The importance of a multidisciplinary team in the rehabilitation of persons after COVID -19

COVID-19 multisistemska je bolest koja, iako dominantno utječe na dišni sustav, može zahvatiti gotovo svaki organski sustav te zahtijeva strukturiranu rehabilitaciju koju provodi multidiciplinarni tim. Akutna, rana, rehabilitacija tijekom prvih 30 dana od infekcije čini tek prvu fazu rehabilitacije osoba oboljelih od bolesti COVID-19. Simptomi i znakovi fizičkih, neurokognitivnih i psihičkih posljedica nakon infekcije virusom SARS-CoV2 mogu trajati tjednima ili mjesecima nakon kraja akutne faze bolesti, a mogu se razviti i u osoba koje su imale blagu kliničku sliku i nisu bile hospitalizirane. Najčešći simptomi i znakovi koji se javljaju nakon akutne faze bolesti COVID-19 jesu umor, zaduha, kašalj, bol u zglobovima i mišićima te nesanica i pojačani efluvij kose. Bolesnici čije je kliničko stanje u akutnoj fazi bolesti zahtijevalo liječenje mehaničkom ventilacijom, mogu imati dugotrajne posljedice uključujući fizičku slabost i neurokognitivnu disfunkciju (brain fog) obilježenu gubitkom intelektualnih funkcija poput koncentracije i kratkoročnog pamćenja. Bolesnici s kognitivnom disfunkcijom imaju problema s prisjećanjem riječi, diskalkulijom i koncentracijom. Rehabilitacijski program Post-COVID dnevne bolnice za fizikalnu medicinu i rehabilitaciju provodi multidisciplinarni tim koji je fokusiran na cjelokupno funkcioniranje bolesnika, a ne samo na ledirani organ ili organski sustav, uključujući posljedice bolesti COVID-19 te moguće komplikacije liječenja i komorbiditete. Cilj rehabilitacije bolesnika u razdoblju poslije COVID-a jest postizanje potpunog funkcionalnog oporavka i adekvatne kvalitete života.COVID-19 is a multisystem disease that, although predominantly affecting the respiratory system, can affect almost any organ system and requires structured rehabilitation of a multidisciplinary team. Acute, early, rehabilitation during the first 30 days of infection constitutes only the first phase of rehabilitation of persons with COVID-19. Symptoms and signs of physical, neurocognitive, and psychological consequences after SARS-CoV2 infection may persist for weeks or months after the end of the acute phase of the disease, and may develop in individuals who have a mild clinical picture and have not been hospitalized. The most common symptoms and signs that occur after the acute phase of COVID-19 are fatigue, shortness of breath, cough, joint and muscle pain, and insomnia and increased hair effluvium. Patients whose clinical condition in the acute phase of the disease required treatment with mechanical ventilation may have long-term consequences, including physical weakness and neurocognitive dysfunction (brain fog) characterized by loss of intellectual functions such as concentration and short-term memory. Patients with cognitive dysfunction have problems with word recollection, dyscalculia, and concentration. The PostCOVID Day Hospital for Physical Medicine and Rehabilitation rehabilitation program is implemented by a multidisciplinary team focused on the overall functioning of patients, not just the treated organ or organ system, including the consequences of COVID-19 disease, possible treatment complications and comorbidities. The goal of rehabilitation of patients in the post-acute COVID-19 period is to achieve complete functional recovery and adequate quality of life

Critical illness myopathy and polyneuropathy in a patient with severe COVID -19 infection – a case report

