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1.
Artigo em Inglês | MEDLINE | ID: mdl-34574600

RESUMO

The psychosocial impact of the work environment during the COVID-19 pandemic on health professionals is a growing issue. The present study examined specific psychosocial work environment indicators during the COVID-19 pandemic, through a multiple regression model of a self-administered cross-sectional online survey in a cohort of physical therapists from a region of Southern Italy from March 2020 to May 2021. The questionnaire contained items on work and healthcare issues related to COVID-19. Eighty physical therapists (29 male and 51 female), mean age 32.5 ± 10.1 years, were involved in this survey. The multiple regression analysis showed that "management activity" was significantly correlated to "therapist frustration" during the COVID-19 pandemic (ΔR2 = 0.16; p < 0.03). Findings of this study underline the importance of a healthy psychosocial work environment to enhance job satisfaction of all health professionals and to avoid role conflict and burnout syndrome during the COVID-19 pandemic.


Assuntos
Esgotamento Profissional , COVID-19 , Fisioterapeutas , Angústia Psicológica , Adulto , Esgotamento Profissional/epidemiologia , Estudos Transversais , Feminino , Humanos , Itália/epidemiologia , Masculino , Pandemias , Percepção , SARS-CoV-2 , Inquéritos e Questionários , Adulto Jovem
2.
Histol Histopathol ; : 18376, 2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34585734

RESUMO

Estrogen receptor (ER) status assessment by immunohistochemistry (IHC) is the gold standard test for the identification of patients with breast cancer who may benefit from endocrine therapy (ET). Whilst most ER+ breast cancers have a high IHC score, about 3% of cases display a low positivity, with 1% to 10% of cells being weakly stained. These tumors are generally classified within the luminal-like category; however, their risk profile seems to be more similar to that of ER-negative breast cancers. The decision on ET for patients with a diagnosis of ER-low breast cancer should be carefully considered in light of the risks and possible benefits of the treatment. Potential pitfalls hinder pathologists and oncologists from establishing an appropriate threshold for "low positivity". Furthermore, several pre-analytical and analytical variables might trouble the pathological identification of these clinically challenging cases. In this review, we sought to discuss the adversities that can be accounted for the pathological identification of ER-low breast cancers in real-world clinical practice, and to provide practical suggestions for the perfect ER testing in light of the most updated recommendations and guidelines.

3.
World J Orthop ; 12(7): 456-466, 2021 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-34354934

RESUMO

Fractures of femur proximal extremity (FFPE) are the most common fragility fractures requiring hospitalization, with a high risk of mortality, low independence in the activities of daily living and severe consequences on health-related quality of life. Timing for surgery has a key role in the management of elderly patients with FFPE as recommended by the Australian and New Zealand guidelines and the National Institute for Health and Care Excellence guidelines. Early surgery (within 48 h from hospital admission) allows significant benefits in terms of lower rates of postoperative complications and risk of death and can provide better functional outcomes. Therefore, time for surgery could be considered as a comorbidity marker. The choice between conservative or surgical approach surprisingly seems to be still not strongly supported by available literature, but it seems that both 30 d and 1 year risk of mortality is higher with the conservative treatment rather than with surgery. In light of these considerations, the optimization of FFPE management care is mandatory to improve functional outcomes and to reduce sanitary costs. Albeit it is widely accepted that transdisciplinary approach to patients suffering from FFPE is mandatory to optimize both short-term and long-term outcomes, the feasibility of a comprehensive approach in clinical practice is still a challenge. In particular, the large variability of figures involved could be considered both a resource and an additional disadvantage taking into account the difficulty to coordinate multidisciplinary approach covering care in all settings. Therefore, the aim of the present article was to summarize current evidence supporting transdisciplinary management of patients with FFPE, highlighting the benefits, feasibility and limitations of this approach.

