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Background: Coronavirusdisease 2019 (COVID‐19) pneumosepsis survivors are at a high risk of developing intensive care unit (ICU)–acquired weakness (ICUAW) because of high incidence of acute respiratory distress syndrome and the common need for prolonged invasive ventilation. It remains unknown whether regular postpneumosepsis physical rehabilitation strategies are suitable for this extraordinary patient category. Methods: We retrospectively compared the physical recovery of COVID‐19 and non‐COVID pneumosepsis ICU survivors during post‐ICU hospitalization, defined as the difference in performance on the Medical Research Council Sum‐Score (MRC‐SS), Chelsea Critical Care Physical Assessment tool (CPAx), and percentage of predicted handgrip strength (POP‐HGS). An analysis of covariance model was built using age, sex, Barthel index, body mass index, admission Acute Physiology And Chronic Health Evaluation II score, adequacy of protein delivery during ICU stay, and ward length of stay as covariates. Results: Thirty‐five COVID‐19 ICU patients could be compared with 21 non‐COVID pneumosepsis ICU survivors. All patients scored ≤48 on the MRC‐SS at ICU discharge, indicating ICUAW. When controlling for covariates, COVID‐19 patients performed worse on all physical assessments upon ICU discharge, but had improved more at hospital discharge on the MRC‐SS (ɳ2 = 0.214, P =.002) and CPAx (ɳ2 = 0.153, P =.011). POP‐HGS remained lower in COVID‐19 patients throughout hospital stay. Conclusion: COVID‐19 ICU survivors are vulnerable to ICUAW, but they show better tendency towards physical rehabilitation than non‐COVID pneumosepsis ICU survivors during the post‐ICU hospitalization period regarding MRC‐SS and CPAx. COVID‐19 ICU patients might benefit from early, more intensive physical therapy. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 37-year-old woman, with non-relevant medical history, presented with fever, asthenia, dysgeusia, anosmia, burning tongue sensation, and dry mouth for three days. It mentions that patient searched for dental tele-assistance due to the worsening of burning sensation in the borders of the tongue and soft palate.

Post-COVID condition is a new and highly debated entity that is still to be outlined in its complexity, especially in the pediatric population. In response to the article by Trapani and colleagues, we report the results of a long-term follow-up conducted in the outpatient clinic of the Pediatric Infectious Diseases Unit on children admitted to our hospital with SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Fibromyalgia may occur due to muscle tension while speaking or singing inaccurately. Symptoms of fibromyalgia are pain, fatigue, alteration in sleep, cognitive dysfunction, anxiety, depression, intestinal disorders, voice, and mood. Women are more affected than men. Voice was evaluated using the GRBAS scale and Dr. Speech software. Perceptually, voice was minimal dysphonia, and acoustically, voice parameters were within normal limits except harmonic–to-noise ratio. [ABSTRACT FROM AUTHOR]

Fatigue has been associated with reductions in daily activity of older people. Summary measures of daily physical activity provide limited understanding of how fatigue affects physical activity behavior. This study examined the hour-by-hour energy expenditure estimated from accelerometry data to provide insight into physical activity behaviors of older people experiencing fatigue. Fatigued participants were matched to ‘not fatigued’ participants by age, sex, and BMI. Each group consisted of 86 people with a mean age 73.8 years (SD 2.0), BMI 26.5 kg⋅m–2 (SD 3.9) and 61% female. The phase-space plot, constructed to express rate of change of average vertical axis counts per hour as a time series, showed fatigued participants deviated from the not fatigued participants during the morning period, when hour-by-hour activity was increasing. Older people who feel fatigued have a different morning activity pattern, which appears to lead to the lower overall levels of physical activity. [ABSTRACT FROM AUTHOR]

Pain is a complex, multidimensional phenomenon and integral component of illness but little is known about its religious construction and interpretation. This article discusses an important yet neglected component of terminal illness which is the religious construction of pain. Eleven hepatitis C Muslim patients admitted to the liver center were recruited for this study. In‐depth interviews helped the identification of dominant themes. The study found that terminal patients construct pain in a religious context and interpret it into religious realms. For them, pain helps to realize their debility and helplessness. They think pain has a transformatory potential and can help them turn to be very strong and brave. The participants also reported having a belief that pain in this world could be compensated in the life hereafter and they will be rewarded with good deeds and bestowed with the Jannah (paradise). The terminal patients strongly influenced by religion and spirituality believed to be experiencing pain as a punishment of their misdeeds. Thus, pain was helping them to normalize their end‐of‐life experiences and ease the terminal stage of their illness. [ABSTRACT FROM AUTHOR]

