ADAPTATIONS TO REHABILITATION SERVICES DURING THE COVID-19 PANDEMIC PROPOSED BY SCIENTIFIC AND PROFESSIONAL REHABILITATION ORGANIZATIONS

ObjectiveTo describe adaptations in the provision of rehabilitation services proposed by scientific and professional rehabilitation organizations to avoid interruptions to patients’ rehabilitation process and delays in starting rehabilitation in patients with COVID-19.MethodsA narrative review approach was used to identify the recommendations of scientific and professional organizations in the area of rehabilitation. A systematic search was performed in the main data bases in 78 international and regional web portals of rehabilitation organizations. A total of 21 publications from these organizations were identified and selected.ResultsThe results are presented in 4 categories: adequacy of inpatient services, including acute care services and intensive care unit for patients with and without COVID-19; adequacy of outpatient services, including home-based rehabilitation and tele- rehabilitation; recommendations to prevent the spread of COVID-19; and regulatory standards and positions during the COVID-19 pandemic expressed by organizations for protecting the rights of health workers and patients.ConclusionHealth systems around the world are rapidly learning from actions aimed at the reorganization of rehabilitation services for patients who are in the process of recovery from acute or chronic conditions, and the rapid response to the rehabilitation of survivors of COVID-19, as well as from efforts in the prevention of contagion of those providing the services.LAY ABSTRACTIn response to the coronavirus disease 2019 (COVID-19) pandemic, which developed very rapidly worldwide, rehabilitation services were forced to modify and adapt the way they provide and deliver services. These measures were proposed and adopted across a wide range of countries, the changes proposed included the following measures: critical patients with SARS-CoV-2 infection should be cared for by a multidisciplinary team providing early mobilization, respiratory, outpatient, and long-term care rehabilitation interventions. Home- based and community rehabilitation can be delivered through different strategies, such as telerehabilitation or direct care. The use of measures to prevent and protect against transmission of COVID-19 are necessary for all patients in rehabilitation care.Key words: rehabilitation service, COVID-19, disability, health professional, rehabilitation organization, health system

The coronavirus disease 2019 (COVID-19) pandemic expanded very rapidly worldwide. Because of its rapid spread, morbidity, and mortality, COVID-19 has had a significant impact on the delivery of healthcare, including rehabilitation services. Globally, rehabilitation services have been forced to modify and adapt the way they provide and deliver services in response to the pandemic, aiming to reduce physical contact between professionals and patients without affecting communication in the rehabilitation process (1). Furthermore, restrictions to contain the spread of COVID-19 have limited patients’ access to many rehabilitation services, causing collateral damage and negative consequences to people with disabilities, increasing functional limitations in chronic conditions, and hampering recovery after acute events (2).The World Health Organization (WHO) called for action to strengthen rehabilitation planning and implementation, including sanitary emergency preparedness and response to the current COVID-19 pandemic (3).However, the rehabilitation processes of people experiencing disability as well as of people with disability have been affected by the lack of continuity of care in rehabilitation services. It is estimated that, due to the pandemic at March 31^st 2020, an estimate range of 1,3–2,2 million people in Europe have had to interrupt their rehabilitation treatments in all phases of their conditions: acute, post-acute and long-term (4).Demographic and epidemiological trends suggest that the key indicators of the health of populations will be affected by the pandemic; not only mortality and morbidity, but also functioning. This, in turn, means that the primary focus of healthcare will need to include the scaling up and strengthening of rehabilitation (5).Furthermore, rehabilitation might benefit any person with rehabilitation needs, patients with any specific health condition(s), persons with any specific impairment, activity limitations and/or participation restrictions, from any cause, at any stage of illness or age. Rehabilitation might be delivered in any location (e.g. rural area, urban area, community, centralized, decentralized); in any mode of service delivery (e.g. inpatient or outpatient settings, day hospital, day services, home and community rehabilitation, telerehabilitation); and there is also consensus that rehabilitation must include habilitation, pre-habilitation, acute, sub-acute postacute and long-term chronic rehabilitation care (6).The objectives that a rehabilitation service plans and aims to achieve include: recovery; improvement of health status; optimizing functioning, such as improving self-care; returning to normal life; returning home; returning to work; improving quality of life services; increasing hospital discharge rates; and decreasing complications and hospital readmissions (6). As a consequence of the current pandemic, there is a need to identify barriers and facilitators to providing rehabilitation services, and to develop new sets of skills to meet the varied needs in these different settings (7).Even during a pandemic, rehabilitation is one of the 5 key health strategies (5). Rehabilitation is an essential part of the continuum of care, prevention, promotion, treatment, and palliation, and should therefore be considered an essential component of integrated health services (8). Rehabilitation is part of universal health coverage, which ensures all people in need, including people with disabilities, reach and maintain an optimal functioning level in interaction with the environment (9).The main aim of this study is to describe the adaptations to rehabilitation services proposed by scientific and professional rehabilitation organizations for the rehabilitation care of patients with and without COVID-19 in both inpatient and outpatient settings. The secondary objectives are to describe preventive measures to reduce the spread of COVID-19, and regulatory measures for protecting health workers and patients’ rights.     

