Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 27.300
Filtrar
1.
Medicine (Baltimore) ; 99(6): e18978, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028407

RESUMO

RATIONALE: AA amyloidosis (AA) is caused by a wide variety of inflammatory states, but is infrequently associated with Castleman disease (CD). CD describes a heterogeneous group of hematologic disorders that share characteristic lymph node histopathology. CD can present with a solitary enlarged lymph node (unicentric CD, UCD) or with multicentric lymphadenopathy (MCD), constitutional symptoms, cytopenias, and multiple organ dysfunction due to an interleukin-6 driven cytokine storm. PATIENT CONCERNS: We are reporting a case of a 26-year-old woman with no significant past medical history who presented with a 3-month history of fatigue and an unintentional 20-pound weight loss. DIAGNOSIS: A CT-scan of the abdomen and pelvis revealed hepatosplenomegaly and a mesenteric mass. Congo Red staining from a liver biopsy showed apple-green birefringence and serum markers were suggestive of an inflammatory process. Post-excision examination of the resected mass revealed a reactive lymph node with follicular hyperplasia with kappa and lambda stains showing polyclonal plasmacytosis consistent with CD. INTERVENTIONS: The patient underwent surgery to remove the affected lymph node. OUTCOMES: IL-6, anemia, leukocytosis, and thrombocytosis resolved or normalized 2 weeks after resection; creatinine normalized 9 months postsurgery. Twenty two months post-surgery her IFN-γ normalized, her fatigue resolved, her proteinuria was reduced by >90% and she had returned to her baseline weight. LESSONS: Our case and literature review suggest that patients presenting with UCD or MCD along with organ failure should prompt consideration of concurrent AA amyloidosis.


Assuntos
Amiloidose/etiologia , Hiperplasia do Linfonodo Gigante/complicações , Doenças Peritoneais/etiologia , Adulto , Amiloidose/sangue , Amiloidose/diagnóstico , Amiloidose/diagnóstico por imagem , Hiperplasia do Linfonodo Gigante/sangue , Hiperplasia do Linfonodo Gigante/diagnóstico , Fadiga/etiologia , Feminino , Humanos , Doenças Peritoneais/sangue , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/diagnóstico por imagem , Proteína Amiloide A Sérica/análise , Tomografia Computadorizada por Raios X , Perda de Peso
2.
Medicine (Baltimore) ; 99(5): e18968, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000424

RESUMO

BACKGROUND: Lung cancer is one of the most common cancers worldwide, and approximately half of the patients with lung cancer receiving chemotherapy suffer from cancer-related fatigue (CRF). Herbal medicines (HMs) have been used in Oriental countries for centuries as tonics. Various beneficial effects of HM on fatigue and cancer have been reported. However, the effectiveness and safety of HM for CRF in lung cancer patients have not been synthesized. The purpose of this systematic review is to evaluate the effectiveness and safety of HM for CRF in patients with lung cancer, regardless of their cancer type or stage. METHODS AND ANALYSIS: A comprehensive search will be conducted in 12 electronic medical databases including 5 English-language databases (Medline via PubMed, EMBASE via Elsevier, the Cochrane Central Register of Controlled Trials [CENTRAL], the Allied and Complementary Medicine Database [AMED] via EBSCO, and the Cumulative Index to Nursing and Allied Health Literature [CINAHL] via EBSCO), 4 Korean-language databases (Oriental Medicine Advanced Searching Integrated System [OASIS], Koreanstudies Information Service System [KISS], Research Information Service System [RISS], and Korea Citation Index [KCI]), 2 Chinese-language databases (China National Knowledge Infrastructure [CNKI] and Wanfang Data), and 1 Japanese-language database (CiNii). Only randomized controlled trials (RCTs) and quasi-RCTs on HM for CRF will be allowed. The severity of fatigue assessed using a validated tool will be considered as theprimary outcome. The secondary outcomes will include the patients' quality of life, activities of daily life, incidence of adverse events, and total effective rate. Two independent researchers will perform the study selection, data extraction, and quality assessment. RevMan version 5.3 will be used for data synthesis. The methodological quality of the included RCTs will be assessed using the Cochrane Collaboration's risk of bias tool. In the meta-analysis, for dichotomous data and continuous data, risk ratio and mean difference, respectively, will be estimated with their 95% confidence intervals. According to the heterogeneity, either a fixed-effects or a random-effects model will be used. ETHICS AND DISSEMINATION: Ethical approval is not required because individual patient data are not included. The findings of this systematic review will be disseminated through a peer-reviewed publication or conference presentation. PROSPERO REGISTRATION NUMBER: CRD42019141660.


