Physical Rehabilitation and Mobilization in Patients Receiving Extracorporeal Life Support: A Systematic Review.

OBJECTIVES: We planned to synthesize evidence examining the potential efficacy and safety of performing physical rehabilitation and/or mobilization (PR&M) in adult patients receiving extracorporeal life support (ECLS). DATA SOURCES: We included any study that compared PR&M to no PR&M or among different PR&M strategies in adult patients receiving any ECLS for any indication and any cannulation. We searched seven electronic databases with no language limitations. STUDY SELECTION AND DATA EXTRACTION: Two reviewers, independently and in duplicate, screened all citations for eligibility. We used the Cochrane Risk of Bias 2 and Cochrane Risk Of Bias In Non-randomized Studies of Interventions tools to assess individual study risk of bias. Although we had planned for meta-analysis, this was not possible due to insufficient data, so we used narrative and tabular data summaries for presenting results. We assessed the overall certainty of the evidence for each outcome using the Grading of Recommendations Assessment, Development, and Evaluation framework. DATA SYNTHESIS: We included 17 studies that enrolled 996 patients. Most studies examined venovenous extracorporeal membrane oxygenation (ECMO) and/or venoarterial ECMO as a bridge to recovery in the ICU. We found an uncertain effect of high-intensity/active PR&M on mortality, duration of mechanical ventilation, ICU length of stay, hospital length of stay, or quality of life compared with low-intensity/passive PR&M in patients receiving ECLS (very low certainty due to very serious imprecision). There was similarly an uncertain effect on safety events including clinically important bleeding, spontaneous intracerebral hemorrhage, limb ischemia, accidental decannulation, or ECLS circuit dysfunction (very low certainty due to very serious risk of bias and imprecision). CONCLUSIONS: Based on the currently available summary of evidence, there is an uncertain effect of high-intensity/active PR&M on patient important outcomes or safety in patients receiving ECLS. Despite indirect data from other populations suggesting potential benefit of high-intensity PR&M in the ICU; further high-quality randomized trials evaluating the benefits and risks of physical therapy and/or mobilization in this population are needed.

Effect of Tithonia diversifolia (Hemsl.) A. Gray intake on in vivo methane (CH4) emission and milk production in dual-purpose cows in the Colombian Amazonian piedmont.

The inclusion of Tithonia diversifolia in pasture-based diets is a promising alternative to increase bovine productivity, due to its chemical composition and wide adaptation, but there are few in vivo studies to determine its effect on methane yield and animal production in grazing systems. The objective of this study was to determine the effects of the T. diversifolia inclusion in a basal diet of Brachiaria humidicola on methane (CH4) emissions by enteric fermentation, and on milk yield and quality in dual-purpose cows. The polytunnel technique was used for the determination of methane yield and two diets were evaluated (Diet 1: Brachiaria humidicola 100%; Diet 2: T. diversifolia 15% + B. humidicola 85% dry matter basis) in the moderate rainy and rainy seasons using a cross-over experimental design; milk production was measured by daily milk weighing, and milk quality was determined using a LACTOSCAN analyzer. The inclusion of T. diversifolia did not increase the dry matter intake (P = 0.369), but increased the intake of crude protein and minerals, and reduced fiber intake, resulting in the increased yield of milk and its components in the moderate rainy season (P = 0.012). The inclusion of T. diversifolia reduced the absolute CH4 emissions (P = 0.016), Ym and emission intensity (per unit of fat, protein and kilogram fat and protein corrected milk yields) both in the moderate rainy and rainy seasons (P < 0.05). We conclude that the inclusion of T. diversifolia in the forage feed base in the humid tropics such as the Amazon piedmont can be used as a tool to both mitigate enteric CH4 emissions and to increase animal productivity and hence reduce emissions intensity, and thus reduce pressure on the agricultural frontier in critical areas such as the Amazon.

Efficacy of the Benznidazole+Posaconazole combination therapy in parasitemia reduction: An experimental murine model of acute Chagas.