4.
Healthcare (Basel) ; 9(7)2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34356276

RESUMO

Vertebral fragility fractures (VFFs) are the most common type of osteoporotic fractures, related to pain and disability. In this scenario, physical and rehabilitative medicine (PRM) physicians prescribe a patient-tailored rehabilitation plan, including spinal orthoses. However, there is a high heterogeneity in the clinical indications of spinal orthoses. Thus, the aim of this survey was to investigate common clinical practice in terms of the prescription of spinal orthoses. This nationwide cross-sectional survey recruited Italian PRM physicians commonly involved in the management of patients with VFFs. One hundred twenty-six PRM physicians completed the survey. The results showed that most PRM physicians prescribe spinal orthoses in outpatients suffering from VFFs (n = 106; 83.9%). The most prescribed spinal orthosis for acute VFF patients was the three-point rigid orthosis (n = 64; 50.8%), followed by the semirigid thoraco-lumbar orthosis (n: 20; 15.9%). However, most PRM physicians prescribed dynamic orthoses in outpatients with chronic VFFs (n = 66; 52.4%). Albeit that a correct management of VFFs is mandatory to improve pain and reduce disability, our findings highlighted uncertainty in the type of spinal orthosis prescription in both the acute and chronic VFF phase. Therefore, high-quality research trials are warranted to provide clear recommendations for the correct clinical management of VFF.

5.
Cells ; 10(6)2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34199522

RESUMO

Despite the remarkable advances in the diagnosis and treatment of breast cancer patients, the presence or development of metastasis remains an incurable condition. Bone is one of the most frequent sites of distant dissemination and negatively impacts on patient's survival and overall frailty. The interplay between tumor cells and the bone microenvironment induces bone destruction and tumor progression. To date, the clinical management of bone metastatic breast cancer encompasses anti-tumor systemic therapies along with bone-targeting agents, aimed at slowing bone resorption to reduce the risk of skeletal-related events. However, their effect on patients' survival remains controversial. Unraveling the biology that governs the interplay between breast neoplastic cells and bone tissue would provide means for the development of new therapeutic agents. This article outlines the state-of-the art in the characterization and targeting the bone metastasis in breast cancer, focusing on the major clinical and translational studies on this clinically relevant topic.


Assuntos
Neoplasias Ósseas , Reabsorção Óssea , Neoplasias da Mama , Microambiente Tumoral , Neoplasias Ósseas/metabolismo , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Neoplasias Ósseas/secundário , Reabsorção Óssea/metabolismo , Reabsorção Óssea/mortalidade , Reabsorção Óssea/patologia , Reabsorção Óssea/terapia , Neoplasias da Mama/metabolismo , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Intervalo Livre de Doença , Feminino , Humanos , Metástase Neoplásica , Taxa de Sobrevida
6.
Artigo em Inglês | MEDLINE | ID: mdl-34229592

RESUMO

Immune checkpoint inhibitors (ICIs) have remarkably modified the way solid tumors are managed, including breast cancer. Unfortunately, only a relatively small number of breast cancer patients significantly respond to these treatments. To maximize the immunotherapy benefit in breast cancer, several efforts are currently being put forward for the identification of i) the best therapeutic strategy (i.e. ICI monotherapy or in association with chemotherapy, radiotherapy, or other drugs); ii) the optimal timing for administration (e.g. early/advanced stage of disease; adjuvant/neoadjuvant setting); iii) the most effective and reliable predictive biomarkers of response (e.g. tumor-infiltrating lymphocytes, programmed death-ligand 1, microsatellite instability associated with mismatch repair deficiency, and tumor mutational burden). This article reviews the impacts and gaps in the characterization of immune-related biomarkers raised by clinical and translational research studies with immunotherapy treatments. Particular emphasis has been put on the documented evidence of significant clinical benefits of ICI in different randomized clinical trials, along with preanalytical and analytical issues in predictive biomarkers pathological assessment.