This article examines how resistance toward capitalism's temporal bullying is performed in contemporary art and activism. It addresses the relationship between creativity, institutions, and empowerment. Building on the conceptual work of Croatian artist Mladen Stilinović (1947–2016), the article explores several aesthetic presentations of resistive temporalities we identify as non-production. The case studies of non-production herein marshaled affirm a performance of resistance that centers discussion of radicality in self-consciously interdependent care networks, ostensibly available to all disabled and nondisabled individuals. This care ethic claps back at the idea of self-optimization and fiduciary endurance amidst economic regimes of exploitation as virtuous. In the place of 'wellness,' this article affirms new directions in care and mutual aid, as premised on queer, crip, and feminist portrayals of disability praxis and pedagogy. [ABSTRACT FROM AUTHOR]

This paper reflects on the qualities of living and learning in digital cultures, the design of digital technologies and the philosophical history that has informed that design. It takes as its critical perspective the field of embodied cognition as it has developed over the last three decades, in concert with emerging neurophysiology and neurocognitive research. From this perspective the paper considers cognitive, neurological and physiological effects that are increasingly becoming noticed in user populations, especially young populations. I call this class of conditions 'sensorimotor debility', to distinguish it from other psychological, social, cultural and political symptoms associated with computer, internet and social media use. [ABSTRACT FROM AUTHOR]

Objective. To study the characteristics of asthenic syndrome and the potential for treating it in the postcovid period. Materials and methods. A continuous sampling method was used to select 129 patients (mean age 49.8 ± 8.9 years) after COVID-19. Study patients were selected at the clinical out-patient and polyclinic facilities in Samara in the period July–August, 2020. All patients signed informed consent. The envelope method was used to randomize patients into two groups: the study group (n = 64) received ethylmethylhydroxypyridine succinate (Neurox) 1 tablet (125 mg) three times daily for four weeks; medications in the reference group (n = 65) did not include any substances of the pharmacological antihypoxant/antioxidant/nootrope groups. Three visits (V) were made: the first (V1) was before inclusion in the study; the second (V2) was at 14 days; the third (V3) was on day 28 from treatment initiation. The dynamics of overall status (weakness, fatigue, concentration of attention, vertigo, headache, sleep impairment) were evaluated on a visual analog scale (VAS); the subjective perception of the severity of asthenia (tiredness, physical and mental fatigue, decreased motivation and activity) was evaluated using the Multidimensional Fatigue Inventory, MFI-20); cognitive functions were assessed using the Mini Mental State Examination (MMSA); and autonomic tone was assessed using the Kérdö index. Results. At the end of the study (V3), statistically significant changes in measures (VAS, MFI-20) were seen only in patients of the study group; the Kérdö Index showed no statistically significant differences. Analysis of MMSE data revealed a decline in cognitive functions in both groups, which may be linked with pseudocognitive deficit due to asthenia. Conclusions. Our studies yielded evidence of a high incidence of asthenic syndrome after COVID-19. Neurox decreased the severity and extent of the symptoms of asthenia. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to analyse the effectiveness and safety of first-line treatment of metastatic colorectal cancer (CRCm) in older patients treated in a tertiary hospital. Material and methods: This was an observational and retrospective study, including patients aged 75 years or older, with CRCm, who received chemotherapy treatment in 2017. The main variables studied were type of treatment, Progression-Free Survival (PFS), Overall Survival (OS), dose reductions, and treatment delays due to adverse events. Results: A total of 59 patients (71.2% men) with a median age of 76 years were enrolled in this study. About 70% presented colon cancer, with the left colon being the most frequent location. They were treated with 9 different schemes, in most cases using polychemotherapy and biological agents. The median PFS and OS was 12 and 30 months, respectively. A total of 23/59 of patients started treatment at doses lower than recommended in the clinical practice guidelines. In terms of safety, 34/59 of patients had at least one dose reduction, and 30/59 suffered one treatment delay. The most frequent adverse reactions were asthenia, peripheral neuropathy, diarrhoea, and palmoplantar erythrodysesthesia. Conclusion: Our patients presented baseline clinical characteristics similar to the general adult population, with no tumour characteristics associated with advanced age. The efficacy and toxicity were similar to those in the clinical trials, although our patients had more dose reductions. Considering the heterogeneity of patients and in the absence of clinical trials in the older population, real-life studies can be very useful. [ABSTRACT FROM AUTHOR]

