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Diarrhea and Malnutrition
Published in Fima Lifshitz, Childhood Nutrition, 2020
Andrea Maggioni, Fima Lifshitz
Therefore, we believe that, when diarrhea of any type and degree strikes a high-risk patient, namely a young infant less than 3 months of age, or a patient who is malnourished, or was born small for gestational age, he or she should be treated with a specifically designed formula for infants with diarrhea if breast-feedings are not available. This may be the safest choice for the initial refeeding as it compensates for all the possible pathophysiological alterations induced by the illness.186 An improved absorption of the formula fed during the acute episode of diarrhea may lead to a more rapid recovery with a lesser number of complications than those resulting when the usual feedings and lactose-containing formula are given to an infant with diarrhea. The feeding during the convalescent period may also be of importance since it may reduce the long-term nutritional impact of diarrheal illness. Dietary intake should be greater than normal during convalescence after diarrhea. The high nutritional requirement may be fulfilled by providing meals of high nutrient density and/or increasing the number of meals offered per day of the formula that is designed for infants with diarrhea with the addition of supplements in accordance with the age of the infant and the feedings fed prior to illness.
Severe Non-influenza Viral Pneumonia in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
David Waldner, Thomas J. Marrie, Wendy Sligl
The HCPS is characterized by sequential progression through prodromal, cardiopulmonary, polyuric, and convalescent phases of illness [84]. Symptom onset typically follows an incubation period of 8–20 days [90]. The prodromal phase is characterized by non-specific symptoms, including fever, myalgia, headache, vomiting, and abdominal pain, and typically lasts for 1–6 days. The cardiopulmonary phase is typically heralded by the abrupt onset of non-productive cough [84]. Hantavirus preferentially distributes to the vascular endothelium of the heart and lungs, leading to increased endothelial permeability, and subsequent non-cardiogenic pulmonary edema, which is associated with profound hypoxemia in the majority of cases [85,91]. During this phase, chest radiography typically reveals bilateral interstitial infiltrates (Figure 16.3) and occasionally pleural effusions [84,85]. Up to 84% of patients require intubation and mechanical ventilation, with further deterioration necessitating extracorporeal membrane oxygenation (ECMO) therapy in up to 75% of cases [85,91]. Additional cardinal features of early HCPS include hemoconcentration, which occurs in 26%–81% of cases, and thrombocytopenia, which is invariably present [85,92]. Polyuria follows non-cardiogenic pulmonary edema, signaling illness resolution. This is followed by a period of convalescence, marked by fatigue and generalized weakness, but typically ends in full recovery [84].
Describing what happens: Clinical case reports, case series, occurrence studies
Published in Milos Jenicek, Foundations of Evidence-Based Medicine, 2019
A considerable discrepancy in clinimetric rigor exists between the care taken to describe the initial clinical stage of disease and all ensuing events, including the eventual death certificate. Convalescence, or a period of waning signs and symptoms and the return to satisfactory morphology and function, is the least known. This is mostly due to poor clinimetric inception of the starting point and end point of convalescence. Frequently, periods such as the beginning of convalescence are defined by the end of the prescribed treatment or by the disappearance of specific manifestations of disease. The end of convalescence is measured in vague terms by a return to the asymptomatic state, daily habits, and working capacity. Studies and understanding of convalescence remain a weak point in the assessment of the impact of therapeutic interventions. Re-adaptation, physiotherapy and any other measures of functional recovery and substitution rely on an equally rigorous clinimetric picture of what happens after the clinical stage of disease. Such an auxology of convalescence or, in other instances, of evolution ‘ad pessimum’ is equally important. Clinicians cannot abandon the patient by simply administering treatment. Clinimetrics stops only at the recovery of health or at death.
Evaluation of post-COVID health status using the EuroQol-5D-5L scale
Published in Pathogens and Global Health, 2022
Siddhi Hegde, Shreya Sreeram, Kaushik R Bhat, Vaishnavi Satish, Sujith Shekar, Mahesh Babu
Patient-reported outcome measures have been perennially used in clinical and research settings to gauge the quality of life of the patient in convalescence. Various studies have successfully outlined its importance[20]. Current evidence denotes the importance of the quality of life assessment for patients recovering from Covid-19 [21–23], emphasizing the role of an international rehabilitation routine to direct physicians to focus on the holistic recovery of the patient [24–26]. The present study is the first of its kind to evaluate the quality of life (QoL) in post-COVID survivors in the Indian subpopulation of Dakshina Kannada. The authors identified the need for such a study, given the prevalence and impact of COVID-19. Literature indicates that multiple questionnaires have been used to explore QoL such as the Professional QoL questionnaire by Busselli et al [27] and a similar tool, PROMIS, by Jacobs et al [28]. However, there is limited literature for the use of EuroQol-5D in evaluating Post-COVID QoL [29–35]. Studies exploring QoL have been conducted widely across the globe including China, Australia, parts of Europe and India as well [36,37]. The Indian studies primarily focused on health care workers (HCWs) and patients with co-morbidities rather than a general overview of the QoL in COVID survivors. Hence, the present study is a pioneer study in elucidating the determining factors QoL in COVID-19 survivors, especially in the current study population and area.
Two-year follow-up after a six-week high-intensity training intervention study with breast cancer patients: physiological, psychological and immunological differences
Published in Disability and Rehabilitation, 2022
Sebastian V. W. Schulz, Uwe Schumann, Stephanie Otto, Johannes Kirsten, Gunnar Treff, Wolfgang Janni, Jens Huober, Elena Leinert, Jürgen M. Steinacker, Daniel A. Bizjak
Breast cancer therapy exerts high mental [1,2] and physiological [3,4] stress on patients before, during and after treatment. To alleviate certain symptoms like increases in depression, fatigue and declines in daily physical activities, exercise in general and specialized training interventions may be non-invasive options besides drug treatment [5–8]. Several guidelines that recommend exercise for cancer therapy were established in the last years. They recommend endurance and strength training at moderate intensity to support the convalescence after therapy [9,10]. Up to now, alternatives to moderate aerobic intensity exercise in cancer therapy like high intensity exercises for strength, endurance or in combination are only rarely examined [11,12]. In addition, there are even fewer studies that followed breast cancer patients over years [13], although it was shown that lifestyle modifications could prevent about one-third of all cases of breast cancer [14]. Adherence to different training regimes also need further examination [15–17].
The Expression and Role of microRNA-133a in Plasma of Patients with Kawasaki Disease
Published in Immunological Investigations, 2022
Yeping Luo, Meng Yu, Pengzhu Li, Lihua Huang, Jiping Wu, Min Kong, Ying Li, Zhixiang Wu, Zhijuan Kang, Lu Yi, Zuocheng Yang
Blood samples were collected from patients with acute (n = 30) and convalescent (n = 30) KD, who were admitted to the Third Xiangya Hospital of Central South University between March 2017 and May 2018, as well from healthy children (n = 30), who came to hospital for routine checkup in the same time (Tables 1 and 2), using EDTA-containing tube. All patients were diagnosed with consistent Kawasaki Disease criteria, as defined in previous studies (Shi et al. 2020). Children were excluded who had scarlet fever, juvenile idiopathic arthritis, infectious mononucleosis, or staphylococcal scald-like skin syndrome. When sampling, the patients with acute KD were not treated with IVIG before. The patients in convalescence stage had a normal laboratory examination result including blood routine, C-reactive protein, and erythrocyte sedimentation rate, and no clinical symptoms. None of the children in control group had a history of KD, infectious disease, cardiovascular disease, autoimmune disease, or allergic disease. All the investigations were in accordance with the Declaration of Helsinki Table 1.