7.
J Hand Ther ; 2021 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-34256988

RESUMO

STUDY DESIGN: Double-blind randomized controlled trial. INTRODUCTION: Carpal tunnel syndrome (CTS) is a common mononeuropathy that causes pain and disability in the affected hand. Kinesio taping (KT) has been recently proposed as a promising conservative approach in CTS patients. PURPOSE OF THE STUDY: To investigate the effectiveness of KT compared to a sham taping on symptoms and hand function in patients affected by mild CTS. METHODS: Patients affected by mild CTS with symptoms for at least 8 weeks were enrolled and randomly allocated into two groups: KT group, according to the technique proposed by Kase plus specific exercises; control group, undergoing a sham taping plus specific exercise. All patients performed 2 sessions/week for 5 weeks of exercises of mobilization of fingers and carpal joint. At the baseline, after 5 weeks (T1), and after 6 months (T2), a physician unaware of patients' allocation assessed the Boston Carpal Tunnel Questionnaire (BCTQ) symptom (BCTQ-S) and functional (BCTQ-F) subscales. RESULTS: Forty-two patients (mean age:54.3 ± 15.0 y) were randomly allocated into KT (n = 21) and control group (n = 21). At T1, in both groups we found a significant improvement in hand function and symptoms, as showed by BCTQ-F (KT:4.2 ± 0.7 vs 3.0 ± 0.6, P < .001; sham: 2.2 ± 0.3 vs 1.7 ± 0.3, P = .012) and by BCTQ-S (KT: 2.2 ± 0.3 vs 1.7 ± 0.3, P < .001; sham: 2.3 ± 0.4 vs 1.9 ± 0.5, P = .007). At T2, only in the KT group there was a significant difference in both sub-items of primary outcome. There were significantly better results in the KT group at T1 and T2. DISCUSSION: The present study showed that KT compared to a sham taping might be more effective in reducing perceived symptoms in mild CTS patients, reporting a clinically significant difference. CONCLUSION: KT might be considered as an effective technique combined to rehabilitative treatment in terms of hand function and symptoms in patients affected by mild CTS.

8.
Diagnostics (Basel) ; 11(6)2021 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-34070871

RESUMO

Anterior cruciate ligament (ACL) injury incidence is often underestimated in tennis players, who are considered as subjects conventionally less prone to knee injuries. However, evaluation of the preactivation of knee stabilizer muscles by surface electromyography (sEMG) showed to be a predictive value in the assessment of the risk of ACL injury. Therefore, this proof-of-concept study aimed at evaluating the role of visual input on the thigh muscle preactivation through sEMG to reduce ACL injury risk in tennis players. We recruited male, adult, semiprofessional tennis players from July to August 2020. They were asked to drop with the dominant lower limb from a step, to evaluate-based on dynamic valgus stress-the preactivation time of the rectus femoris (RF), vastus medialis, biceps femoris, and medial hamstrings (MH), through sEMG. To highlight the influence of visual inputs, the athletes performed the test blindfolded and not blindfolded on both clay and grass surfaces. We included 20 semiprofessional male players, with a mean age 20.3 ± 4.8 years; results showed significant early muscle activation when the subject lacked visual input, but also when faced with a less-safe surface such as clay over grass. Considering the posteromedial-anterolateral relationship (MH/RF ratio), tennis players showed a significant higher MH/RF ratio if blindfolded (22.0 vs. 17.0% not blindfolded; p < 0.01) and percentage of falling on clay (17.0% vs. 14.0% in grass; p < 0.01). This proof-of-principle study suggests that in case of absence of visual input or falling on a surface considered unsafe (clay), neuro-activation would tend to protect the anterior stress of the knee. Thus, the sEMG might play a crucial role in planning adequate athletic preparation for semiprofessional male athletes in terms of reduction of ACL injury risk.

9.
Int J Mol Sci ; 22(11)2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34072015

RESUMO

Osteoarthritis (OA) is a painful and disabling disease that affects millions of patients. Its etiology is largely unknown, but it is most likely multifactorial. OA pathogenesis involves the catabolism of the cartilage extracellular matrix and is supported by inflammatory and oxidative signaling pathways and marked epigenetic changes. To delay OA progression, a wide range of exercise programs and naturally derived compounds have been suggested. This literature review aims to analyze the main signaling pathways and the evidence about the synergistic effects of these two interventions to counter OA. The converging nutrigenomic and physiogenomic intervention could slow down and reduce the complex pathological features of OA. This review provides a comprehensive picture of a possible signaling approach for targeting OA molecular pathways, initiation, and progression.


