Utjecaj prijeoperacijske respiracijske rehabilitacije kod kardiokirurških bolesnika

The aim of the study was to evaluate the effects of preoperative respiratory rehabilitation on functional capacity, length of stay in intensive care unit (ICU), duration of mechanical ventilation (MV) and total hospitalization, as well as to estimate arterial blood gas (ABG) values in patients undergoing cardiac surgery. Nineteen patients were included in the randomized observational study, divided into two groups: group A (intervention) and B (control). Preoperative and postoperative rehabilitation was performed in group A, and only postoperative rehabilitation in group B. Rehabilitation was carried out according to a predefined protocol. We used ABG to evaluate respiratory function, two-minute walk test (2MWT) and sit-to-stand test to assess functional capacity. The following data were obtained from medical documentation: duration of MV, length of stay at ICU, occurrence of postoperative pulmonary complications, and length of total hospitalization in both groups. Significant between-group difference was found for the length of total hospitalization and duration of MV (p<0.05 both). Analysis of the mean values of 2MWT on the last day of hospitalization (p=0.005), sit-to-stand test before surgery (p=0.022) and on the last day of hospitalization (p=0.008) showed statistically significant differences. The length of hospital stay significantly correlated with preoperative rehabilitation in group A (r=0.885; p<0.0001). There was no difference in ABG parameters between the groups. The study showed that preoperative respiratory rehabilitation had an effect on reducing duration of MV and length of total hospitalization, and improved functional capacity.Cilj rada je bio procijeniti učinak prijeoperacijske respiracijske rehabilitacije na funkcionalni kapacitet, dužinu boravka u jedinici intenzivnog liječenja (JIL), trajanje mehaničke ventilacije (MV) i ukupnu hospitalizaciju te procijeniti vrijednosti plinske analize arterijske krvi (ABG) kod bolesnika podvrgnutih kardiokirurškim operacijama. U radomiziranu opservacijsku studiju bilo je uključeno 19 bolesnika podijeljenih u dvije skupine: skupina A (ispitivana) i B (kontrolna). Prijeoperacijska i poslijeoperacijska rehabilitacija provedena je u skupini A, a samo poslijeoperacijska rehabilitacija u skupini B. Rehabilitacija je provođena prema unaprijed utvrđenom protokolu. Rabili smo parametre ABG za procjenu respiracijske funkcije, a za procjenu funkcionalnog kapaciteta 2-minutni test hoda (2MWT) i sit-to-stand test. Sljedeći podaci prikupljeni su iz medicinske dokumentacije: dužina MV, dužina boravka u JIL, pojava komplikacija i dužina ukupne hospitalizacije. Nađena je značajna razlika između skupina za dužinu ukupne hospitalizacije (p<0,05) i dužinu MV (p<0,05). Analiza srednjih vrijednosti 2MWT posljednjeg dana hopitalizacije (p=0,005), sit-to-stand testa prije operacije (p=0,022) i posljednjeg dana hospitalizacije (p=0,008) između skupina pokazala je statistički značajnu razliku. Dužina hospitalizacije je značajno korelirala s prijeoperacijskom rehabilitacijom u skupini A (r=0,885; p<0,0001). Nije bilo razlike u parametrima ABG između skupina. Studija je pokazala da je prijeoperacijska respiracijska rehabilitacija utjecala na smanjenje dužine MV, dužinu trajanja ukupne hospitalizacije te na poboljšanje funkcionalnog kapaciteta

Dijabetička polineuropatija i rizik od pada: strah od pada i drugi čimbenici

The aim of the study was to analyze postural stability, walking speed and fear of falling in patients with diabetic polyneuropathy (DPN) in order to determine the risk factors for falls, as well as the effect of DPN characteristics as additional factors. A sample of 48 patients with type 2 diabetes and DPN were enrolled in this non-randomized observational study. The patients were divided into two groups of fallers and non-fallers. All subjects underwent evaluation with the Functional Reach Test (FRT), Tinetti Falls Efficacy Scale (Tinetti FES) and 10-Meter Walk Test (10MWT). Neuropathy was quantified with the Michigan Neuropathy Screening Instrument (MNSI, Questionnaire part) and 5.07/10-g Semmes Weinstein monofilament examination (SW-ME). The 10MWT and SW-ME were significantly different between the faller and non-faller groups (p<0.05). Duration of DPN correlated positively with SW-ME (p=0.005) in the faller group. FES showed significant positive correlation with MNSI and negative correlation with 10MWT in the non-faller group. Logistic regression analysis revealed that SW-ME was significantly associated with the probability of falling (p=0.0076; OR=1.378). Study results suggested that the loss of protective sensitivity of foot could be a risk factor for falls in people suffering from type 2 diabetes.Cilj ovoga rada bio je analizirati posturalnu stabilnost, brzinu hoda i strah od pada u bolesnika s dijabetičkom polineu-ropatijom (DPN) kako bi se utvrdili rizični čimbenici za padove, kao i utjecaj karakteristika DPN kao dodatnih čimbenika. Uzorak od 48 bolesnika s dijabetesom tipa 2 i DPN uključen je u ne-randomiziranu opservacijsku studiju. Sudionici su ­podijeljeni u dvije skupine: skloni padovima (faller) i neskloni padovima (non-faller). Svi ispitanici su podvrgnuti ocjeni ­pomoću sljedećih testova: Functional Reach Test (FRT), Tinetti Falls Efficacy Scale (Tinetti FES) i 10-Meter Walk Test (10MWT). Neuropatija je kvantificirana pomoću Michigan Neuropathy Screening Instrument (MNSI) (Upitnik-dio) i testa 5,07/10-g Semmes Weinstein monofilament (SW-ME). Rezultati na 10 MWT i SW-ME su bili značajno različiti između skupina bolesnika sklonih padovima i onih nesklonih padovima (p<0,05). Trajanje DPN bilo je pozitivno povezano sa ­SW-ME (p=0,005) u skupini bolesnika sklonih padovima. Ljestvica FES je značajno pozitivno korelirala s MNSI i negativno s 10MWT u skupini bolesnika nesklonih padovima. Logistička regresijska analiza je pokazala da je SW-ME značajno pove-zana s vjerojatnošću pada (p=0,0076; OR=1,378). Studija je ukazala na to da je gubitak zaštitne osjetljivosti stopala znača-jan čimbenik za pad kod osoba koje pate od dijabetesa tipa 2

Does diabetes affect stability in people with unilateral transtibial amputation?

Introduction/Objective. Currently, analysis of the stability of amputees with diabetes is lacking. The aim of this case study was to examine the effects of unilateral transtibial amputation on the stability and balance confidence of patients with below-knee amputation caused by trauma and diabetes. Methods. Seventeen subjects, 12 males and five females, with the average age of 51.47 ± 12.12 years, who use a unilateral transtibial prosthesis, were examined. The balance of 10 traumatic amputees (TTA) and seven diabetic amputees (TDA) was assessed by Activities-Specific Balance Confidence (ABC) scale, Timed Up and Go (TUG) test, and One-Legged Stance Test (OLST). Plantar pressure distribution was recorded using Gaitview AFA-50. Results. For 10 TTA and one TDA, ABC scores were > 80%, the mean value of the TUG test was 11 (range: 8.08–23 seconds). All the subjects could stand on the healthy leg, two women with diabetes were unable to stand on the prosthetic leg. The distribution of load between the healthy and the prosthetic leg showed higher overload on the healthy leg (average: 56.62%). Conclusion. The data from this case series describe stability problems of people with transtibial amputation. Plantar pressure distribution has the potential to provide information about the properties of stability in the amputees who use prosthesis