Cilj: Cilj ovoga rada je prikazati bolesnika s teškim oblikom infekcije COVID-19 koji je razvio miopatiju i polineuropatiju kritične bolesti, uz tešku funkcijsku onesposobljenost te proces rehabilitacije, uz pregled literature. Prikaz slučaja: Bolesnik u dobi od 58 godina razvija teški oblik infekcije COVID-19 uz razvoj akutne respiratorne insuficijencije zbog obostrane COVID pneumonije. Zbog pogoršanja kliničke slike mehanički je ventiliran, razvija septički šok te se liječi polifarmakološkom terapijom uz suportivno liječenje i doziranu rehabilitaciju. Nakon poboljšanja kliničkog statusa, bolesnik postaje vitalno i hemodinamski stabilan, na suplementaciji kisikom od 4L/min. Zbog razvoja miopatije i polineuropatije kritične bolesti (engl. Critical-Illness Related Myopathy and Neuropathy; CRYMNE) s posljedičnom generaliziranom teškom mišićnom slabosti uz tešku onesposobljenost, započinje post-COVID multidisciplinarnu rehabilitaciju po individualnom rehabilitacijskom programu (IRP). IRP se sastoji od respiratorne i neuromišićne rehabilitacije te rehabilitacije funkcije za osposobljavanje u aktivnostima svakodnevnog života. Nakon provedenog IRP-a bolesnik je bez zaduhe i zamora pri opterećenju. Saturacija kisikom je postojana te nema razloga za daljnjom oksigenoterapijom. Napredak u rehabilitacijskim ishodima prati se funkcijskim alatima te se registrira smanjenje bolova u zglobovima, jačanje mišićne snage velikih skupina mišića, povećanje snage stiska obiju šaka te smanjenje općeg umora. Bolesnik hoda samostalno pomoću hodalice i peronealne ortoze radi zaostale pareze obaju peroneusa, a mjere funkcijske neovisnosti također su poboljšane, što pridonosi boljoj kvaliteti života. Zaključak: Miopatija i polineuropatija kritične bolesti posljedice su složenih patofizioloških mehanizama uslijed dugotrajne vitalno ugrožavajuće bolesti uz razvoj teške onesposobljenosti i gubitka funkcije. Individualni rehabilitacijski program provodi se kontinuirano, prilagođen je težini kliničke slike, a provodi ga multidisciplinarni tim.Aim: The aim of this paper is to present a patient with severe COVID-19 infection who has developed critical illness myopathy and polyneuropathy (CRYMNE), with severe functional disability as well as the rehabilitation process, with a review of literature. Case report: A 58-year-old patient develops a severe form of COVID-19 infection with the development of acute respiratory failure due to bilateral COVID-19 pneumonia. Due to the worsening of the clinical condition, he is mechanically ventilated, develops septic shock and is treated with polypharmacological therapy with supportive treatment and gradually progressive rehabilitation. Upon improvement of clinical status, the patient becomes vital and hemodynamically stable, on oxygen supplementation of 4L/min. Due to the development of critical-illness related myopathy and neuropathy (CRYMNE) and the consequent generalized severe muscle weakness with severe disability, he started post- COVID-19 multidisciplinary rehabilitation according to an individual rehabilitation program (IRP). IRP consists of respiratory and neuromuscular rehabilitation, and rehabilitation of the training function in everyday life activities. According to the performed IRP, the patient is free of shortness of breath and fatigue. Oxygen saturation is persistent and there is no reason for further oxygen therapy. Progress in rehabilitation outcomes is monitored by functional tools and a reduction in joint pain, strengthening of muscle strength of large muscle groups, increase in the grip strength of both hands and reduction of general fatigue are registered. The patient walks independently with a walker and peroneal orthoses due to residual paresis of both peroneal nerves. Functional independence indexes as assessment tools of function have also been improved, which is proof of a better quality of life. Conclusion: CRYMNE is the consequence of complex pathophysiological mechanisms due to long-term, life-threatening disease with the development of severe disability and loss of function. The individual rehabilitation program is implemented continuously, adjusted to the severity of the clinical condition under supervision of a multidisciplinary team

