Objectives: Multiple limb amputations are an uncommon complication from inotrope-induced peripheral gangrene. Case Presentation: A 20-year-old lady with valvular heart disease had septic shock secondary to infective endocarditis and required prolonged cardiopulmonary resuscitation. Despite aggressive fluid resuscitation, the patient had triple strength intravenous noradrenaline to maintain hemodynamic stability. On day 5 of post-shock, dry gangrene occurred in distal parts of all limbs, and inotrope was stopped. Although the gangrenous changes were non-progressive, she required a significant degree of assistance with mobility and daily function performance. The patient was counseled for multiple limb amputations to promote walking and hand function through prosthetic restoration. Five months after the event, she had a right transtibial amputation, left Chopart amputation, left wrist disarticulation, and right second, third, fourth, and fifth fingers amputation. Three specific goals for inpatient rehabilitation were independent short-distance ambulation with prostheses, performing basic activities of daily living with adaptive devices, and independent wheelchair propulsion for long-distance mobility using a right-sided transtibial prosthesis, left-sided Syme's prosthesis with Kingsley's foot, right-sided silicone-based cosmetic glove and left-sided body-powered transradial prosthesis. Discussion: Although an uncommon complication, inotrope may lead to multiple limb amputations secondary to peripheral gangrene. Following amputation, the ultimate rehabilitative goal is to restore the mobility and capacity to perform daily functions through prosthetic restoration, whether walking for lower amputees or functioning hand for upper limb amputees. Prescribing prosthesis in a single limb loss is relatively straightforward, but restoring multiple limb amputations bears many challenges toward successful recovery of walking and functions.
Abstract Background Pain is one of the prevalent Long COVID Symptoms (LCS). Pain interferes with the quality of life (QoL) and induces disease burden. Purpose The study aimed to elicit the clinical presentation of pain and determine the relationships between QoL and pain in LCS. Methods This household cross-sectional study of 12,925 SARS-CoV-2 cases between July and December 2021 was carried out in eight administrative divisions of Bangladesh. Stratified random sampling from the cases retrieved from the Ministry of Health was employed. Symptom screening was performed through COVID-19 Yorkshire Rehabilitation Scale, and long COVID was diagnosed according to World Health Organization (WHO) criteria. The analyses were conducted using IBM SPSS (Version 20.00). Results The prevalence of pain in long COVID was between 01 and 3.1% in the studied population. The study also found five categories of pain symptoms as LCS in Bangladesh: muscle pain 3.1% (95% CI; 2.4–3.8), chest pain 2.4% (95% CI; 1.8–3.1), joint pain 2.8% (95% CI; 2.2–2.3), headache 3.1% (95% CI; 2.4–3.8), and abdominal pain 0.3% (95% CI; 0.01–0.5). People with LCS as pain, multiple LCS, and longer duration of LCS had significantly lower quality of life across all domains of the WHOQOL-BREF ( P < 0.001) compared to asymptomatic cases. Conclusion Three out of ten people with long COVID experience painful symptoms, which can significantly reduce their quality of life. Comprehensive rehabilitation can improve the symptoms and reduce the burden of the disease.
This study aimed to compare the effects of intensity (I) and duration (D) on the oxidative stress marker (malondialdehyde, MDA) and the responses of the antioxidant enzymes (catalase, CAT; glutathione peroxidase, GPx; superoxide dismutase, SOD) among sedentary adults. In a crossover design, 25 sedentary adults performed nine cycling exercise sessions with a constant load of 50%, 60%, and 70% VO2peak for 10-, 20-, and 30-min each. Plasma MDA, CAT, GPx, and SOD activity were measured before and immediately after each exercise session. Results show that MDA concentration and SOD activity increased significantly immediately after exercise at all intensities and durations, except SOD decreased significantly at 70% V˙O2pk for 30 min. CAT activities also increased significantly after exercise at 50% V˙O2pk for 10 and 20 min but decreased at 60% V˙O2pk for 30 min and at 70% V˙O2pk for all durations. GPx activity decreased significantly after 20 and 30 min at all intensity levels. In conclusion, our results show that cycling at 50%, 60%, and 70% V˙O2pk for 10, 20, and 30 min increased oxidative stress and antioxidant activities, but with different responses. These findings suggest that the starting exercise intensity for sedentary adults should not exceed 70% V˙O2pk.