Assuntos
Sobreviventes de Câncer , Medicamentos de Ervas Chinesas/uso terapêutico , Fadiga/tratamento farmacológico , Fadiga/etiologia , Medicina Herbária/métodos , Neoplasias Pulmonares/complicações , Medicina Tradicional do Leste Asiático/métodos , Revisão Sistemática como Assunto , Humanos , Projetos de Pesquisa
3.
J Nurs Adm ; 50(2): 66-71, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31929347

RESUMO

A quality improvement process was implemented within a large, tertiary healthcare organization to develop and implement a roundtable culture as part of a fatigue risk management system focused on mitigating nurse leader fatigue and stress. Strategies to form trusting collaboration and reduce leader attrition were initiated and assessed for effectiveness. Results show measurable decreases in reported levels of stress and attrition. Acute, chronic, and persistent fatigue continue to challenge those in leadership roles.


Assuntos
Fadiga/prevenção & controle , Enfermeiras Administradoras/psicologia , Cuidados de Enfermagem/organização & administração , Melhoria de Qualidade/organização & administração , Centros de Atenção Terciária/organização & administração , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
Rev Med Liege ; 75(1): 49-52, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31920044

RESUMO

Elite athletes participate in multiple competitions and are exposed to important training load. There is a need to match the recovery process against such a number of competitions and important training load, with the aim of preventing overtraining and injury. Several recovery strategies exist. Some strategies such as hydration, diet, cold water immersion and sleep are effective in their ability to counteract the fatigue mechanisms. Elite athletes regularly display compromised sleep quantity and quality with sleep quality being most vulnerable prior to major competitive events, during periods of high-intensity training and following long-haul travel to competitions. Compromised sleep quantity and/or quality may be detrimental to the outcome of the recovery process after training and competition. Future studies should focus on the interest of sleep hygiene strategies to optimise recovery, performance and preventing injury.


Assuntos
Atletas , Transtornos do Sono-Vigília , Esportes , Fadiga , Humanos , Sono
5.
Br J Nurs ; 29(1): 28-34, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31917951

RESUMO

A study was conducted to explore whether fatigue, workload, burnout and the work environment can predict the perceptions of patient safety among critical care nurses in Oman. A cross-sectional predictive design was used. A sample of 270 critical care nurses from the two main hospitals in the country's capital participated, with a response rate of 90%. The negative correlation between fatigue and patient safety culture (r= -0.240) indicates that fatigue has a detrimental effect on nurses' perceptions of safety. There was also a significant relationship between work environment, emotional exhaustion, depersonalisation, personal accomplishment and organisational patient safety culture. Regression analysis showed that fatigue, work environment, emotional exhaustion, depersonalisation and personal accomplishment were predictors for overall patient safety among critical care nurses (R2=0.322, F=6.117, P<0.0001). Working to correct these predictors and identifying other factors that affect the patient safety culture are important for improving and upgrading the patient safety culture in Omani hospitals.


Assuntos
Atitude do Pessoal de Saúde , Enfermagem de Cuidados Críticos/organização & administração , Recursos Humanos de Enfermagem no Hospital/psicologia , Cultura Organizacional , Segurança do Paciente , Adulto , Esgotamento Profissional/epidemiologia , Estudos Transversais , Fadiga/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Omã/epidemiologia , Carga de Trabalho , Local de Trabalho , Adulto Jovem
7.
Br J Nurs ; 29(2): 111-117, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31972112

RESUMO

BACKGROUND: Cancer-related fatigue (CRF) is considered to be one of the most common symptoms reported by cancer patients. However, little information is available regarding the variables associated with CRF among Jordanian patients. AIMS: To assess the prevalence of CRF and explore its predictors among Jordanian patients. METHODS: A cross-sectional survey design was used. FINDINGS: Of the 240 patients surveyed, 210 (87.5%) had fatigue at the time of the survey. The total mean fatigue score was 6.2 (SD=1.7) out of a maximum possible score of 10. The results also showed that being unemployed, with longer hospitalisation, low haemoglobin, and having lung cancer seem to predict higher levels of CRF. CONCLUSION: Several variables and factors associated with CRF were identified. In response to these results, healthcare providers should pay more attention to CRF, which needs to be assessed on a regular basis and to be managed with the available pharmacological and non-pharmacological interventions.