Hypertrophic osteoarthropathy (OAH) is a primary or secondary clini coradiological entity. OAH is most often secondary to pulmonary neoplasia. We report a rare case of OAH secondary to thymic carcinoma. A 60-year-old Men with no pathological history, he was a nonsmoker. He has been suffering from distal polyarthritis for 2 months, in a context of asthenia and weight loss. The clinical examination revealed a digital clubbing, synovitis of the knees and ankles bilateral and symmetrical. His balance sheet showed periosteal appositions of the long bones of the upper and lower limbs, without pinching or erosion, and an inflammatory syndrome. The chest CT SCAN shows a heterogeneous tissue mass of the thymic compartment, the biopsy has concluded that there is undifferentiated thymic carcinoma. The occurrence of OAH during thymic carcinoma may be a sign of poor prognosis, given the possible relationship between VEGF and OAH. [ABSTRACT FROM AUTHOR]

Objective: to describe the clinical profile and outcomes of patients diagnosed with COVID-19 admitted to a private hospital in southern Brazil. Method: descriptive study, conducted with 110 patients with COVID-19 who required hospitalization between March and May 2020. Sociodemographic data, clinical profile, signs and symptoms, and clinical outcomes were collected. Descriptive analysis was adopted for data interpretation. Results: male predominated (64.5%). Prevalent comorbidity: Systemic Arterial Hypertension (45.5%). Signs and symptoms with greater prominence: cough (53.6%) and dyspnea (48.2%). Clinical outcomes evidenced: chest tomography with ground-glass opacities (98.2%), supplementation with oxygen therapy (86.4%), referral to the Hospitalization Unit (90.9%). Observed complications: cardiac arrhythmias (18.2%) and hypoxemia (18.2%). Predominant outcome was improved discharge (90%). Conclusion: the description of the clinical profile and outcome of patients with COVID-19 will provide the direction of care with care flows and protocols that guarantee quality of care and safety in clinical practice. [ABSTRACT FROM AUTHOR]

A 6-year-old, male Arabian crossbred horse was necropsied after a 10 day history of loss of appetite, debility and weight loss. Gross and histologic examination was consistent with purulent papillitis due to Streptococcus infantarius subsp. infantarius. The isolate was sensitive to all the antibiotics tested. [ABSTRACT FROM AUTHOR]

This article endeavours to understand the strenuous circumstances which caused neurasthenia and nervous debility in Canadian nursing sisters during the First World War. By examining the treatment they received for their condition at the Canadian Red Cross X Special Hospital and at Northwood Hospital for Sick Sisters in Buxton, this article also explores how Canadian medical authorities handled the nurses' treatment and momentarily challenged previous conceptions concerning mental illness in women. [ABSTRACT FROM AUTHOR]

Introduction: The impact of chronic asthenia after thyroidectomy has been evaluated in two previous studies comparing total thyroidectomy and hemithyroidectomy. We compared its impact on patients undergoing thyroidectomy, parathyroidectomy for primary hyperparathyroidism, and cholecystectomy. Methods: Patients recruited for surgery (233 consecutive total thyroidectomies for non-toxic multinodular goiter, Group I, 43 consecutive parathyroidectomies for primary hyperparathyroidism, group II and a sample of 43 laparoscopic cholecystectomies, group III) were compared at three times: pre-operative, 6 months after surgery, 1 year after surgery. A brief fatigue inventory (BFI) was administered to assess asthenia. We excluded intermediate or high-risk thyroid carcinomas, Grave's disease, obese patients, secondary and tertiary hyperparathyroidism, vitamin D deficiency, and acute cholecystitis. In the postoperative period, patients who had undergone complications of each surgical procedure were also excluded. Demographics, smoking, alcohol abuse, chronic diseases (renal, cardiac, pulmonary, hepatic, and diabetes mellitus), anxiety and depression were noted. Results: In Group I the significant increase of asthenia during the three periods of detection (p < 0.001) was confirmed. Renal failure further increased the risk of asthenia. In Group II, asthenia after 6 months and 1 year after surgery decreased significantly (p < 0.001). In Group III, the variations in BFI during the three periods were not significant. Conclusions: Asthenia is a frequent sequela of total thyroidectomy, also in comparison with other types of surgery. Patients undergoing thyroidectomy must be informed of the possible implications of surgery, which should be calibrated on the strict application of guidelines. [ABSTRACT FROM AUTHOR]