Assuntos
Suplementos Nutricionais , Suscetibilidade a Doenças , Osteoartrite/etiologia , Osteoartrite/metabolismo , Transdução de Sinais , Animais , Antioxidantes , Biomarcadores , Condrócitos/metabolismo , Gerenciamento Clínico , Exercício Físico , Humanos , Nutrigenômica/métodos , Osteoartrite/diagnóstico , Osteoartrite/tratamento farmacológico , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais/efeitos dos fármacos
10.
Artigo em Inglês | MEDLINE | ID: mdl-34151769

RESUMO

Breast cancer is the most common malignant tumor and the most prevalent cause of mortality in women. Advances in early diagnosis and more effective adjuvant therapies have improved the long-term survival of these patients. Pharmacotherapies and intrinsic tumor-related factors may lead to a wide spectrum of treatment-related disabling complications, such as breast cancer-related lymphedema, axillary web syndrome, persistent pain, bone loss, arthralgia, and fatigue. These conditions have a detrimental impact on the health-related quality of life of survivors. Here, we sought to provide a portrait of the role that rehabilitation plays in breast cancer survivors. Particular emphasis has been placed on recovering function, improving independence in activities of daily living, and reducing disability. This complex scenario requires a precision medicine approach to provide more effective decision-making and adequate treatment compliance.

11.
Cancer Cell Int ; 21(1): 266, 2021 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-34001143

RESUMO

The clinical outcome of patients with a diagnosis of hormone receptor (HR)+ breast cancer has improved remarkably since the arrival of endocrine therapy. Yet, resistance to standard treatments is a major clinical challenge for breast cancer specialists and a life-threatening condition for the patients. In breast cancer, mismatch repair (MMR) status assessment has been demonstrated to be clinically relevant not only in terms of screening for inherited conditions such as Lynch syndrome, but also for prognostication, selection for immunotherapy, and early identification of therapy resistance. Peculiar traits characterize the MMR biology in HR+ breast cancers compared to other cancer types. In these tumors, MMR genetic alterations are relatively rare, occurring in ~3 % of cases. On the other hand, modifications at the protein level can be observed also in the absence of gene alterations and vice versa. In HR+ breast cancers, the prognostic role of MMR deficiency has been confirmed by several studies, but its predictive value remains a matter of controversy. The characterization of MMR status in these patients is troubled by the lack of tumor-specific guidelines and/or companion diagnostic tests. For this reason, precise identification of MMR-deficient breast cancers can be problematic. A deeper understanding of the MMR biology and clinical actionability in HR+ breast cancer may light the path to effective tumor-specific diagnostic tools. For a precise MMR status profiling, the specific strengths and limitations of the available technologies should be taken into consideration. This article aims at providing a comprehensive overview of the current state of knowledge of MMR alterations in HR+ breast cancer. The available armamentarium for MMR testing in these tumors is also examined along with possible strategies for a tailored pathological characterization.

12.
J Back Musculoskelet Rehabil ; 34(6): 925-936, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33998532

RESUMO

BACKGROUND: Radiographic methods to assess skeletal maturity (SM) have a key role in adolescent idiopathic scoliosis (AIS) management, allowing to predict risk of spinal curve progression. Cervical vertebral maturation (CVM) has been recently introduced as an alternative tool to assess skeletal maturity; however, its clinical role is still debated. OBJECTIVE: This systematic review aimed to investigate the reliability of CVM in the SM assessment of growing subjects, comparing it to hand wrist maturation (HVM). METHODS: PubMed, Scopus, and Web of Science databases were systematically searched from inception until 31st December 2020 to identify observational studies presenting: growing subjects as participants; CVM methods as intervention; HVM methods as comparator; reliability for SM assessment as outcome. A 10-item quality tool has been used to assess study quality. RESULTS: Out of 205 papers, 12 papers were included in the data synthesis. We classified 10 studies (83.3%) as medium-quality studies and 2 studies (16.7%) as high-quality studies. Eight studies reported a significant correlation between CVM Baccetti and different HWM methods. CONCLUSION: Taken together, these findings suggested that CVM might be considered as reliable SM assessment method compared to HWM in growing subjects. However, further studies are warranted to confirm these findings.


