Post-COVID-19 patients in geriatric rehabilitation substantially recover in daily functioning and quality of life

BackgroundAfter an acute infection, older persons may benefit from geriatric rehabilitation (GR).ObjectivesThis study describes the recovery trajectories of post-COVID-19 patients undergoing GR and explores whether frailty is associated with recovery.DesignMulticentre prospective cohort study.Setting59 GR facilities in 10 European countries.ParticipantsPost-COVID-19 patients admitted to GR between October 2020 and October 2021.MethodsPatients’ characteristics, daily functioning (Barthel index; BI), quality of life (QoL; EQ-5D-5L) and frailty (Clinical Frailty Scale; CFS) were collected at admission, discharge, 6 weeks and 6 months after discharge. We used linear mixed models to examine the trajectories of daily functioning and QoL.Results723 participants were included with a mean age of 75 (SD: 9.91) years. Most participants were pre-frail to frail (median [interquartile range] CFS 6.0 [5.0–7.0]) at admission. After admission, the BI first steeply increased from 11.31 with 2.51 (SE 0.15, P P P P ConclusionsPost-COVID-19 patients admitted to GR showed substantial recovery in daily functioning and QoL. Frailty at GR admission was not associated with recovery and should not be a reason to exclude patients from GR.Public Health and primary careGeriatrics in primary car

Retrospective Analysis of Non-Surgical Treatment of Acute Cholecystitis

Item does not contain fulltextBackground: Worldwide, acute cholecystitis is a common disease. The current standard of treatment is according to the Tokyo Guidelines established in 2018. Conservative management with various combinations of analgesics, anti-inflammatory drugs, and percutaneous drainage are sometimes used to avoid or delay surgery, especially in frail patients, but little is known about the efficacy and safety of these strategies. Therefore, we evaluated the effect of antibiotic agents, with or without gallbladder drainage, or symptomatic treatment alone in patients with acute cholecystitis who were considered unfit for acute surgery. Patients and Methods: All patients whose initial treatment for cholecystitis was conservative who were admitted between 2014 and 2016 were included in this study. Patients were divided into three groups: those treated with antibiotic agents, those who received antibiotic agents in combination with percutaneous gallbladder drainage and those whose treatment was only symptomatic. Demographic characteristics, comorbidities, Tokyo Severity Classification, length of stay, re-admission rates, secondary treatment (delayed drainage or surgery), and complication rates were retrieved from their medical records. Results: Initially 33 were treated with conservative methods in this period. Fifteen patients were treated initially with antibiotic agents, 12 patients with antibiotic agents in combination with percutaneous drainage, and 6 patients received symptomatic treatment only. One patient had mild cholecystitis (Tokyo Severity Classification grade I) and the other 32 patients had moderate to severe (grade II or III) cholecystitis. Eventually, 25 patients (76%) underwent cholecystectomy, 2 of whom (8%) were emergency operations because of disease progression. Twelve patients (36%) were re-admitted, of whom the majority (83%) was re-admitted before cholecystectomy. Conclusion: Treatment of cholecystitis with antibiotic agents, drainage, or analgesic agents is feasible. However, it should be regarded as a bridge to surgery rather than a definitive solution because of frequent recurrence. Occasionally, an emergency operation could not be avoided as a result of disease progression under conservative treatment

Use of stimulated serum estradiol measurements for the prediction of hyperresponse to ovarian stimulation in in vitro fertilization (IVF).

Purpose: In ovarian stimulation an exaggerated ovarian response is often seen and is related to medical complications, such as ovarian hyperstimulation syndrome (OHSS), and increased patient discomfort. If it were possible to identify hyperresponders at an early stage of the stimulation phase, adaptation of the stimulation protocol would become feasible to minimize potential complications. Therefore, we studied the usefulness of measuring stimulated serum estradiol (E(2)) levels in predicting ovarian hyperresponse. Methods: A total of 109 patients undergoing their first IVF treatment cycle using a long protocol with GnRH agonist was prospectively included. The E(2) level was evaluated on day 3 and 5 of the stimulation phase. Two outcome measures were defined. The first was ovarian hyperresponse (collection of ≥15 oocytes at retrieval and/or peak E(2) >10000 pmol/L, or cancellation due to ≥30 follicles growing and/or peak E(2) >15000 pmol/L, or OHSS developed). The second outcome measure comprised a subgroup representing the more severe hyperresponders, named extreme-response (cancellation or OHSS developed). Results: The data of 108 patients were analyzed. The predictive accuracy of E(2) measured on stimulation day 3 towards ovarian hyperresponse was clearly lower than that of E(2) measured on stimulation day 5 (area under the receiver operating characteristic curve (ROC(AUC)) 0.75 and 0.81, respectively). For extreme-response the predictive accuracy of E(2) measured on stimulation day 3 or 5 was comparable (ROC(AUC) 0.81 and 0.82, respectively). For both outcome measures the stimulated E(2) tests yielded only acceptable specificity with moderate sensitivity at higher cutoff levels. Prediction of extreme-response seemed slightly more effective due to a lower error rate. Conclusions: There is a significant predictive association between E(2) levels measured on stimulation day 3 and 5 and both ovarian hyperresponse and extreme-response in IVF. However, the clinical value of stimulated E(2) levels for the prediction of hyperresponse is low because of the modest sensitivity and the high false positive rate. For the prediction of extreme-response the clinical value of stimulated E(2) levels is moderate

Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: a meta-analysis and comparison with basal follicle-stimulating hormone level.

Objective: To assess the predictive performance of the antral follicle count (AFC) as a test for ovarian reserve in IVF patients and to compare this performance with that of basal FSH level. Design: Meta-analysis. Setting: Tertiary fertility center. Patient(s): Patients undergoing IVF. Intervention(S): None. Main Outcome Measure(s): Poor ovarian response, nonpregnancy. Result(s): We identified 11 studies on AFC and an updated total of 32 studies on basal FSH from the literature on the basis of preset criteria. The estimated summary receiver operating characteristic (ROC) curves showed AFC to perform well in the prediction of poor ovarian response. Also, prediction of poor ovarian response seemed to be more accurate with AFC compared with basal FSH. The estimated summary ROC curves for the prediction of nonpregnancy indicated a poor performance for both AFC and basal FSH. Conclusion(s): Transvaginal ultrasonography is an easy-to-perform and noninvasive method that provides essential predictive information on ovarian responsiveness. The predictive performance of AFC toward poor response is significantly better than that of basal FSH. Therefore, AFC might be considered the test of first choice in the assessment of ovarian reserve prior to IV