Assuntos
Fadiga/enfermagem , Neoplasias/complicações , Adulto , Estudos Transversais , Fadiga/epidemiologia , Feminino , Humanos , Jordânia/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação em Enfermagem
9.
Sports Biomech ; 19(1): 76-89, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29902127

RESUMO

A potential challenge associated with sports is that athletes must often perform the cognitive processing associated with decision-making (i.e., movement selection) when fatigued. The purpose of this systematic review was to summarise studies that have analysed the extent to which fatigue influences the effects of decision-making on lower extremity mechanics during execution of common sports manoeuvres. We specifically focused on mechanics associated with ACL injury risk. Reviewers searched the PubMed, SPORTDiscus, CINAHL and Web of Science databases. The search identified 183 unique articles. Five of these articles met our eligibility criteria. Two of the studies incorporated fatigue protocols where athletes progressed to exhaustion and found that the effects of decision-making on mechanics were more pronounced with fatigue. The nature of the results appears to indicate that fatigue may compromise an athlete's cognitive processing in a manner that diminishes their ability to control movement when rapid decision-making is required. However, three subsequent studies utilised fatigue protocols designed to mimic sports participation and found that fatigue did not influence the effects of decision-making on mechanics. In general, these findings appear to indicate that fatigue may only affect the cognitive processing associated with decision-making when athletes approach a state of exhaustion.


Assuntos
Atletas/psicologia , Tomada de Decisões , Fadiga/psicologia , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Antecipação Psicológica , Traumatismos em Atletas/fisiopatologia , Humanos , Extremidade Inferior/fisiologia , Movimento/fisiologia , Fadiga Muscular/fisiologia , Fatores de Risco
11.
Int J Radiat Oncol Biol Phys ; 106(1): 146-156, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31521718

RESUMO

PURPOSE: Human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) commonly affects people of working age, yet there is limited data regarding the return-to-work experience in this cohort. This study aimed to investigate the proportion of survivors currently working after completion of radiation therapy and to explore potential facilitators and barriers to working after treatment. METHODS: A cross-sectional, single-institutional study was undertaken at the Peter MacCallum Cancer Centre, a comprehensive cancer center in Melbourne, Victoria, Australia. Eligible participants were 18 to 65 years old at diagnosis, were employed at or within the 3 months before diagnosis, and had completed curative treatment for HPV-associated OPC ≥4 months before enrollment. Participants completed a paper-based survey to assess baseline demographics, employment status, and quality of life (QOL; Functional Assessment of Cancer Therapy Head and Neck). Open-ended questions explored factors affecting return to work. Associations between current employment status and various disease, treatment, and demographic variables and with QOL were examined. Free-text items were analyzed by summarizing content analysis. RESULTS: Of 93 participants approached, 68 responded (73.1%). Mean age was 54.1 years (range, 39-64 years), and 89.7% were male. Most participants (67.6%) had stage II disease and were treated with chemoradiation (85.3%). Mean time after treatment was 2.6 years (range, 0.3-9.1 years). Fifty-eight of 68 participants (85.3%) were working at enrollment; median time to return to work was 6.0 months (interquartile range, 4-10 months); 45 (77.6%) were in the same role and 35 (60.3%) worked the same number of hours. Ten participants were not working, 3 had retired, 5 reported persistent and significant treatment toxicity preventing employment. Survivors currently working reported higher physical, functional, and global QOL scores. Access to leave and support from treating doctors were facilitators for return to work, whereas fatigue was frequently reported as a barrier to returning to work. CONCLUSION: With time, the majority of participants with HPV-associated OPC will return to work after radiation therapy. Attention to symptom management and support from the workplace may enable more successful return to work.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Emprego/estatística & dados numéricos , Neoplasias Orofaríngeas/terapia , Infecções por Papillomavirus/complicações , Qualidade de Vida , Retorno ao Trabalho/estatística & dados numéricos , Adulto , Sobreviventes de Câncer/psicologia , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/estatística & dados numéricos , Estudos Transversais , Fadiga/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Orofaríngeas/patologia , Neoplasias Orofaríngeas/virologia , Papillomaviridae , Pesquisa Qualitativa , Aposentadoria/estatística & dados numéricos , Retorno ao Trabalho/psicologia , Licença Médica/estatística & dados numéricos , Apoio Social , Inquéritos e Questionários , Fatores de Tempo , Vitória , Tolerância ao Trabalho Programado , Local de Trabalho
12.
Int J Radiat Oncol Biol Phys ; 106(1): 100-107, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31627177