Assuntos
Escoliose , Punho , Adolescente , Determinação da Idade pelo Esqueleto , Vértebras Cervicais/diagnóstico por imagem , Humanos , Reprodutibilidade dos Testes , Escoliose/diagnóstico por imagem
13.
Curr Opin Pharmacol ; 58: 27-34, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33848933

RESUMO

Muscle maintenance relies on a multidimensional biologic balance that is extremely delicate in breast cancer patients, particularly those with advanced-stage disease. The biology that underpins breast cancer tumorigenesis, tumor progression and response to pharmacotherapies can modify muscle homeostasis, resulting in volumetric muscle loss. This condition dramatically increases the overall patients' frailty, leading to reduced survival and impaired quality of life. Physical activity may potentially improve muscle health in these patients, providing that an optimal patients selection is performed. The understanding of volumetric muscle loss biology in breast cancer survivors, coupled with focused clinical studies, would allow for the implementation of individualized rehabilitation protocols.


Assuntos
Neoplasias da Mama , Biologia , Neoplasias da Mama/tratamento farmacológico , Exercício Físico , Terapia por Exercício , Feminino , Humanos , Músculos , Qualidade de Vida
14.
Biomolecules ; 11(3)2021 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-33652804

RESUMO

In recent years, the interest in oxygen-ozone (O2O3) therapy application has considerably increased in the field of rehabilitation. Despite its widespread use in common clinical practice, the biochemical effects of O2O3 are still far from being understood, although its chemical properties seem to play a pivotal role in exerting its positive effects on different pathological conditions. Indeed, the effectiveness of O2O3 therapy might be partly due to the moderate oxidative stress produced by O3 interactions with biological components. O2O3 therapy is widely used as an adjuvant therapeutic option in several pathological conditions characterized by chronic inflammatory processes and immune over-activation, and most musculoskeletal disorders share these pathophysiological processes. The present comprehensive review depicts the state-of-the-art on the mechanisms of action, safety and effectiveness of O2O3 therapy in the complex scenario of the management of musculoskeletal disorders. Taken together, our findings suggest that O2O3 therapy seems to reduce pain and improve functioning in patients affected by low back pain and knee osteoarthritis, as reported by several studies in the literature. However, to date, further studies are warranted to clearly investigate the therapeutic effects of this promising therapy on other musculoskeletal disorders in the field of rehabilitation.


Assuntos
Doenças Musculoesqueléticas/tratamento farmacológico , Doenças Musculoesqueléticas/metabolismo , Osteoartrite do Joelho/tratamento farmacológico , Osteoartrite do Joelho/metabolismo , Oxigênio/uso terapêutico , Ozônio/uso terapêutico , Animais , Fibromialgia/tratamento farmacológico , Fibromialgia/metabolismo , Humanos , Dor Lombar/tratamento farmacológico , Dor Lombar/metabolismo , Cervicalgia/tratamento farmacológico , Cervicalgia/metabolismo
15.
Curr Opin Pharmacol ; 57: 148-156, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33735662

RESUMO

The generalized skeletal muscle disorder that involves (in elderly subjects) the progressive loss of muscle mass and function has been defined sarcopenia, whereas the rapid-onset (traumatic or surgical) and focal (unilateral) loss of skeletal muscle with resultant functional impairment has been defined volumetric muscle loss. Different tools and approaches are commonly used in the clinical settings to quantify the loss of muscle or lean mass and to assess the consequent motor impairment. This review describes the technical principles and provides a summary of the main parameters that can be obtained to assess lean mass (and its distribution) or muscle size (and its structure) through the two imaging techniques most easily accessible and therefore frequently adopted in the clinical practice: dual-energy X-ray absorptiometry and muscle ultrasonography.