Background: A diverse spectrum of long COVID symptoms (LCS) have the scope of physical rehabilitation. Due to limited resources, very little is known about the physiotherapy and rehabilitation interventions for LCS and their clinical application. This study aims to explore the role of physiotherapy and rehabilitation interventions in the management of musculoskeletal, neurological, cognitive, cardiorespiratory, mental health, and functional impairments of LCS.Methods: The study was a systematic scoping review of the literature published between April 2020 and July 2022.Results: 87 articles were extracted followed by a standard process of The Preferred Reporting Items for Systematic reviews and meta-analysis (PRISMA) extension for Scoping reviews (PRISMA-ScR). The included studies had a 3223 LCS population. All types of primary and secondary articles were retrieved except for qualitative studies. The evidence was evaluated by an appraisal scoring tool followed by the guidelines of the “Enhancing the Quality and Transparency of Health Research ( EQUATOR) network”. The included papers had a mean appraisal score of 0.7807 on a 0 to 1 scale (SD 0.08), the minimum score was for study protocols (0.5870), and the maximum score was for Cohort studies (.8977). Sixty seven (67) evidence-based interventions were documented from 17 clinical categories. The most weighted interventions were treating underlying symptoms of long COVID (Adjusted score 1/1), management of fatigue (Adjusted score 0.963/1), aerobic exercise and balance training (Adjusted score 0.951/1), multidisciplinary rehabilitation (Adjusted score 0.926/1), and low resistance training and aerobic exercise (Adjusted score 0.889/1).Conclusion: We recommend Long COVID rehabilitation in a multidisciplinary approach by treating the individual symptoms, especially fatigue. Physiotherapy interventions play a significant role as most of the recommended interventions were exercise, modalities, patient education, respiratory rehabilitation, and telerehabilitation Scoping reviews do not require protocol registration from PROSPERO.
Pregnancy is linked to a higher incidence of severe Covid-19. It's critical to find safe vaccinations that elicit protective pregnant and fetal immune responses. This review summarises the rate of COVID-19 infection, maternal antibodies responsiveness, placenta antibody transmission, and adverse events after COVID-19 vaccination in pregnancy studied in epidemiological studies evaluating mRNA vaccines. Potential COVID-19 infection in pregnant women can be prevented using mRNA-based vaccinations. Gestation, childbirth, and perinatal mortality were proven unaffected by COVID-19 vaccination. Injection-site discomfort, tiredness, and migraine are the most prevalent side effects, but these are temporary. After the first dosage of vaccinations, fast antibody responses were demonstrated. The adaptive immunity is found to be more significant after booster vaccination, and is linked to improved placental antigen transmission. Two vaccination doses are associated with more robust maternal and fetal antibody levels. Longer delays between the first immunization dosage and birth are linked to greater fetal IgG antibody levels with reduction in antigen transmission proportion. The mRNA vacciness are effective in reducing the severity of COVID-19 infection and these vaccinations are regarded to be safe options for pregnant women and their unborn fetus.