Fibromyalgia – syndrome of chronic widespread pain – a case report

Cilj: Prikaz slučaja bolesnice s fibromialgijom koja se inicijalno prezentirala kroničnom proširenom boli te je proveden dijagnostičko-terapijski postupak. Prikaz slučaja: Bolesnica u dobi od 61 godine liječena je pri Zavodu za fizikalnu i rehabilitacijsku medicinu s reumatologijom zbog jakih kroničnih bolova u zglobovima i mišićima. Bolesnica dodatno opisuje poteškoće sa spavanjem, tegobe depresije i anksioznosti. Boluje od hipotireoze, a prethodno su na magnetskoj rezonanciji utvrđene degenerativne promjene kralježnice. Opsežnom je dijagnostičkom obradom isključena upalna reumatska bolest, neurološka bolest, paraneoplastični sindrom, neregulirana hipotireoza te kronična infekcija. Dijagnostički upitnik za fibromialgiju potvrdio je sumnju da bolesnica boluje od fibromialgije temeljem rezultata upitnika (Widespread pain index (WPI) 15; symptom severity scale (SSS) 9). Procjena umora kronične bolesti dala je izrazito loš rezultat (The Functional Assessment of Chronic Illness Therapy (FACIT-F) 15/52), što je ukazalo na lošu kvalitetu života. Provedeno je nefarmakološko liječenje koje se sastojalo od edukacije, individulane kineziterapije i fizikalno-terapijskih procedura te multimodalno farmakološko liječenje. Izborom lijekova djelovalo se na nociceptivnu i neuropatsku vrstu boli, kao i na anksioznost bolesnice s povoljnim terapijskim odgovorom. Navedenim pristupom liječenja postignuto je značajno poboljšanje tegoba sindroma fibromialgije u naše bolesnice. Zaključak: U bolesnika s proširenom kroničnom boli, kroničnim umorom i poremećajima mentalnog stanja treba posumnjati na fibromialgiju. Dijagnostičkom je obradom potrebno isključiti drugu ozbiljnu bolest. Za postavljanje dijagnoze fibromialgije koriste se dijagnostički kriteriji iz 2016. godine – American College of Rheumatology (ACR). Ovim prikazom bolesnice željeli smo podignuti svijest o ovoj bolesti koja je u svijetu prepoznata kao ozbiljan zdravstveni problem iako ponekad zanemaren i nepriznat.Aim: To present a case of a patient with fibromyalgia who initially presented with chronic widespread pain and a diagnostic-therapeutic procedure. Case report: A 61-year-old patient was treated at the Department of physical and rehabilitation medicine with rheumatology for severe chronic joint and muscle pain. The patient additionally describes difficulty of sleeping, depression, and anxiety. She suffers from hypothyroidism and degenerative changes of the spine have been previously determined on magnetic resonance imaging. Extensive diagnostic treatment ruled out inflammatory rheumatic disease, neurological disease, paraneoplastic syndrome, unregulated hypothyroidism, and chronic infection. The Fibromyalgia Diagnostic Questionnaire confirmed the suspicion that the patient was suffering from fibromyalgia based on the results of the questionnaire Widespread pain index (WPI) 15 and symptom severity scale (SSS) 9. The Functional Assessment of Chronic Illness Therapy-fatigue (FACIT-F) gave an extremely poor result, 15 points. Non-pharmacologic treatment was conducted, consisted of education, individual exercise, physical therapy procedures and multimodal pharmacological therapy, with the choice of drugs affected the nociceptive and neuropathic type of pain, as well as the anxiety of the patient with a favorable therapeutic response. This approach to treatment has achieved a significant improvement in the symptoms of fibromyalgia syndrome in our patient. Conclusion: Fibromyalgia should be suspected in patients with widespread chronic pain, chronic fatigue, and mental disorders. It is necessary to exclude another serious disease by diagnostic processing. The 2016 American College of Rheumatology (ACR) diagnostic criteria are used to diagnose fibromyalgia. With this presentation of the patient, we wanted to raise awareness about this disease, which is recognized in the world as a serious health problem, although sometimes neglected and unrecognized

The importance of a multidisciplinary team in the rehabilitation of persons after COVID -19