Assuntos
Sarcopenia , Absorciometria de Fóton , Idoso , Humanos , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Sarcopenia/diagnóstico por imagem , Ultrassonografia
16.
Curr Opin Pharmacol ; 57: 132-139, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33721616

RESUMO

Spinal cord injury (SCI) is a condition defining the damage of the spinal cord that leads to musculoskeletal sequelae, including volumetric muscle loss (VML) in a significant proportion of patients. VML occurring after SCI is responsible for delayed recovery, with detrimental consequences in terms of functional outcomes and additional alterations of the muscle tissue. The treatment of muscle alterations in these patients usually relies on nutritional supplementation. However, rehabilitation therapy has a well-recognized role in improving muscle mass and function, even in subjects affected by SCI. Furthermore, novel medical therapies have been recently investigated, with positive results. In this scoping review, we portray the state-of-the-art treatment of muscle modifications after SCI, focusing on the multidisciplinary and multidimensional management of these patients.


Assuntos
Traumatismos da Medula Espinal , Suplementos Nutricionais , Humanos , Músculo Esquelético , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/tratamento farmacológico
17.
NeuroRehabilitation ; 48(1): 49-57, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33386822

RESUMO

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease affecting upper and lower motor neurons. The current practice of caring for patients affected by ALS involves a multidisciplinary team without any indication about oral health care. OBJECTIVE: We sought to investigate the functional status and oral health in patients with ALS to define a specific multidisciplinary management. METHODS: In this cross-sectional study, we included patients affected by ALS, evaluating their functional status, using the Revised ALS Functional Rating Scale (ALSFRS-R) and their oral health status through specific parameters, including Brief Oral Health Status Examination (BOHSE), Winkel Tongue Coating Index (WTCI), and Oral Food Debris Index (OFDI). RESULTS: All 37 patients (mean age: 61.19±11.56 years) showed a poor oral status, independent from the functional status and strictly correlated to the severity of sialorrhea (p = 0.01). OFDI index was negatively correlated with the ALSFRS-R upper limb (p = 0.03). Patients with bulbar onset had significantly lower ability to perform adequate tongue movements in terms of protrusion (p = 0.006) and lateralization (p < 0.001). Significant negative correlations between survival rate and BOHSE (p = 0.03) was found. CONCLUSIONS: Taken together, our findings showed that a poor oral health status might be correlated to a worse functional status and survival time. Thus, an adequate oral health care and rehabilitation should be considered as crucial in the multidisciplinary management of patients with ALS.


Assuntos
Esclerose Amiotrófica Lateral/fisiopatologia , Progressão da Doença , Estado Funcional , Saúde Bucal/tendências , Idoso , Esclerose Amiotrófica Lateral/diagnóstico , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Extremidade Superior/fisiopatologia
18.
Diagnostics (Basel) ; 11(1)2021 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-33466426

RESUMO

BACKGROUND: Neuropathic pain is an injury or disease of the central and/or peripheral somatosensory nervous system, and it has a significant impact on quality of life, especially since it is often refractory to treatment. Rehabilitative intervention is considered in various guidelines on neuropathic pain treatment, although not in an organic nor detailed way. The aim of this systematic review was to analyze the most indicated therapeutic strategies, providing rehabilitative recommendations in the management of neuropathic pain. METHODS: A systematic review was performed according to PRISMA guidelines. The scientific search, carried out until July 2020, considered guidelines in English language of the last thirteen years. RESULTS: Six guidelines were analyzed, from which emerges that a multidisciplinary approach, comprehensive of pharmacologic and nonpharmacologic interventions, should drive neuropathic pain management. A relevant role in non-pharmacological intervention is played by rehabilitation, through an adequate tailored rehabilitation program and physical therapies. CONCLUSION: This analysis highlights the importance of rehabilitation but also the lack of evidence on various rehabilitative practices. Arises hence the need for further studies in this field to better define a rehabilitative treatment strategy.

