 pneumonia nutritional/functional rehabilitation.

[Delirium: The 7th Vital Sign?] / Delirium: O 7º Parâmetro Vital?

INTRODUCTION: Delirium is an acute, transient and fluctuating neuropsychiatric syndrome that is common in medical wards, particularly in the geriatric and palliative care population. MATERIAL AND METHODS: We present a brief literature review of the definition, pathophysiology, aetiology, diagnosis, prevention and treatment of delirium and its social and economic impact. RESULTS AND DISCUSSION: Delirium is under-recognized, especially by health professionals, and is associated with higher morbidity, mortality and economic burden. Moreover, the presence of delirium interferes with the evaluation and approach to other symptoms. Furthermore, it causes significant distress in patient's families and health professionals. The best treatment for delirium is prevention which is based on multidisciplinary interventions that addresses the main risk factors. The scientific evidence for the treatment of delirium is scarce. Non-pharmacological approaches are usually the first choice, and includes environmental, behavioural and social strategies. Pharmacological options, mainly antipsychotics, are a second-line treatment used essentially to prevent self harm. CONCLUSION: The recognition and prevention of delirium are crucial. Health professional education and training, patient clinical monitoring and families support are mandatory. Considering the impact of delirium on patients, relatives, health services and professionals we must be more aware of delirium and, why not, make it the 7th vital sign.

Introdução: O delirium é uma síndrome neuropsiquiátrica transitória e flutuante com início súbito frequente nos doentes internados, em particular na população geriátrica e paliativa. Material e Métodos: Através de uma breve revisão da literatura, os autores propuseram-se a sistematizar a definição, fisiopatologia e etiologia do delirium, principais ferramentas para o seu diagnóstico, prevenção e tratamento, bem como o seu impacto socio-económico.Resultados e Discussão: O delirium é uma entidade pouco reconhecida pelos profissionais de saúde, que se associa a maior morbi-mortalidade e custos, interfere com a avaliação e abordagem da dor e de outros sintomas e acarreta elevado distress nos doentes, famílias e profissionais de saúde. O melhor tratamento do delirium é a prevenção, que se baseia em intervenções multidisciplinares sob os principais fatores de risco para o seu desenvolvimento. A evidência científica para o tratamento do delirium existe, mas é escassa, sendo a terapêutica preferencial a não farmacológica, com implementação de estratégias ambientais, comportamentais e sociais. O tratamento farmacológico é de segunda linha e deverá ser instituído de forma a prevenir que o doente se coloque em risco, nomeadamente através do uso de antipsicóticos. Conclusão: O reconhecimento e prevenção do delirium são essenciais, pelo que é fundamental a educação e formação dos profissionais de saúde, bem como o acompanhamento e apoio aos familiares. É por todo o impacto que tem nos serviços de saúde, nos profissionais e, sobretudo, nos doentes e seus familiares, que sugerimos maior atenção ao delirium e, porque não, passar a considerá-lo como o 7º sinal vital.

Tetraparesia: an unusual presentation of disseminated tuberculosis.

A 48-year-old man with a 4 months history of asthenia, anorexia, 10 kg weight loss and 1 month of hematuria and dysuria was admitted to another hospital for sudden muscular weakness. He was found to have areflexic tetraparesis and was referred to our hospital.On admission, he was bradycardic, tachypneic, with flaccid tetraplegia. Laboratory results showed metabolic acidemia, severe hyperkalemia and hyponatremia, acute renal dysfunction and sterile pyuria. After hyperkalemia correction, the neurological symptoms resolved.On the second day, he became febrile and chest radiograph and CT images showed a pulmonary bilateral reticulomicronodular pattern, left hydronephrosis and diffuse bladder wall thickening. Disseminated tuberculosis was considered as diagnosis by the coexistence of this imagiologic alterations and sterile pyuria. Acid-fast test for Mycobacteriumtuberculosis was negative, but the urine culture became positive after 2 weeks.Antituberculosis treatment was started. One year later, he was asymptomatic and the structural urinary lesions had disappeared.