INTRODUCTION: Benznidazole (BZL) and Nifurtimox (NFX) are the pharmacological treatment for acute phase Chagas Disease (CD); however, therapy resistance and residual mortality development remain important unresolved issues. Posaconazole (POS) has shown a trypanocidal effect in vivo and in vitro. Thus, this study aimed at comparing the T. Cruzi parasitic load-reducing effect of the combination of BZL+POS against that of monotherapy with either, during acute phase CD, in an experimental murine model. METHODS: Nineteen Wistar rats were randomly allocated to four groups and inoculated with the trypomastigotes of T. cruzi strain´s JChVcl1. The rats were administered anti-parasites from day 20-29 post-infection. The Pizzi and Brener method was used for parasitemia measurement. Longitudinal data analysis for the continuous outcome of repeated measures was performed using parasitemia as the outcome measured at days 20, 22, 24, 27, and 29 post-infection. RESULTS: All four groups had similar parasitic loads (p=0.143) prior to therapy initiation. Among the three treatment groups, the BZL+POS (n=5) group showed the highest mean parasitic load reduction (p=0.000) compared with the control group. Likewise, the BZL+POS group rats showed an earlier therapeutic effect and were the only ones without parasites in their myocardial samples. CONCLUSIONS: Treatment of acute phase CD with BZL+POS was more efficacious at parasitemia and myocardial injury reduction, compared with monotherapy with either.

Dual use of bronchodilators versus monotherapy, and its impact on pulmonary rehabilitation in COPD patients.

INTRODUCTION: Long-acting bronchodilators are the therapy with the best evidence for treating stable chronic obstructive pulmonary disease (COPD). Long-acting combinations of ß2 agonists and anticholinergics (LABA-LAMA) are recommended in advanced stages when monotherapy has not generated the desired effects. Pulmonary Rehabilitation (PR) is an effective non-pharmacological strategy. The aim of this study was to compare the results obtained in patients with COPD who received monotherapy versus dual bronchodilator therapy in terms of functional aerobic capacity, symptoms and quality of life. MATERIALS AND METHODS: Prospective non randomized intervention study; the patients were divided into two groups: in one group patients were treated with LAMA (Tiotropium Bromide, 5 µg every 24 h) and in the other group patients were treated with LABA + LAMA (Indacaterol/Glycopyrronium, 110/50 µg once a day). After receiving the concept of pulmonology, patients were intervened with 8 weeks of PR. The study was approved by the committee of the Clinica Neumológica del Pacifico in Cali and the Institución Universitaria Escuela Nacional del Deporte, Colombia. To determine the differences, t pair test for intragroup, and t-test was performed for intergroup analysis. For all tests, a p-value <0.05 was considered as statistically significant. RESULTS: 53 patients participated in this study, of which 20 were assigned to the LAMA group and 33 to the LAMA + LABA group. Patients in both groups presented changes in the distance of the 6MWT, in the VO2e, dyspnea and in all the SGRQ domains. Regarding the comparison between groups, there were found no differences in the variables at the beginning of the PR and significant differences (p < 0.05) at the end of the 8 week-period in favor of the LABA + LAMA group, in symptoms with the mMRC scale, functional aerobic capacity with the 6 min walking test and in health related quality of life specifically in the symptoms domain, where the dual therapy group obtained better results. CONCLUSION: The addition of LABA to the treatment with LAMA showed better response results compared with the monotherapy in patients with COPD who attended PR.

Efficacy of the Benznidazole+Posaconazole combination therapy in parasitemia reduction: An experimental murine model of acute Chagas

Abstract INTRODUCTION: Benznidazole (BZL) and Nifurtimox (NFX) are the pharmacological treatment for acute phase Chagas Disease (CD); however, therapy resistance and residual mortality development remain important unresolved issues. Posaconazole (POS) has shown a trypanocidal effect in vivo and in vitro. Thus, this study aimed at comparing the T. Cruzi parasitic load-reducing effect of the combination of BZL+POS against that of monotherapy with either, during acute phase CD, in an experimental murine model. METHODS Nineteen Wistar rats were randomly allocated to four groups and inoculated with the trypomastigotes of T. cruzi strain´s JChVcl1. The rats were administered anti-parasites from day 20-29 post-infection. The Pizzi and Brener method was used for parasitemia measurement. Longitudinal data analysis for the continuous outcome of repeated measures was performed using parasitemia as the outcome measured at days 20, 22, 24, 27, and 29 post-infection. RESULTS All four groups had similar parasitic loads (p=0.143) prior to therapy initiation. Among the three treatment groups, the BZL+POS (n=5) group showed the highest mean parasitic load reduction (p=0.000) compared with the control group. Likewise, the BZL+POS group rats showed an earlier therapeutic effect and were the only ones without parasites in their myocardial samples. CONCLUSIONS: Treatment of acute phase CD with BZL+POS was more efficacious at parasitemia and myocardial injury reduction, compared with monotherapy with either.