COVID-19 multisistemska je bolest koja, iako dominantno utječe na dišni sustav, može zahvatiti gotovo svaki organski sustav te zahtijeva strukturiranu rehabilitaciju koju provodi multidiciplinarni tim. Akutna, rana, rehabilitacija tijekom prvih 30 dana od infekcije čini tek prvu fazu rehabilitacije osoba oboljelih od bolesti COVID-19. Simptomi i znakovi fizičkih, neurokognitivnih i psihičkih posljedica nakon infekcije virusom SARS-CoV2 mogu trajati tjednima ili mjesecima nakon kraja akutne faze bolesti, a mogu se razviti i u osoba koje su imale blagu kliničku sliku i nisu bile hospitalizirane. Najčešći simptomi i znakovi koji se javljaju nakon akutne faze bolesti COVID-19 jesu umor, zaduha, kašalj, bol u zglobovima i mišićima te nesanica i pojačani efluvij kose. Bolesnici čije je kliničko stanje u akutnoj fazi bolesti zahtijevalo liječenje mehaničkom ventilacijom, mogu imati dugotrajne posljedice uključujući fizičku slabost i neurokognitivnu disfunkciju (brain fog) obilježenu gubitkom intelektualnih funkcija poput koncentracije i kratkoročnog pamćenja. Bolesnici s kognitivnom disfunkcijom imaju problema s prisjećanjem riječi, diskalkulijom i koncentracijom. Rehabilitacijski program Post-COVID dnevne bolnice za fizikalnu medicinu i rehabilitaciju provodi multidisciplinarni tim koji je fokusiran na cjelokupno funkcioniranje bolesnika, a ne samo na ledirani organ ili organski sustav, uključujući posljedice bolesti COVID-19 te moguće komplikacije liječenja i komorbiditete. Cilj rehabilitacije bolesnika u razdoblju poslije COVID-a jest postizanje potpunog funkcionalnog oporavka i adekvatne kvalitete života.COVID-19 is a multisystem disease that, although predominantly affecting the respiratory system, can affect almost any organ system and requires structured rehabilitation of a multidisciplinary team. Acute, early, rehabilitation during the first 30 days of infection constitutes only the first phase of rehabilitation of persons with COVID-19. Symptoms and signs of physical, neurocognitive, and psychological consequences after SARS-CoV2 infection may persist for weeks or months after the end of the acute phase of the disease, and may develop in individuals who have a mild clinical picture and have not been hospitalized. The most common symptoms and signs that occur after the acute phase of COVID-19 are fatigue, shortness of breath, cough, joint and muscle pain, and insomnia and increased hair effluvium. Patients whose clinical condition in the acute phase of the disease required treatment with mechanical ventilation may have long-term consequences, including physical weakness and neurocognitive dysfunction (brain fog) characterized by loss of intellectual functions such as concentration and short-term memory. Patients with cognitive dysfunction have problems with word recollection, dyscalculia, and concentration. The PostCOVID Day Hospital for Physical Medicine and Rehabilitation rehabilitation program is implemented by a multidisciplinary team focused on the overall functioning of patients, not just the treated organ or organ system, including the consequences of COVID-19 disease, possible treatment complications and comorbidities. The goal of rehabilitation of patients in the post-acute COVID-19 period is to achieve complete functional recovery and adequate quality of life