RESUMO

PURPOSE: In patients with non-small cell lung cancer (NSCLC), concurrent chemoradiation therapy (CRT) exacerbates a cluster of difficult-to-manage symptoms, especially cancer-related fatigue. Minocycline is a readily available, low-cost antibiotic with antiinflammatory properties. We conducted a phase 2 randomized, double-blinded, placebo-controlled trial to investigate the effect of minocycline in reducing CRT-symptom burden in NSCLC. METHODS AND MATERIALS: Patients with NSCLC scheduled to receive CRT provided consent and were randomized to receive either minocycline (100 mg twice daily) or a matching placebo during 6 to 7 weeks of CRT. Patient-reported fatigue and other symptoms were assessed on MD Anderson Symptom Inventory weekly from the start of CRT for 12 weeks. The primary outcome was 12-week (±2 days) area under the curve for symptom burden, which was compared between treatment groups. RESULTS: Forty of 49 enrolled patients (80%) were evaluable (19 on minocycline and 21 on placebo). There were no grade 3 + adverse events related to the study medication. Fatigue was significantly reduced in the minocycline group compared with placebo group during the 12-week trial period (area under the curve = 31.2 ± 14.2 vs 45.0 ± 20.9, P = .011), with a large effect size (Cohen's d = 0.77). Pain (Cohen's d = 0.54) and shortness of breath (Cohen's d = 0.55) were also significantly reduced in the minocycline group (all P < .05). CONCLUSIONS: Minocycline during CRT for NSCLC was feasible, had a low toxicity profile, and yielded a clinically and statistically significant positive signal in reducing symptom burden related to NSCLC and CRT. This study is a proof of concept so a larger trial in CRT patients is warranted.


Assuntos
Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Quimiorradioterapia/efeitos adversos , Fadiga/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Minociclina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Carcinoma Pulmonar de Células não Pequenas/complicações , Método Duplo-Cego , Dispneia/tratamento farmacológico , Fadiga/etiologia , Feminino , Humanos , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Estudo de Prova de Conceito , Estudos Prospectivos , Qualidade de Vida
13.
Niger J Clin Pract ; 22(12): 1662-1668, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31793471

RESUMO

Background: Postpartum fatigue means tiredness, sense of suffocation, and decreased physical and mental capacity. Fatigue reduces postpartum women's ability of concentrate, which may increase the frequency of postpartum depression, and their babies and cause babies' weaning off breastmilk earlier. Aim: Postpartum fatigue reduces the ability of mothers to concentrate and has a negative effect on communication between mothers and their babies. This study was performed to determine the effect of fatigue on breastfeeding and breastfeeding behaviors in postpartum women. Subjects and Methods: The study had a descriptive desing and was carreid out in a postpartum clinic of a maternal, obstetric, and pediatric diseases hospital. It included 374 women giving normal vaginal birth. Data were gathered with a socio-demographic features form and Visual Analogue Scale for Fatigue. Results: The mean score was 6,91 ± 2,25 for the subscale fatigue and 2,38 ± 0,91 for the subscale energy. The women reporting that it was not difficult to give birth and that they had little or some fatigue had significantly higher scores for energy (P = 0.001). The women starting to breastfeed in the hour of giving birth (P = 0.003) and the women breastfeeding at 1-hour intervals (P = 0.100) had a lower score for fatigue. The women not needing help while breastfeeding had a significantly lower score for fatigue (P = 0.001), while those reporting to give additional food had a significantly higher score for fatigue (P = 0.014). Conclusion: Women feel tired in the early postpartum period due to giving birth and their tiredness is increased by breastfeeding and infant care.


Assuntos
Aleitamento Materno/psicologia , Fadiga/complicações , Mães/psicologia , Período Pós-Parto/psicologia , Adulto , Parto Obstétrico , Depressão Pós-Parto , Fadiga/psicologia , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Inquéritos e Questionários , Turquia
14.
An Acad Bras Cienc ; 91(4): e20180957, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800698