An ethnobotanical survey was conducted among herbalists in the north-central region of Morocco using a questionnaire in order to highlight knowledge and know-how and to establish an inventory of herbal remedies used in the treatment of diseases common in the region and rarely cited in the bibliography: in this case, it is insomnia, asthenia, and oral-gum infections. The results showed that 120 herbalists were interviewed in different areas of the Fez-Meknes region, about 86 species were cited and grouped into 60 families (47 plants to treat asthenia, 25 to treat insomnia, and 21 to treat oral and gum infections). The reported plants have been identified and presented with the binomial name, family, part used, and method of preparation. In addition, the versatility was observed in several plants, indicating that the same plant could be used to treat conditions of different groups. Herbalists are people of both sexes belonging to different age groups and have different socioeconomic and intellectual levels. Eighty percent of surveyed herbalists are willing to provide us information about plants in the studied area. The most cited plants for treating these diseases are Lavandula dentata, Matricaria chamomilla, Rosmarinus officinalis, Allium cepa, Origanum vulgare, Origanum majorana, Marrubium vulgare, Lepidium sativum, and Ocimum basilicum. The Lamiaceae are the most quoted family. The leaves are the most commonly used organs. Infusion is the most common form of preparation. The results of this ethnobotanical study could constitute an important source of information and databases for further research in the fields of phytochemistry and pharmacology in order to find new bioactive molecules. In addition, this document can be used in the protection of indigenous knowledge. [ABSTRACT FROM AUTHOR]

Coronary artery bypass graft (CABG) is known to be one of the most important surgical methods for treating coronary heart disease (CHD) which significantly reduces mortality and improves the quality of life of patients. In most cases, surgical intervention is a serious lifethreatening event and also a strong stress factor that affects the patients mental state. For this reason, there is an urgent need for psychological support for patients with CHD who are preparing for CABG. Therefore, when developing rehabilitation programmes and optimising psychodiagnostic and psychocorrectional measures, it is very important to study the psychoemotional characteristics of patients with CHD prior to CABG surgery. The objective of the present research was to study the dynamics of psychoemotional characteristics (including manifestations of asthenia, anxiety and psychopathological symptoms) in the patients with CHD during their stay in the cardiology hospital prior to CABG surgery. The study used a clinical-psychological method and an experimentalpsychological method, including the Scale of Asthenic State (SAS), Integrative Anxiety Test (IAT), Symptom Check List-90-Revised (SCL-90-R), and the Big Five Personality Test. A comparative study of the asthenic state in the patients with CHD before and after myocardial revascularisation during inpatient treatment revealed the presence of a more pronounced asthenic component in the postoperative period as compared with the results obtained at the preoperative stage. The patients with CHD prior to CABG during inpatient treatment had a higher level of anxiety as compared with the postoperative stage, especially regarding the general level of state anxiety, including emotional discomfort and social defence reactions. In the postoperative period, a higher rate of the asthenic component was observed in the structure of state anxiety. A comparative study of the severity of psychopathological symptoms in the patients with CHD prior to CABG surgery and during the postoperative period recorded more intense manifestations of anxiety, obsessiveness and compulsiveness as well as paranoid tendencies before the operation. In the structure of personal characteristics of the patients with CHD during their stay in the cardiology hospital prior to CABG surgery, the lowest indicators, on average, were Agreeableness and Conscientiousness. The results obtained are crucial for planning psychological intervention for patients with CHD.