19.
JAMA Netw Open ; 4(1): e2036142, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33502487

RESUMO

Importance: Although plenty of data exist regarding clinical manifestations, course, case fatality rate, and risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19), long-term respiratory and functional sequelae in survivors of COVID-19 are unknown. Objective: To evaluate the prevalence of lung function anomalies, exercise function impairment, and psychological sequelae among patients hospitalized for COVID-19, 4 months after discharge. Design, Setting, and Participants: This prospective cohort study at an academic hospital in Northern Italy was conducted among a consecutive series of patients aged 18 years and older (or their caregivers) who had received a confirmed diagnosis of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection severe enough to require hospital admission from March 1 to June 29, 2020. SARS-CoV-2 infection was confirmed via reverse transcription-polymerase chain reaction testing, bronchial swab, serological testing, or suggestive computed tomography results. Exposure: Severe COVID-19 requiring hospitalization. Main Outcomes and Measures: The primary outcome of the study was to describe the proportion of patients with a diffusing lung capacity for carbon monoxide (Dlco) less than 80% of expected value. Secondary outcomes included proportion of patients with severe lung function impairment (defined as Dlco <60% expected value); proportion of patients with posttraumatic stress symptoms (measured using the Impact of Event Scale-Revised total score); proportion of patients with functional impairment (assessed using the Short Physical Performance Battery [SPPB] score and 2-minute walking test); and identification of factors associated with Dlco reduction and psychological or functional sequelae. Results: Among 767 patients hospitalized for severe COVID-19, 494 (64.4%) refused to participate, and 35 (4.6%) died during follow-up. A total of 238 patients (31.0%) (median [interquartile range] age, 61 [50-71] years; 142 [59.7%] men; median [interquartile range] comorbidities, 2 [1-3]) consented to participate to the study. Of these, 219 patients were able to complete both pulmonary function tests and Dlco measurement. Dlco was reduced to less than 80% of the estimated value in 113 patients (51.6%) and less than 60% in 34 patients (15.5%). The SPPB score was suggested limited mobility (score <11) in 53 patients (22.3%). Patients with SPPB scores within reference range underwent a 2-minute walk test, which was outside reference ranges of expected performance for age and sex in 75 patients (40.5%); thus, a total of 128 patients (53.8%) had functional impairment. Posttraumatic stress symptoms were reported in a total of 41 patients (17.2%). Conclusions and Relevance: These findings suggest that at 4 months after discharge, respiratory, physical, and psychological sequelae were common among patients who had been hospitalized for COVID-19.


Assuntos
COVID-19/complicações , Transtornos Respiratórios/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Idoso , COVID-19/patologia , COVID-19/psicologia , COVID-19/virologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Desempenho Físico Funcional , Transtornos Respiratórios/virologia , Testes de Função Respiratória , SARS-CoV-2 , Transtornos de Estresse Pós-Traumáticos/virologia , Fatores de Tempo
20.
J Back Musculoskelet Rehabil ; 34(1): 43-47, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33164924

RESUMO

INTRODUCTION: Scoliosis is frequently associated with pain and radiculopathy, but it is not considered a possible cause of acute spinal cord injury (SCI). Here we present a case report in which scoliosis was apparently linked to spinal cord ischaemia. CASE PRESENTATION: A 20-year-old woman with conservatively treated severe scoliosis presented with acute spinal cord infarction, which occurred during a spinal flexion while she was tidying up the bed. Other causes of SCI were excluded. Early rehabilitation was started and the patient progressively regained motor and sensory functions, with an AIS reduction from A to C. Bowel and bladder disorders persisted and were autonomously managed with a trans-anal irrigation device and intermittent catheterisation after voluntary micturition. DISCUSSION: Early detection and management of spinal curvature disorders are essential in preventing long-term complications of scoliosis. Although the aetiology of spinal cord ischaemia in severe scoliosis should be better clarified, this rare case report suggests that scoliosis might be involved in its pathogenesis. Thus, we recommend early diagnosis of spinal curvature disorders and adequate rehabilitative treatment in order to prevent potential subsequent neurological complications.


Assuntos
Escoliose/complicações , Isquemia do Cordão Espinal/etiologia , Coluna Vertebral/diagnóstico por imagem , Diagnóstico Precoce , Feminino , Humanos , Escoliose/diagnóstico por imagem , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/reabilitação , Adulto Jovem
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