Fibromyalgia – syndrome of chronic widespread pain – a case report

Cilj: Prikaz slučaja bolesnice s fibromialgijom koja se inicijalno prezentirala kroničnom proširenom boli te je proveden dijagnostičko-terapijski postupak. Prikaz slučaja: Bolesnica u dobi od 61 godine liječena je pri Zavodu za fizikalnu i rehabilitacijsku medicinu s reumatologijom zbog jakih kroničnih bolova u zglobovima i mišićima. Bolesnica dodatno opisuje poteškoće sa spavanjem, tegobe depresije i anksioznosti. Boluje od hipotireoze, a prethodno su na magnetskoj rezonanciji utvrđene degenerativne promjene kralježnice. Opsežnom je dijagnostičkom obradom isključena upalna reumatska bolest, neurološka bolest, paraneoplastični sindrom, neregulirana hipotireoza te kronična infekcija. Dijagnostički upitnik za fibromialgiju potvrdio je sumnju da bolesnica boluje od fibromialgije temeljem rezultata upitnika (Widespread pain index (WPI) 15; symptom severity scale (SSS) 9). Procjena umora kronične bolesti dala je izrazito loš rezultat (The Functional Assessment of Chronic Illness Therapy (FACIT-F) 15/52), što je ukazalo na lošu kvalitetu života. Provedeno je nefarmakološko liječenje koje se sastojalo od edukacije, individulane kineziterapije i fizikalno-terapijskih procedura te multimodalno farmakološko liječenje. Izborom lijekova djelovalo se na nociceptivnu i neuropatsku vrstu boli, kao i na anksioznost bolesnice s povoljnim terapijskim odgovorom. Navedenim pristupom liječenja postignuto je značajno poboljšanje tegoba sindroma fibromialgije u naše bolesnice. Zaključak: U bolesnika s proširenom kroničnom boli, kroničnim umorom i poremećajima mentalnog stanja treba posumnjati na fibromialgiju. Dijagnostičkom je obradom potrebno isključiti drugu ozbiljnu bolest. Za postavljanje dijagnoze fibromialgije koriste se dijagnostički kriteriji iz 2016. godine – American College of Rheumatology (ACR). Ovim prikazom bolesnice željeli smo podignuti svijest o ovoj bolesti koja je u svijetu prepoznata kao ozbiljan zdravstveni problem iako ponekad zanemaren i nepriznat.Aim: To present a case of a patient with fibromyalgia who initially presented with chronic widespread pain and a diagnostic-therapeutic procedure. Case report: A 61-year-old patient was treated at the Department of physical and rehabilitation medicine with rheumatology for severe chronic joint and muscle pain. The patient additionally describes difficulty of sleeping, depression, and anxiety. She suffers from hypothyroidism and degenerative changes of the spine have been previously determined on magnetic resonance imaging. Extensive diagnostic treatment ruled out inflammatory rheumatic disease, neurological disease, paraneoplastic syndrome, unregulated hypothyroidism, and chronic infection. The Fibromyalgia Diagnostic Questionnaire confirmed the suspicion that the patient was suffering from fibromyalgia based on the results of the questionnaire Widespread pain index (WPI) 15 and symptom severity scale (SSS) 9. The Functional Assessment of Chronic Illness Therapy-fatigue (FACIT-F) gave an extremely poor result, 15 points. Non-pharmacologic treatment was conducted, consisted of education, individual exercise, physical therapy procedures and multimodal pharmacological therapy, with the choice of drugs affected the nociceptive and neuropathic type of pain, as well as the anxiety of the patient with a favorable therapeutic response. This approach to treatment has achieved a significant improvement in the symptoms of fibromyalgia syndrome in our patient. Conclusion: Fibromyalgia should be suspected in patients with widespread chronic pain, chronic fatigue, and mental disorders. It is necessary to exclude another serious disease by diagnostic processing. The 2016 American College of Rheumatology (ACR) diagnostic criteria are used to diagnose fibromyalgia. With this presentation of the patient, we wanted to raise awareness about this disease, which is recognized in the world as a serious health problem, although sometimes neglected and unrecognized

Epidemiology and Clinical Course of Haemorrhagic Fever with Renal Syndrome in New Endemic Area for Hantavirus Infection in Croatia

Background: Hantaviruses remain an important case of emerging and re-emerging infections in human medicine. This study aimed to analyse the epidemiology, clinical presentation, and outcome of hantavirus infections in the western part of Republic of Croatia, a new geographical area for hantavirus infections. Methods: Retrospective analysis of medical records of patients treated for hemorrhagic fever with renal syndrome (HFRS) at the infectious diseases Clinic of the Clinical Hospital Center in Rijeka, Croatia, from 1 January 2014, to 31 December 2021. Results: During the eight-year period, 251 patients were hospitalized and treated for HFRS, with epidemic outbreaks in years 2014 and 2021. Most patients had a typical clinical course of HFRS and received supportive care. Serological analysis revealed the Puumala Virus (PUUV) as the predominant etiology of the disease. Epidemiological analysis revealed clustering of infections in the region of Gorski Kotar and spread to the area on the Mediterranean coast (Adriatic Sea), which was previously considered an area free from hantavirus infections. Conclusions: The presented results indicate the spread of hantavirus infections in Croatia from the central low-lying parts of the country to the tourist-attractive western area adjacent to the Mediterranean coast, which was previously considered free of hantavirus infections