Introduction: Tivozanib is a potent and selective tyrosine kinase inhibitor of vascular endothelial growth factor receptor 1 (VEGFR-1), VEGFR-2, and VEGFR-3, recently approved in Europe for the first-line treatment of metastatic renal cell carcinoma (mRCC). Methods: Retrospective analysis of safety and activity of tivozanib administered at 1.34 mg daily (3 weeks on, 1 week off) within a compassionate-use program to patients with mRCC with no prior systemic treatment in Italy. Results: From August 2018 to April 2019, 64 patients have started tivozanib in 9 oncology units. The median age was 67.5 years (range 40–85), 62.5% males. According to International Metastatic Renal Cell Carcinoma Database Consortium criteria, 27.1% of patients were good prognosis, 57.6% intermediate, and 15.3% poor. Primary tumor had been removed in 71.9% of patients. Histology was clear cell 89%, papillary 4.7%, and unclassified 6.3%. The response rate was 34.4%, stable disease 40.6%, and progression 15.6%. Grade 3–4 toxicities were 7.8% hypertension, 4.7% anemia, 3.1% mucositis, 3.1% asthenia, 1.6% diarrhea, 1.6% anorexia, 1.6% worsening of renal function, and 3.1% cardiac events. Dose reduction to 0.89 mg was applied to 17.2% of patients, and the discontinuation rate due to toxicity was 5.8%. Median progression-free survival was 12.4 months, with 68.7% of patients alive at 12 months. The developing of hypertension predicted increased progression-free survival at multivariate analysis (HR, 0.128; 95% CI, 0.03–0.59; p = 0.008). Conclusions: Tivozanib showed good activity and favorable safety profile in a real-world cohort of unselected patients with mRCC. Predictive biomarkers of response to antiangiogenic therapy are urgently needed in order to identify RCC patients who could still receive a monotherapy with VEGFR inhibitors in the first line. [ABSTRACT FROM AUTHOR]

The medical profession's increasing acceptance of "physician aid-in-dying" indicates the ascendancy of what we call the provider-of-services model for medicine, in which medical "providers" offer services to help patients maximize their "well-being" according to the wishes of the patient. This model contrasts with and contradicts what we call the Way of Medicine, in which medicine is a moral practice oriented to the patient's health. A steadfast refusal intentionally to harm or kill is a touchstone of the Way of Medicine, one unambiguously affirmed by Christians through the centuries. Moreover, physician aid-in-dying contradicts one of the distinctive contributions that the Christian era brought to medicine, namely, a taken-for-granted solidarity between medical practitioners and those suffering illness and disability. Insofar as medical practitioners cooperate in aid-in-dying, they contradict this solidarity and undermine the trust that patients need to allow themselves to be cared for by physicians when they are sick and debilitated. [ABSTRACT FROM AUTHOR]

One challenge in providing an adequate definition of physical disability is that of unifying the heterogeneous bodily conditions that count as disabilities. We examine recent proposals by Elizabeth Barnes [2016], and Dana Howard and Sean Aas [2018], and show how this debate has reached an impasse. Barnes's account struggles to deliver principled unification of the category of disability, whilst Howard and Aas's account risks inappropriately sidelining the body. We argue that this impasse can be broken by using a novel concept—marginalised functioning. Marginalised functioning concerns the relationship between a person's bodily capacities and their social world—specifically, their ability to function in line with the default norms about how people can typically physically function that influence the structuring of social space. We argue that attending to marginalised functioning allows us to develop, not one, but three different models of disability, all of which—whilst having different strengths and weaknesses—unify the category of disability without sidelining the body. [ABSTRACT FROM AUTHOR]

To examine possible differences in physical match performance and the injury occurrence before and after the COVID-19 induced interruption of the 2019/2020 season of the German Bundesliga. Due to the interruption, matches and soccer-specific training were suspended for nine weeks, matches after the resumption of play occurred congested, and the playing situation changed, regarding, e.g., an increase to five substitutions. For this purpose, the 25 match-days before (pre) and the 9 match-days after (post) the COVID-19 induced interruption were examined regarding total distance, sprinting distance, average peak velocity, high-intensity distance, and injury occurrence. Average peak velocity increased slightly for the comparison of pre and post with a small effect size (MD = 0.28 km/h, 95% CI: 0.11–0.45, p < 0.01, ES = 0.30, 95% CI: 0.12–0.48). There were no relevant differences in total distance, sprinting distance, high-intensity distance, and injury occurrence (0.11 ≤ p ≤ 0.82; 0.02≤ ES≤0.15). In terms of physical match performance and injury occurence results suggest the opportunity to recover and work on individual physical weaknesses during the interruption alongside with an increased number of substitutions was sufficient to compensate for the short soccer-specific preparation phase before the commencement of matches and the congested match schedule after the COVID-19 break. [ABSTRACT FROM AUTHOR]

We performed a prospective cohort study of 311 outpatients with non-severe COVID-19 (187 women, median age 39 years). Of the 214 (68.8%) who completed the 6-week follow-up questionnaire, 115 (53.7%) had recovered. Others mostly reported dyspnea (n = 86, 40.2%), weight loss (n = 83, 38.8%), sleep disorders (n = 68, 31.8%), and anxiety (n = 56, 26.2%). Of those who developed ageusia and anosmia, these symptoms were still present at week 6 in, respectively, 11/111 (9.9%) and 19/114 (16.7%). Chest CT scan and lung function tests found no explanation in the most disabled patients (n = 23). This study confirms the high prevalence of persistent symptoms after non-severe COVID-19. [ABSTRACT FROM AUTHOR]

The objectives of this study were to describe the anatomy, histology, and ultrastructure of the equine filum terminale (FT) and to describe the FT in hereditary equine regional dermal asthenia (HERDA), a model of human Ehlers-Danlos syndromes (EDS). Those humans suffer from tethered cord syndrome (TCS) caused by an abnormally structured FT wherein its attachment at the base of the vertebral column leads to long-term stretch-induced injury to the spinal cord. The pathophysiology of TCS in EDS is poorly understood, and there is a need for an animal model of the condition. Histopathologic and ultrastructural examinations were performed on FT from HERDA (n = 4) and control horses (n = 5) and were compared to FT from human TCS patients with and without EDS. Adipose, fibrous tissue, and neuronal elements were assessed. CD3 and CD20 immunohistochemistry was performed to clarify cell types (HERDA n = 2; control n = 5). Collagen fibrils were assessed in cross-section for fibril diameter and shape, and in longitudinal section for fibril disorganization, swelling, and fragmentation. The equine and human FT were similar, with both containing fibrous tissue, ependyma, neuropil, and nerve twigs. Hypervascularity was observed in both HERDA horses and human EDS-TCS patients and was not observed in equine or human controls. Moderate to severe abnormalities in collagen fibril orientation and architecture were observed in all HERDA horses and were similar to those observed in human EDS-TCS patients. [ABSTRACT FROM AUTHOR]

Background: The increase in the survival of oncology patients include multiple side effects as cancer-related asthenia and dyspnea, which represents a serious health problem. An implementation of the conventional clinical practice, developed through multimodal physical exercise and functional rehabilitation program intervention, may be useful in controlling dyspnoea. This study aims to evaluate the effects of a multimodal exercise and functional rehabilitation program on fatigue, pain, functional capacity, and quality of life in cancer patients with cancer-related asthenia. Methods: This is a protocol for an experimental, prospective, randomised study using a parallel, fixed assignment scheme, with an experimental group and a control group in patients from the oncology hospitalisation unit at the Salamanca University Hospital Complex in Spain, using consecutive sampling to select 50 participants with oncological asthenia who are hospitalised at the time of inclusion. After the baseline evaluation, the participants will be randomised into two groups. Both groups will receive standard clinical practice care and the normal health education program at discharge, but in addition, the participants assigned to the experimental group will also complete a multimodal exercise and functional rehabilitation program lasting one month. The primary outcomes will be basic activities of daily living (Barthel Index) and degree of asthenia (FACT-An scale). Additionally, physical performance will be evaluated with the Short Physical Performance Battery (SPPB), as will the attention and executive functions (Trail-Making Test), fear/avoidance of movement (TAMPA scale), pain (VAS scale), and body composition (waist, hip, brachial, thigh, wrist, and ankle circumferences). Discussion: The results of this study may be translated to clinical practice, incorporating a specific autonomy recovery programme into comprehensive rehabilitation programmes of care for cancer patients with asthenia. The current study addresses to improve the conventional clinical practice by proposing a multimodal physical exercise and functional rehabilitation program intervention, which will be implemented by an interdisciplinary team, to try to improve the autonomy of cancer patients with cancer-related asthenia. Trial registration: ClinicalTrials.gov; ID: NCT04761289. (February 18, 2021). https://clinicaltrials.gov/ct2/show/ NCT04761289. [ABSTRACT FROM AUTHOR]

Background: We report a pediatric patient presenting in good general condition despite a hemoglobin value of 1,9 g/dL, which is normally regarded as life-threatening. Case presentation: An African 5 years-old girl presented to our Emergency Department (ED) for worsening asthenia, within a clinical picture of good general condition. The hemoglobin value at admission was 1,9 g/dL. The subsequent diagnostic-therapeutic pathway highlighted the presence of two different causes, both well known to be responsible for chronic anemia (with slow reduction of hemoglobin values): iron deficiency anemia (IDA) due to a very low dietary intake of iron-rich foods, and homozygous sickle cell disease (HbSS). She received transfusions of packed red blood cells (overall 15 ml/kg) and subsequently intravenous iron preparations (total amount 200 mg) followed by oral iron supplements. The Hb value at discharge, 10 days after the admission, was 9.8 g/dL. Conclusions: When approaching a picture of severe anemia, we suggest pediatricians take into consideration clinical conditions rather than laboratory values and to take advantage of detailed anamnestic data in order to make the diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Cytokines have been the mainstay of treatment in metastatic renal cell cancer (mRCC) for decades before the introduction of tyrosine kinase inhibitors (TKIs), which dramatically changed the therapeutic landscape in these patients. This observational study was designed to evaluate use of TKIs in the treatment of cytokine-intolerant mRCC patients. Methods: A total of 151 cytokine-intolerant mRCC patients who were treated with TKIs (sunitinib, pazopanib and sorafenib) were enrolled in this prospective, non-interventional, multi-center observational study at 16 oncology centers across Turkey. Mean (SD) age was 61.3 (11.1) years and 74.8% were males. Data on duration of TKI treatment was the primary outcome measure. Additionally, overall response rate (ORR), progression free survival (PFS), overall survival (OS) and safety data were recorded. Results: Median duration of treatment was 8.2 months at a median follow up of 17.9 months. ORR and disease control rate were 12.5% and 70.8%, respectively. Median PFS and OS were 7.5 months (95%CI: 6.4–10.4) and 27.3 months (95%CI: 17.6–27.3) with no significant difference among three TKI agents in terms of treatment duration, ORR, PFS and OS. The most common adverse events excluding progression-which was the protocol requirement were diarrhea (13.6%), asthenia (13.6%) and hand-foot syndrome (12.6%). Dose modifications were required in 30.5% of the patients and 15% discontinued TKIs because of toxicity. Conclusions: Our findings confirm the efficacy and safety profile of TKIs in the first-line treatment of mRCC patients intolerant to cytokine treatment. There was no significant difference among three TKI agents in terms of treatment duration, ORR, PFS and OS. Trial registration: TURCOS ClinicalTrials.gov Identifier: NCT01585974. Registered April 25, 2012. [ABSTRACT FROM AUTHOR]

The topic of aging has been somewhat overlooked in disability studies, perhaps owing to the adage that "everyone is disabled if they live long enough." If the life course is simply a state of debility, why create a distinct category for bodily and sensory impairment? Disability in old age, I argue, is not a mark of precarity but of capability. The work of writers and artists who continue to experiment formally while becoming increasingly disabled in later years (Beethoven, Henry James, Merce Cunningham) offers an opportunity to complicate "late style" as developed by Theodor Adorno and Edward Said and account for the role of complex embodiment in the production of new work. Finally, I consider Samuel Beckett, whose characters are often aging and disabled and for whom bodily and sensory decline are central to their ability to "go on." [ABSTRACT FROM AUTHOR]