This special issue is dedicated to the Borneo International Spinal Cord Injury (SCI) Rehabilitation Conference (BISCIR) which was held on 30th July – 1st August 2021 through a virtual platform. It was co-organized by the Department of Rehabilitation Medicine, Queen Elizabeth Hospital, and Rehabilitation Medicine Unit, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah in partnership with Docquity and Kelab Perubatan Rehabilitasi Sabah. Attended by almost 500 delegates from Southeast Asian countries including the hosting country of Malaysia, the conference served its purpose as a global sharing platform by having invited local and international experts from Thailand, the Philippines, India, South Korea, and Australia. With the theme “SCI Rehabilitation: Basics and Beyond”, there was a great opportunity for participating delegates to submit their abstracts for oral and poster competition on spinal cord-related disorders and their rehabilitation. The covered areas include but are not exhaustive to the spinal cord pathophysiology, disease presentations, complications, and management, as well as rehabilitation interventions. Each submitted abstract was double-blinded peer-reviewed by two external reviewers. A total of 15 abstracts were accepted after rigorous review based on objective judging criteria, with seven and eight abstracts as oral and poster submissions respectively. Most of them were case reports with four cross-sectional studies and one review article. “Managing Tetraplegia with Blindness: Rehabilitation Approach” presented the improvement in mobility and daily living skills through orientation and mobility training with sensory education and repeated verbal instructions for compensating the loss of visual and sensory feedback. The “International Lower Urinary Tract Function Data Set: A Study in SCI Population in HRC” reviews the epidemiology of spinal cord injury patients with the neurogenic bladder in the largest rehabilitation hospital in Malaysia. “Navigating Neurological Recovery with NeuroAiD in Severe Spinal Cord Injury: A Noteworthy Novelty?” reported a case of complete tetraplegia who regained some neurological recovery following NeuroAiD supplementation. “A Case of Incomplete Spinal Cord Injury Associated with Brown Sequard Syndrome After Cervical Blunt Trauma with Atlanto-Axial Rotatory Subluxation in a Paediatric Patient” exhibited a case of a paediatric patient with high cervical spinal cord injury secondary to blunt trauma that has resulted in atlantoaxial rotatory subluxation. The “Long Cervicothoracolumbal Rigid Bracing Stabilization on Incomplete Spinal Cord Injury of Post-Operated Multi-Focal Upper Cervical-Thoracic Spinal Tuberculosis: A Unique Case Report” showed that the use of long CTLSO rigid external stabilization justifies the reason to boost protection while recovering from spinal tuberculosis despite receiving stable internal stabilization. “Orthotic Intervention for Ageing Individuals with Spinal Cord Injury: A Brief Review” explored the use of orthotic intervention among the elderly with SCI in 25 published articles. The “Demographic Characteristic of Spinal Cord Injury Patients Referred for Rehabilitation in Miri Hospital” aimed to explore the demographic characteristics among the referrals for rehabilitation among spinal cord injury populations in that tertiary hospital. The “Autonomic Dysreflexia with Concurrent Orthostatic Hypotension: A Clinical Approach Dilemma” highlighted the complicated conditions of managing concurrent Autonomic dysreflexia and orthostatic hypotension in a patient with high cervical spinal cord injury. “A Pinch of Salt Won’t Kill: The Role of Salt Tablets in Reversing Intractable Orthostatic Hypotension in an Incomplete Tetraplegic Patient” presented a case of intractable orthostatic hypotension in incomplete tetraplegia, which resolved after the initiation of salt tablets. The “Marching Forward with Mirabegron: A Novel Treatment Option for Neurogenic Detrusor Overactivity in Traumatic Spinal Cord Injury” showcased a case of young traumatic paraplegia who has been successfully treated with Mirabegron as an alternative to anticholinergics in treating overactive bladder for its better tolerability and comparable efficacy. “A Retrospective Pilot Study on the Prevalence of Acceptability for Teleconsultation among Spinal Cord Injury Patients” observed the acceptability of teleconsultation among SCI patients in a major tertiary rehabilitation hospital with a description of their clinical and demographic features. “Performing Solat in Spinal Cord Injury Patients: Challenges and Solutions” emphasized the importance to educate healthcare workers for identifying the limitations and leniency in Islam related to performing prayer (solah) and understand the conditions of the validity of the performed prayer as means to equip patients with the right knowledge and method. The ”Sharing of Experience of Teleconsultation with Spinal Cord Injury Patients” proven that the use of teleconsultation is a beneficial service among SCI patients during the COVID-19 pandemic. “Fleet Enema-Induced Autonomic Dysreflexia in Spinal Cord Injured Patient” reported the use of fleet enema in spinal cord injured patients that can cause autonomic response leading to severe complication of a generalized tonic-clonic seizure. The “An Uncommon Case Post-traumatic Syringobulbia: A Case Report” showed that the formation of syringobulbia, although rare, is one of the causes of the delayed-onset neurological deterioration in spinal cord injured patients. The accepted abstracts are presented in the following sections of this issue. Readers are welcome to contact us for any comments or queries.