Neutropenia febril asociada a quimioterapia en pacientes con neoplasias hematológicas de un centro de referencia en Colombia: características clínicas y desenlaces / Febrile neutropenia in patients with hematological malignancies at a reference center in Colombia

RESUMEN Objetivo: analizar las características epidemiológicas, clínicas y bacteriológicas que influyen en la supervivencia de los pacientes con neoplasias hematológicas que desarrollaron neutropenia febril posterior a quimioterapia. Materiales y métodos: estudio de corte transversal que incluyó adultos con diagnóstico de neoplasias hematológicas que presentaron neutropenia febril durante la hospitalización en 2014 en las sedes de Oncólogos de Occidente en Pereira, Manizales y Armenia (Colombia). Se realizaron análisis univariados y multivariados; la supervivencia se estableció según el método de Kaplan-Meier. Se estableció un valor de p <0.05. Se usó el software STATA. Se tuvo aval de bioética de la Universidad Tecnológica de Pereira. Resultados: se incluyó a 55 pacientes. La mediana de edad fue de 48 años (31-63), 27(49 %) fueron hombres. Los diagnósticos oncológicos más frecuentes fueron el linfoma no Ho-dgkin (29 %), leucemia mieloide aguda (24%) y leucemia linfoblástica aguda (20 %). La mayor letalidad se presentó en los días 21, 32 y 48. La mortalidad general fue del 9 % y la mortalidad por neutropenia profunda fue del 18 %. Conclusión: el número de neutropenias febriles, mayor tiempo de duración de la neutropenia febril, índice de Charlson y el antecedente de ingreso a UCI son factores de riesgo para mortalidad, mientras que el uso de piperacilina-tazobactam y el incremento en la puntuación del índice de MASCC son factores protectores.

ABSTRACT Objective: analyze the epidemiological, clinical and bacteriological characteristics that influence the survival of patients with haematological malignancies who developed febrile neutropenia after chemotherapy. Materials and methods: cross-sectional study of adult patients diagnosed with hema-tologic malignancies who presented febrile neutropenia during hospitalization in 2014 at Oncólogos de Occidente in Pereira, Manizales and Armenia (Colombia). Univariate and multivariate analyzes were performed. The survival analysis was established according to the Kaplan-Meier method. A value of p<0.05 was established for it. The STATA software was used. This study was endorsed by the bioethics committee of the Universidad Tecnológica de Pereira. Results: 55 patients were included. The median age was 48 years (31-63), 27 (49%) were men. The most frequent oncological diagnoses were non-Hodgkin's lymphoma (29 %), acute myeloid leukemia (24 %) and acute lymphoblastic leukemia (20 %). The highest lethality occurred on days 21, 32 and 48. Overall mortality was 9 %, mortality due to deep neutro-penia was 18 %. Conclusion: the number of febrile neutropenia, longer duration of febrile neutropenia, Charlson index and the history of admission to the ICU are risk factors for mortality, while the use of piperacillin-tazobactam and the increase in the score of the MASCC index are protective factors.

A biomechanical analysis of the effects of low-Dye taping on arch deformation during gait.

BACKGROUND: The low-Dye technique serves to limit hindfoot pronation and medial arch collapse. Few studies exist that investigate the effects on medial arch deformation from a biomechanical perspective. METHODS: Kinematic data was collected using a Motion Analysis System. Foot function of 21 healthy adults was assessed during the stance phase of gait. Subjects were evaluated prior to and immediately following the low-Dye tape application, as well as at 48 h. Foot deformation was assessed during the stance phase of gait using the calcaneus, navicular and 1st metatarsal head markers to calculate the medial longitudinal arch angle (MLA) and the dynamic arch height index (dAHI). Paired t-tests were used to assess low-Dye tape effectiveness. RESULTS: There was a significant 19.3% reduction in MLA immediately after application of the tape. However only 4.01% reduction remained in deformation after 48 h. The MLA deformation findings were consistent with the AHI change, showing a significant change in the arch deformation between Pre and Post0 low-Dye taping. The effects were short-lived. CONCLUSIONS: There are measurable changes to medial arch height and amount of arch height deformation during gait following low-Dye taping. Although changes were present immediately after application, results were diminished 48 h after application.