RESUMO

The mechanism behind exercise-induced fatigue is a significant topic in the field of sports physiology. Therefore, establishing and evaluating an acute exercise-induced fatigue animal model that explores the limits of the motor system may provide greater insight into these mechanisms. Heart rate is an important quantitative parameter that accurately reflects the immediate change in physical function due to exercise load. And there is likely to be an important correlation between heart rate and behavioral performance. In this study, changes in heart rate and behavioral indexes during exercise-induced fatigue were quantitatively analyzed in rats using heart rate telemetry and video methods respectively. The behavioral indexes were used as independent variables and the degree of fatigue was used as the forecast value. Ternary quadratic function curve fitting was used to deduce a formula to calculate a fatigue score: Y = 15.2548+0.4346∙xa-0.1154∙xb+0.6826∙xc+0.0044∙xa∙xb-0.0021∙xb∙xc-0.0013∙xc∙xa-0.0023∙xa2-0.0016∙xb2 (r2=0.906). It identified a linear relationship between heart rate and exercise intensity, with a plateau in heart rate occurring during difference periods. It will serve as an effective reference for the modeling of exercise-induced fatigue. In addition, it also provides a theoretical method for analyzing the correlation between peripheral and central parameters.


Assuntos
Teste de Esforço , Fadiga , Condicionamento Físico Animal/fisiologia , Resistência Física/fisiologia , Animais , Masculino , Modelos Animais , Ratos , Ratos Wistar , Fatores de Tempo
15.
Nephrol Nurs J ; 46(6): 591-595, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31872989

RESUMO

This article describes an example of a pilot study that was done to determine the feasibility of measuring fatigue in patients on hemodialysis several times a day for one week to track patterns of fatigue. Pilot studies are studies done on a smaller scale that use the same methods and procedures to be used in a larger study and are important in determining the feasibility of a research project. Lessons learned regarding the feasibility of this pilot study are discussed, including difficulties in participant recruitment, retention, and data collection. Suggestions to improve feasibility of studying this topic in patients on hemodialysis are examined and highlight the importance of pilot studies in designing larger scale studies.


Assuntos
Fadiga , Diálise Renal , Coleta de Dados , Estudos de Viabilidade , Humanos , Projetos Piloto
16.
Nephrol Nurs J ; 46(6): 615-649, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31872992

RESUMO

The purpose of this study was to investigate changes in sleep quality, fatigue, mental health, and health-related quality of life (HRQoL) over a two-year period among patients undergoing peritoneal dialysis treatment at home. We further explored the extent to which sleep quality, fatigue, and mental health predicted health-related quality of life outcomes. This prospective study included 55 patients. Sleep parameters changed over two years, independently of treatment. Sleep variables at baseline, to some extent, predicted sleep quality after two years. Daytime sleepiness can be a long-term problem. Findings indicate improvements in nocturnal sleep over a two-year time period, independently of dialysis treatment. In contrast, fatigue remained unchanged over the same time period. Transplantation seems to generally benefit the outcome of HRQoL. Strategies to improve sleep and HRQoL may include systematic risk factor modification and efforts to optimise symptomatic treatment.


Assuntos
Fadiga , Diálise Peritoneal , Qualidade de Vida , Transtornos do Sono-Vigília , Humanos , Estudos Prospectivos , Diálise Renal , Sono
17.
Adv Neurobiol ; 23: 331-346, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31667814

RESUMO

Brain glycogen stored in astrocytes produces lactate as a neuronal energy source transported by monocarboxylate transporters (MCTs) to maintain neuronal functions, such as hippocampus-regulated memory formation. Although exercise activates brain neurons, the role of astrocytic glycogen in the brain during exercise remains unknown. Since muscle glycogen fuels active muscles during exercise, we hypothesized that astrocytic glycogen plays an energetic role in the brain during exercise to maintain endurance capacity through lactate transport. To explore this hypothesis, we have used a rat model of prolonged exercise, microwave irradiation for the accurate detection of brain glycogen, capillary electrophoresis-mass spectrometry-based metabolomics, and inhibitors of glycogenolysis (1,4-dideoxy-1,4-imino-D-arabinitol; DAB) and lactate transport (α-cyano-4-hydroxycinnamate; 4-CIN). During prolonged exhaustive exercise, muscle glycogen was depleted and brain glycogen decreased when associated with decreased blood glucose levels and increased serotonergic activity known as central fatigue factors, suggesting brain glycogen decrease as an integrative factor for central fatigue. Prolonged exhaustive exercise also increased MCT2 protein in the brain, which takes up lactate in neurons, just as muscle MCTs are increased. Metabolomics revealed that brain but not muscle adenosine triphosphate (ATP) was maintained with lactate and other glycogenolytic and glycolytic sources. Intracerebroventricular (icv) injection of DAB suppressed brain lactate production and decreased hippocampal ATP levels at exhaustion. An icv injection of 4-CIN also decreased hippocampal ATP, resulting in lower endurance capacity. Our findings provide direct evidence that astrocytic glycogen-derived lactate fuels the brain to maintain endurance capacity during exhaustive exercise. Brain ATP levels maintained by glycogen might serve as a possible defense mechanism for neurons in the exhausted state.