Retinal image registration is important to assist diagnosis and monitor retinal diseases, such as diabetic retinopathy and glaucoma. However, registering retinal images for various registration applications requires the detection and distribution of feature points on the low-quality region that consists of vessels of varying contrast and sizes. A recent feature detector known as Saddle detects feature points on vessels that are poorly distributed and densely positioned on strong contrast vessels. Therefore, we propose a multiresolution difference of Gaussian pyramid with Saddle detector (D-Saddle) to detect feature points on the low-quality region that consists of vessels with varying contrast and sizes. D-Saddle is tested on Fundus Image Registration (FIRE) Dataset that consists of 134 retinal image pairs. Experimental results show that D-Saddle successfully registered 43% of retinal image pairs with average registration accuracy of 2.329 pixels while a lower success rate is observed in other four state-of-the-art retinal image registration methods GDB-ICP (28%), Harris-PIIFD (4%), H-M (16%), and Saddle (16%). Furthermore, the registration accuracy of D-Saddle has the weakest correlation (Spearman) with the intensity uniformity metric among all methods. Finally, the paired t -test shows that D-Saddle significantly improved the overall registration accuracy of the original Saddle.
Action observation therapy (AOT) is a rehabilitation approach integrating sensory perception of motor skills among stroke survivors. This review article aims to investigate the effectiveness of AOT for gait training among comparative studies in stroke rehabilitation. We searched through MEDLINE, Scopus, and Google Scholar using the following subsets of terms: 'stroke' AND 'gait' AND 'action observation.' Randomised controlled trials (RCTs) and non-RCT studies focusing on AOT for gait training in stroke patients were included. Eleven RCTs and one non-RCT study met the inclusion criteria and were included for analysis. Data were extracted on sample size, inclusion criteria, type of intervention, functional outcome measures, gait parameters, and intervention effectiveness. Overall, AOT demonstrated positive results as an adjunctive intervention for improving gait properties among stroke individuals. The review highlighted its neurophysiological mechanisms and benefits in stroke rehabilitation. AOT shows promise as a beneficial adjunctive intervention for improving gait properties among stroke individuals. Further research is warranted to explore its optimal implementation and long-term effects in stroke rehabilitation.
Hemodialysis (HD) patients have a high rate of poor sleep. The Pittsburgh Sleep Quality Index (PSQI) is the most popular self-reported instrument to measure sleep quality. No study has tested the psychometric efficiency of the Bahasa (Indonesian language) PSQI in hemodialysis (HD) patients, and no cross-cultural adaptation has been done. The purpose of this research was to translate the PSQI into Bahasa and improve its psychometric properties for use in evaluating HD patients in Indonesia. This study used instrument translation, cultural adaptation, content validation, and equivalence to crossculturally validate and adapt an instrument. The hemodialysis center at a West Java medical facility served as a source of potential HD patients throughout the period of October 2022 to February 2023. A content validity index (CVI) was calculated for each item and the entire scale. The factor structure of the Bahasa PSQI has been evaluated by confirmatory factor analysis and internal consistency was calculated using Cronbach's alpha. The online survey received a response rate of 62.8% from a total of 220 patient with HD (about ten responders each item). The level of language clarity was 87.8%, and the level of cultural relevance was 84.5%. The CVI varied from 0.92 to 1.00. Each factor had factor loading ranging from 0.51 to 0.62. that Cronbach alpha for total score was 0.803, and the subscale ranged from 0.771 to 0.863. Our research provides preliminary evidence of the validity and reliability of the translated and adapted tool using data from HD patients in Indonesian hospitals.
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