Rehabilitación pulmonar en tuberculosis multirresistente (TB-MDR): informe de un caso / Pulmonary rehabilitation in multi-drug resistant tuberculosis (TB MDR): a case report

Introducción: En la tuberculosis (TB) el gran componente inflamatorio, ocasiona lesiones importantes que desencadenan reacción fibroblástica, fibrosis y retracción de la pared costal, y comprometen la expansión pulmonar lo que se traduce clínica y funcionalmente en un patrón restrictivo moderado y disnea al ejercicio. Lo anterior favorece la discapacidad pulmonar, y ocasiona dependencia económica y social del núcleo familiar. Las medidas tendientes a controlar la enfermedad tuberculosa son sólo curativas, hecho que se debe considerar como insuficiente porque las acciones dirigidas hacia la habilitación y rehabilitación podrían evitar o disminuir la incidencia de discapacidad cardiopulmonar por TB. La importancia de la rehabilitación pulmonar (RP) como tratamiento no farmacológico en pacientes con enfermedades respiratorias crónicas y/o con factores de riesgo para adquirirlas, está documentada en la literatura, y su aplicación permite mejorar la condición física del paciente, restaurar la calidad de vida relacionada con la salud (CVRS), la autonomía y la integración social. Objetivo: Describir el deterioro de la funcionalidad de un paciente con tuberculosis multirresistente (TB-MDR) y su proceso de recuperación en un programa de RP. Resultados: Se observó un aumento en la distancia recorrida en el test de caminata de los seis minutos (TC6M) de 240 m a 350 m. La puntuación de disnea con la escala del Medical Research Council (MRC) mejoró de 4 a 1 y con la escala de Borg mejoró de 7 a 0. La fuerza en la musculatura de los miembros superiores e inferiores aumentó de 3 a 4. Conclusión: Para este paciente un periodo de RP entre 8 y 10 semanas de duración, fue suficiente para mejorar la funcionalidad.

Introduction: In tuberculosis (Tb), the great inflammatory component causes major injuries that trigger fibroblastic reaction, fibrosis and chest wall retraction, compromising the pulmonary expansion which translates to a clinically and functionally moderate restrictive pattern and dyspnea during exercise. This favors lung disability, causing economic and social dependence upon the nuclear family. Measures to control the Tb disease are just focused on healing; and this fact must be considered insufficient because the actions aimed to habilitation and rehabilitation could prevent or reduce the incidence of Tb by cardiopulmonary disability. The importance of pulmonary rehabilitation (RP) as a non-pharmacological treatment in patients with chronic respiratory disease and/or risk factors for acquiring it is documented in the literature, allowing to improve the patient’s physical condition and to restore health related quality of life (HRQOL), autonomy and social integration. Objective: To describe the deterioration of the functionality of a patient with multi-drug resistant tuberculosis (MDR-TB) and his recovery in a PR program. Results: An increase of the distance covered in the six minute walk test (6MWT) from 240 m to 350 m was observed. Dyspnea score with the medical research council (MRC) improved from 4 to 1, and with the Borg scale improved from 7 to 0. The strength in muscles of upper and lower limbs increased from 3 to 4. Conclusion: A period of PR of 8 to 10 weeks was enough to improve this patient’s functionality.

Tumores estromales gastrointestinales: enfoque actual: Presentación de seis casos / Gastrointestinal stromal tumors: current management and report of six cases

Se presentan seis pacientes con diagnóstico inmuno-histoquímico de tumores estromales gastrointestinales y extragastrointestinales localizados en diferentes ór-ganos del tracto digestivo y otras áreas, estudiados e intervenidos en nuestra institución a partir del año 2000, con seguimiento en su evolución clínica hasta la fecha por los servicios de hemato- oncología y cirugía; a ex-cepción de una paciente. En su mayoría sin diagnósti-co claro en su preoperatorio o con alta sospecha de presentar tumores mesenquimales complicados por masa compresiva, oclusión intestinal o sangrado.Se plantean de manera concreta los aspectos rele-vantes en su diagnóstico y clasificación patológi-ca, manejo quirúrgico y tratamiento en relación a la literatura actual, exponiendo algunas de las con-troversias existentes. Además de fijar nuestra posi-ción como grupo terapéutico frente a esta neoplasia, con base en la revisión realizada y nuestra limitada experiencia