Assuntos
Astrócitos/metabolismo , Encéfalo/metabolismo , Fadiga/metabolismo , Glicogênio/metabolismo , Resistência Física/fisiologia , Trifosfato de Adenosina/metabolismo , Animais , Encéfalo/citologia , Glicogenólise , Hipocampo/citologia , Hipocampo/metabolismo , Ácido Láctico/metabolismo , Metabolômica , Neurônios/metabolismo , Ratos
19.
Intern Med ; 58(21): 3179-3183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31685787

RESUMO

Human brucellosis, one of the most common zoonoses worldwide, rarely occurs in Japan, and only a few chronic cases have been reported. We herein report the case of a 39-year-old Japanese woman with chronic human brucellosis, considered a Brucella canis infection, that persisted for 19 years. Her medical history and fever pattern suggested chronic brucellosis, and the diagnosis was made based on the results of a serum tube agglutination test (SAT). After undergoing combination therapy with streptomycin and doxycycline, she achieved symptomatic relief and showed negative SAT results. Even in non-endemic areas, chronic brucellosis is an important differential diagnosis in patients with long-term persistent fatigue or a fever.


Assuntos
Brucelose/diagnóstico , Zoonoses/diagnóstico , Administração Oral , Adulto , Animais , Antibacterianos/administração & dosagem , Brucella canis , Brucelose/tratamento farmacológico , Doença Crônica , Diagnóstico Diferencial , Doxiciclina/administração & dosagem , Quimioterapia Combinada , Fadiga/diagnóstico , Fadiga/microbiologia , Feminino , Febre/diagnóstico , Febre/microbiologia , Humanos , Injeções Intramusculares , Japão , Estreptomicina/administração & dosagem , Zoonoses/tratamento farmacológico
20.
Ophthalmic Physiol Opt ; 39(6): 399-413, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31696537

RESUMO

PURPOSE: The aim was to compare fatigue levels between patients with visual impairment and controls with normal sight and to examine the association between fatigue and vision loss severity. METHODS: A systematic literature search was performed using databases of PubMed, Embase, PsycINFO and Cochrane to identify observational studies with outcomes related to fatigue (e.g. vitality subscale of the Short-Form 36, Fatigue Assessment Scale). A meta-analysis was performed using standardised mean differences (SMDs) and odds ratios (OR) to quantitatively summarise the association between visual impairment and fatigue. Sources of heterogeneity were explored by subgroup and sensitivity analyses. Study quality was assessed with the Newcastle-Ottawa scale. RESULTS: After reviewing 4477 studies, 22 studies with a total of 40 004 participants were included, of which 18 contributed to meta-analysis. Among these, eight were assessed as moderate quality studies and 10 as high quality studies. Pooled analysis involving 2500 patients and 8395 controls showed higher fatigue severity levels (S.M.D. = -0.36, 95% CI -0.50 to -0.22, 14 studies) among visually impaired patients compared to normally sighted controls. This effect size was small and persisted in sensitivity analyses that involved study quality, fatigue assessment tools and visual acuity data. Furthermore, pooled analysis of four studies including 2615 patients and 5438 controls showed a significant association between visual impairment and fatigue (OR = 2.61, 95% CI 1.69 to 4.04). Secondary meta-analysis of four studies showed no significant difference in fatigue severity (S.M.D. = 0.01, 95% CI -0.37 to 0.39) between patients with moderate visual impairment and patients with severe visual impairment or blindness. CONCLUSIONS: Current moderate to high quality evidence suggest that patients with visual impairment experience more severe fatigue symptoms than persons with normal sight. However, a limited number of available studies indicates that fatigue is not associated with severity of vision loss. Future studies are required to determine which factors and underlying mechanisms may explain the association between visual impairment and fatigue. Discussing fatigue at an early stage and developing intervention options for vision-related fatigue should be considered within the field of low vision rehabilitation.


Assuntos
Fadiga/complicações , Estudos Observacionais como Assunto/métodos , Transtornos da Visão/etiologia , Acuidade Visual , Saúde Global , Humanos , Incidência , Transtornos da Visão/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA