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Introduction: Few studies have evaluated the route of nutritional therapy in patients with head trauma. Objective: We aimed at investigating whether early enteral (EN) or parenteral nutrition (TPN) may differ in protein/ calorie supply, serum glucose modifications, and acute phase response in patients with traumatic brain injury (TBI). Methods: Twenty two patients with moderate TBI (Glasgow score between 9-12) were randomized to receive isocaloric and isonitrogeneous either EN (n = 12) or TPN (n = 10). The daily amount of calories and nitrogen (N) supplied, the nitrogen balance, and the daily serum level of glucose, C-reactive protein, and albumin were collected for 5 consecutive days. Clinical endpoints as length of stay and mortality were also compared. Results: Mortality was 9.1% (two cases) with one case in each group. A progressive caloric deficit occurred in both groups (p = 0.001) without difference between them. The mean serum glucose level in TNP patients (134.4, 95% CI = 122.6 to 146.2 mg/dl) was significantly higher than in the EN group (102,4; 95% CI 91.6 to 113.2 mg/dL) (p < 0.001). There was a trend (p = 0.06) of 24 h urinary N loss to be greater in TPN group which received higher amounts of N than the NE group (p < 0.05). However, nitrogen balance was similar in the two groups. There was no difference in either the clinical outcome variables or the acute phase response. Conclusion: Both routes were able to supply increasing provision of calories to brain injured patients. TPN provided significantly greater amount of nitrogen but losses were also greater. Nitrogen balance was similar with both types of therapy. Parenteral compared to enteral nutrition lead to greater hyperglycemia. There was no influence of the route in both the early inflammatory response and clinical outcome. [ABSTRACT FROM AUTHOR]

Após a caracterização dos adultos portadores de estoma intestinal cadastrados no Programa de Educação e Apoio ao Estomizado do Município de Ribeirão Preto -- SP, realizou-se um estudo descritivo de avaliação de resultados do processo de demarcação do estoma intestinal com análise das complicações tardias. A amostra ficou circunscrita a 50 sujeitos, sendo 76% portadores de colostomia e 34% portadores de ileostomias. Em relação à localização do estoma 12% não demonstraram as especificações científicas indicadas para a distância da linha da cintura, 2% para a crista ilíaca e 2% para a cicatriz cirúrgica. As complicações tardias aparecem em 44%, sendo 28% hérnia periestomal, 16% prolapso de estomia e 4% hiperemia de pele.

Background: Patients who were incarcerated were disproportionately affected by COVID-19 compared with the general public. Furthermore, the impact of multidisciplinary rehabilitation assessments and interventions on the outcomes of patients admitted to the hospital with COVID-19 is limited., Objective: We aimed to compare the functional outcomes of oral intake, mobility, and activity between inmates and noninmates diagnosed with COVID-19 and examine the relationships among these functional measures and discharge destination., Methods: A retrospective analysis was performed on patients admitted to the hospital for COVID-19 at a large academic medical center. Scores on functional measures including the Functional Oral Intake Scale and Activity Measure for Postacute Care (AM-PAC) were collected and compared between inmates and noninmates. Binary logistic regression models were used to evaluate the odds of whether patients were discharged to the same place they were admitted from and whether patients were being discharged with a total oral diet with no restrictions. Independent variables were considered significant if the 95% CIs of the odds ratios (ORs) did not include 1.0., Results: A total of 83 patients (inmates: n=38; noninmates: n=45) were included in the final analysis. There were no differences between inmates and noninmates in the initial (P=.39) and final Functional Oral Intake Scale scores (P=.35) or in the initial (P=.06 and P=.46), final (P=.43 and P=.79), or change scores (P=.97 and P=.45) on the AM-PAC mobility and activity subscales, respectively. When examining separate regression models using AM-PAC mobility or AM-PAC activity scores as independent variables, greater age upon admission decreased the odds (OR 0.922, 95% CI 0.875-0.972 and OR 0.918, 95% CI 0.871-0.968) of patients being discharged with a total oral diet with no restrictions. The following factors increased the odds of patients being discharged to the same place they were admitted from: being an inmate (OR 5.285, 95% CI 1.334-20.931 and OR 6.083, 95% CI 1.548-23.912), "Other" race (OR 7.596, 95% CI 1.203-47.968 and OR 8.515, 95% CI 1.311-55.291), and female sex (OR 4.671, 95% CI 1.086-20.092 and OR 4.977, 95% CI 1.146-21.615)., Conclusions: The results of this study provide an opportunity to learn how functional measures may be used to better understand discharge outcomes in both inmate and noninmate patients admitted to the hospital with COVID-19 during the initial period of the pandemic., (©Matthew S Briggs, Erin Shevawn Kolbus, Kevin Michael Patterson, Lindsay Elizabeth Harmon-Matthews, Shana McGrath, Catherine C Quatman-Yates, Cristiane Meirelles, Marka Jean Salsberry. Originally published in JMIR Rehabilitation and Assistive Technology (https://rehab.jmir.org), 27.06.2023.)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in multiorgan damage primarily mediated by viral infiltration via angiotensin-converting enzyme-2 receptors on the surface of cells. A primary symptom for many patients is exertional dyspnoea which may persist even beyond recovery from the viral infection. Respiratory muscle (RM) performance was hypothesised as a contributing factor to the severity of coronavirus disease 2019 (COVID-19) symptoms, such as dyspnoea, and outcomes. This was attributed to similarities between patient populations at elevated risk for severe COVID-19 symptoms and those with a greater likelihood of baseline RM weakness and the effects of prolonged mechanical ventilation. More recent evidence suggests that SARS-CoV-2 infection itself may cause damage to the RM, and many patients who have recovered report persistent dyspnoea despite having mild cases, normal lung function or undamaged lung parenchyma. These more recent findings suggest that the role of RM in the persistent dyspnoea due to COVID-19 may be more substantial than originally hypothesised. Therefore, screening for RM weakness and providing interventions to improve RM performance appears to be important for patients with COVID-19. This article will review the impact of SARS-CoV-2 infection on RM performance and provide clinical recommendations for screening RM performance and treatment interventions., Competing Interests: Conflict of interest: The authors have nothing to disclose, (Copyright ©The authors 2022.)

Background: Impaired postural balance is a common symptom after stroke and a common cause of falling. Most common daily tasks use arm and hand movements. Impairment in an upper extremity is a common stroke symptom, affecting 50-80% in the acute phase after stroke, and 40-50% in the sub-acute phase. The impact of leg function on postural balance has been investigated in several studies, but few have stressed the importance of arm function on postural balance. Objective: To explore whether there is any association between arm function and postural balance after stroke. Method: A cross sectional study where 121 adults (mean age: 70 ± 12.3 years, 72 men) from two different data sources, Gothenburg Very Early Supported Discharge (GOTVED), and a study by Carvalho et al. were merged. Time for assessments ranged from 1 to 13 years when the patients were in the chronic phase. The dependent variables were Berg Balance scale (BBS) and Time Up and Go (TUG) both dichotomized to "impaired postural balance" and "not impaired postural balance." As independent variables, the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) scale was used. The FMA-UE was presented with the total score. Results: The motor function in the arm affected after stroke onset correlated with postural balance both measured with the BBS (0.321, p < 0.001 ) and the TUG (-0.315, p = 0.001 ) . Having impaired motor function in the arm was significantly associated with impaired postural balance assessed with the BBS with OR = 0.879 (CI 0.826-0.934, p < 0.001). Regression analysis with the TUG showed the same result, OR = 0.868 (CI 0.813-0.927, p < 0.001) for FM-UE. Conclusion: The motor function of the affected arm was significantly associated with impaired postural balance post stroke, as assessed by BBS or TUG. It could be of clinical importance to be aware of the fact that not only lower extremity impairment, but also arm function can have an impact on postural balance in a late stage after stroke. Trial Registration: VGFOUGSB-669501.

Objectives: Myelopathy is a well-established long-term clinical manifestation of HTLV-1 infection. Besides motor dysfunction, cognitive impairment may be another consequence of HTLV-1 infection. Moreover, inflammatory markers may be associated with cognitive impairment in these patients. The present study compared the cognitive performance of HAM/TSP patients with healthy controls and investigated the associations between cognitive performance, proviral load and blood inflammatory markers., Methods: Eighty-three patients fulfilling diagnostic criteria for HAM/TSP were submitted to a comprehensive clinical, cognitive and functional evaluation, brain magnetic resonance imaging and determination of levels of IL-1β, IL-6, TNF-α, immunoglobulins and HTLV-1 proviral load in blood and cerebrospinal fluid. The control group was composed of 88 cognitively healthy subjects, matched for age, sex and educational level., Results: Compared to healthy subjects, HAM/TSP patients displayed significant global cognitive impairment and executive function deficits. HAM/TSP cognitive impairment was significantly associated with altered levels of IgM, IgG, IL-6 and TNF-α in blood. There was no association between HAM/TSP cognitive impairment and HTLV-1 proviral load., Conclusions: This study suggests cognitive impairment may be a long-term clinical manifestation of HTLV-1 infection, which seems to be linked to the persistent inflammatory activity that is found in the disease., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To explore the relationship between self-reporting and physical measures and compare self-reported physical activity (PA) levels in persons who have had a stroke with self-reported PA levels in a control population., Design: Cross-sectional assessment of a convenience sample of survivors of a stroke living in the community and a population-based sample from the same community., Setting: University hospital., Participants: Seventy persons (48 men and 22 women; average age, 60 years) who had a stroke a mean of 6 years earlier and 141 persons (70 men and 71 women; average age, 59 years) who served as control subjects., Main Outcome Measurements: The Physical Activity Scale for the Elderly (PASE) was used, and self-selected and maximum walking speeds were measured. Motor function after stroke was assessed with the Fugl-Meyer Assessment., Results: The median Fugl-Meyer score for motor function in the leg was 29. Mean self-selected and maximum walking speeds after having a stroke were 1.0 m/s and 1.3 m/s, corresponding to 72% and 65% of control values. A regression model with PASE as the dependent variable and age and walking speed as independent variables explained 29% (P < .001) of the variation in the stroke group. For the control group, age and self-selected walking speed explained 8% of the variation (P < .01). The mean PASE score in the stroke group was 119, compared with 161 in the control group., Conclusion: Persons who have experienced a stroke and live in the community are less physically active than the population of the same age who have not had a stroke. However, it appears that factors other than motor impairment have an impact on a person's PA level, because only a low association was found between PA level and motor function, with a large dispersion in PA levels in persons with a history of stroke who were physically well recovered., (Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the prevalence of dysmenorrhea, limitations in daily living and health care use due to menstrual pain., Material and Methods: Observational transversal study of 274 adolescents and young adults (age ≤ 26) who had menstruated in the six months prior to the study, assisted at a Primary Health Care Center. Data were obtained by a 24-item anonymous questionnaire, which included questions about socio-demographic variables, menstrual cycle, presence, duration, severity, treatment and limitations of dysmenorrhea., Results: One hundred and seventy-two (62.8%) subjects experienced menstrual pain. Of these, 65.7% reported having limitations in their daily activities due to dysmenorrhea. The prevalence of limitations in daily living was influenced by the presence of additional symptoms (r=0.331; p <0.001), pain intensity (r=0.281; p <0.001) and pain duration (r=0.172; p=0.027). The most commonly mentioned limitation was anxiety/depression (42.5%). Fourteen of the subjects reported missing school or work due to dysmenorrhea. A total of 48 respondents sought medical help and 135 reported using therapeutic measures to ease their pain. The most common treatments reported for pain treatment included NSAID's (38.5%) and oral pills (37.0%). The existence of additional symptoms (r=0.247; p=0.001) and the intensity of pain (r=0.160; p=0.039) led to the search for health care., Conclusions: Dysmenorrhea is highly prevalent among this sample of adolescents and young adults and is related to absenteeism. Thus, health care providers should regularly screen for dysmenorrhea and offer appropriate treatment.

Introduction: Few studies have evaluated the route of nutritional therapy in patients with head trauma., Objective: We aimed at investigating whether early enteral (EN) or parenteral nutrition (TPN) may differ in protein/ calorie supply, serum glucose modifications, and acute phase response in patients with traumatic brain injury (TBI)., Methods: Twenty two patients with moderate TBI (Glasgow score between 9-12) were randomized to receive isocaloric and isonitrogeneous either EN (n=12) or TPN (n=10). The daily amount of calories and nitrogen (N) supplied, the nitrogen balance, and the daily serum level of glucose, C-reactive protein, and albumin were collected for 5 consecutive days. Clinical endpoints as length of stay and mortality were also compared., Results: Mortality was 9.1% (two cases) with one case in each group. A progressive caloric deficit occurred in both groups (p=0.001) without difference between them. The mean serum glucose level in TNP patients (134.4, 95% CI=122.6 to 146.2 mg/dl) was significantly higher than in the EN group (102,4; 95% CI 91.6 to 113.2 mg/dL) (p<0.001). There was a trend (p=0.06) of 24 h urinary N loss to be greater in TPN group which received higher amounts of N than the NE group (p<0.05). However, nitrogen balance was similar in the two groups. There was no difference in either the clinical outcome variables or the acute phase response., Conclusion: Both routes were able to supply increasing provision of calories to brain injured patients. TPN provided significantly greater amount of nitrogen but losses were also greater. Nitrogen balance was similar with both types of therapy. Parenteral compared to enteral nutrition lead to greater hyperglycemia. There was no influence of the route in both the early inflammatory response and clinical outcome.

Aim: Weight reduction strategies usually include diet and regular physical activity. A very low-carbohydrate and high protein diet (VLCD) may be preferred instead of a low energy conventional diet (CONV). The effects of VLCD on strength performance are yet to be understood. Aim of the study is to determine the effects of two different restrictive diets on strength performance., Methods: Sedentary women were assigned to either a VLCD (<40 g carbohydrate; n=12) or a CONV diet (500 to 800 kcal restrictive; 48%, 22% and 30% from carbohydrate, protein and fat, respectively; n=12). Knee extension isokinetic strength tests (3 yen 15 reps at 60 degrees .s-1, with 90 or 180 s rest interval between sets) were performed prior and after a one week diet period., Results: Both groups reduced body mass (VLCD: -2.6+/-1.0% vs. CONV: -1.9+/-1.3%; P<0.05), with no between diets effect. The sum of the total work in three sets (ATW) was 4850+/-1002 J vs. 4801+/-973 J with 90 s rest interval, and 4812+/-1174 J vs. 4812+/-1210 J with 180 s rest interval, respectively, in the pre vs. post-VLCD period. For CONV, values were 4709+/-729 J vs. 4530+/-996 J with 90 s rest interval, and 4760+/-732 J vs. 4816+/-702 J with 180 s rest interval, respectively, in the pre vs. post-CONV treatment. No significant differences were detected in the ATW between groups., Conclusion: Short-term hypoenergetic diets, irrespective of the carbohydrate content, seem to reduce significantly body mass, but do not impair acute strength performance.

Following the characterization of adults with an intestinal stoma who were registered in the Program of Education and Support to Stomized Patients, the authors developed a descriptive study in order to evaluate the results of the process of intestinal stoma demarcation as well as to analyze late complications. The sample was formed by 50 subjects, 76% of whom had colostomies and 34% had ileostomies. Regarding the stoma location, 12% did not demonstrate the scientific specifications indicated for the distance from the waist line, 2% for the iliac crest and 2% for the surgery scar. Late complications appeared in 44% of the cases, such as: 28% of peristomal hernias, 16% of stoma prolapses and 4% of skin hyperemias.

The present research focuses on the study of intestinal stoma demarcation. It reviews the historical development of the knowledge produced in this field, considering the advancement implemented in the area of abdominal surgeries which proposes the externalization of intestinal segments. In order to make the demarcation of intestinal stoma, it is necessary to limit the ideal region and to perform it with special pen which will propitiate the making of an anatomically appropriate opening. The stoma should favor the adaptation of devices which do the collection of effluents from the patient's intestines with a minimum of discomfort to the patient. The choice for the localization of the stoma, which is based on scientific principles, is made taking into consideration the structure of the recto-abdominal muscle and the distance from critical areas. At last, the most performed techniques of demarcation of the intestinal stoma are presented, as well as the procedures to be followed by the nurse or by the stoma therapist nurse.