A 9-year-old male captive savannah monitor (Varanus exanthematicus) with a history of general debility was submitted for necropsy. Grossly, there were multiple white masses in the colon, mesorchium and tracheal adventitia. Histologically, the lesions were composed of epithelioid to spindloid neoplastic cells arranged in sheets to interlacing and interwoven bundles, and separated by abundant myxoid material or extensive stromal hyalinization and fibrosis with occasional chondroid metaplasia. Perivascular infiltration of epithelioid neoplastic cells was occasionally seen. Neoplastic cells were immunopositive for alpha-smooth muscle actin, melan-A and S100. The unique histological features and concurrent myogenic and melanocytic immunophenotypes suggest a malignant perivascular epithelioid cell tumour. To our knowledge, this is the first report of perivascular epithelioid cell tumours in a non-human species. [ABSTRACT FROM AUTHOR]

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Abstract Cancer cachexia is a multifactorial syndrome characterized by a progressive loss of skeletal muscle mass, along with adipose tissue wasting, systemic inflammation and other metabolic abnormalities leading to functional impairment. Cancer cachexia has long been recognized as a direct cause of complications in cancer patients, reducing quality of life and worsening disease outcomes. Some related conditions, like sarcopenia (age‐related muscle wasting), anorexia (appetite loss) and asthenia (reduced muscular strength and fatigue), share some key features with cancer cachexia, such as weakness and systemic inflammation. Understanding the interplay and the differences between these conditions is critical to advance basic and translational research in this field, improving the accuracy of diagnosis and contributing to finally achieve effective therapies for affected patients.

The article is devoted to the analysis of various pathogenetic mechanisms involved in the formation of chronic brain ischemia. The authors discuss current trends in society, leading to a wide spread of cerebrovascular diseases: an increase in life expectancy and a constantly increasing level of psychosocial stresses. The paper considers the variety of clinical manifestations, course options, the pace of development of this pathology, diagnostic and therapeutic difficulties encountered by doctors treating this category of patients. Particular attention is paid to symptoms that prevent a full course of treatment and prevention of chronic cerebral ischemia, such as asthenia and impaired statolocomotor function. The leading pathogenetic mechanisms that play a role in the formation of these syndromes are discussed. Various approaches to the treatment of this pathological condition are considered. The possibility of using drugs with a multimodal effect is discussed. An analysis of a clinical case involving a patient with a long history of chronic brain ischemia is presented. The main factors that are obstacles to a full pathogenetically directed treatment are identified and ways to solve this therapeutic problem are given. The authors conclude that it is necessary to formulate a wellthought- out therapy strategy for this pathological condition, including timely, well-considered use of drugs with a neurotrophic, neuromodulating effect, which allows further measures, including non-pharmacological approaches. Particular attention is paid to the role of social support and physical activity for the prevention of cerebrovascular diseases.

Background: Available evidence from randomized clinical trials is contrasting and definitely inconclusive in determining whether or not CoQ 10 dietary supplementation is advisable in patients with statin intolerance or poor statin tolerability. Methods: This randomized, double-blind, placebo-controlled clinical study aimed at investigating the effect of chronic dietary supplementation with coenzyme Q 10 (CoQ 10 ) phytosome on physical performance in older adults with a ≥3-month history of statin-associated asthenia. The study's participants were randomized to either a placebo or 300 mg daily CoQ 10 phytosome (equivalent to 60 mg CoQ 10 ; Ubiqsome ® , Indena SpA, Milan, Italy). Asthenia, handgrip strength (HGs), 2-min step test (2MST), and 1-min sit-to-stand (STS) repetitions were assessed at baseline and at 8-week follow-up. Results : After the first 4 weeks of dietary supplementation, individuals taking CoQ10 phytosome showed a greater improvement in asthenia compared to the placebo group ( p < 0.05). Even more significantly, at 8-week follow-up, participants receiving CoQ10 showed substantial improvements in asthenia (-30.0 ± 20.0%), HGS (+29.8 ± 3.6%), 2MST (+11.1 ± 1.8%), and 1-min STS repetitions (+36.4 ± 3.9%) compared to both baseline and placebo ( p < 0.05). Conclusions : According to our findings, chronic dietary supplementation with CoQ 10 phytosome significantly enhances physical performance in older adults with statin-associated asthenia. This could have relevant implications for improving the compliance of older adults with statin treatment., Competing Interests: The authors declare no conflicts of interest.