STUDY OF THE PARTNERS OF WOMEN WITH HUMAN PAPILLOMAVIRUS INFECTION

Background. Genital human papillomavirus (HPV) infection is one of the most common sexually transmitted diseases, and it has been identified as a significant risk factor for the development of dysplasia and cancer of the uterine cervix. The possible influence of male HPV lesions on female cervix oncogenesis has not been elucidated so far. In the present study we evaluate the male partners of women with clinical or subclinical HPV infection with particular interest in the clinical features of this infection in both partners. Methods. We examined 81 male partners of women affected with human papillomavirus infections. Condylomata acuminata were searched for by visual inspection. Subclinical lesions were searched by 5 power optical magnification lens after application of 5% acetic acid. Results. In men we observed the following percentage of infection: 67% of the partners of women affected with condylomata acuminata, 46% of the partners of women affected with subclinical lesions (acetic acid positive), and 40% of the partners of women with association of HPV and cervical intraepithelial neoplasia. Conclusions. Our data stress that very often the partners of women with HPV subclinical infection, especially when associated with CIN, do not present lesions, and consequently primary prevention may be very difficult.     

Interactions of Monoamine Oxidase Inhibitors,N-Acetylenic Analogues of Tryptamine,with Rat Liver Microsomal Cytochrome P450

Abstract— Interactions between some novel and potent monoamine oxidase inhibitors (MAOIs), acetylenic analogues of tryptamine, and rat liver microsomal cytochrome P450 (P450) as evidenced by visible spectra analysis were analysed. Compounds with a secondary aliphatic amine moiety throughout induced type II difference spectra and exhibited the highest affinity for P450, whereas tertiary amines induced type I spectral changes and showed diminished affinity. P450 dependent aniline hydroxylase activity was inhibited by all compounds in an irreversible time-dependent manner. Only tertiary aliphatic amines constituted the substrate for P450-dependent N-demethylase activity, with comparable kinetic parameters. The N-demethylated metabolites were identified by thin-layer chromatography and mass-spectrometric analyses. These findings describe the role of P450-dependent microsomal mono-oxygenase systems in the metabolism of some MAOI acetylenic tryptamine derivatives and the possible hepatic contribution to adverse interactions between MAOIs, endobiotics and sympathomimetic compounds.     

LONG-TERM FOLLOW-UP OF''CURED''PROLACTINOMA PATIENTS AFTER SUCCESSFUL ADENOMECTOMY

The long-term follow-up (greater than or equal to 4 years) of clinical, hormonal and radiological aspects in 22 'cured' prolactinoma patients after adenomectomy was studied. Dynamic secretion of PRL and TSH was also evaluated, in order to identify the persistence of any underlying abnormality of hypothalamic pituitary control and to predict relapses. A relapse into hyperprolactinaemia was shown in 36% of patients 5-90 months (mean 46) after surgery. This was accompanied by reappearance of clinical symptoms but not by the radiological demonstration of the adenoma in any patients. A significant PRL rise after domperidone, a dopaminergic antagonist drug, was shown in cured patients after surgery (mean +/- SEM peak, 2977 +/- 645 mU/l) but this was markedly lower than that observed in control subjects (5732 +/- 440 mU/l). In fact, normal PRL increments were shown in only 6/16 (37%) patients. TSH hyper-responsiveness to domperidone normalized in only 46% of patients. Similar PRL responses to those obtained with domperidone were shown when a TRH test was given. A relapse into hyperprolactinaemia was observed in six of ten (60%) non-responders to domperidone and in four of seven (57%) non-responders to TRH, whereas six normal responders to domperidone and TRH had not relapsed at that time. Plasma PRL levels during pregnancy showed increments lower than those observed in normal pregnant women only in domperidone and TRH non-responder patients. These results indicate that a relapse into hyperprolactinaemia and a blunted PRL rise during pregnancy were present only in patients with persistently reduced PRL response to dynamic tests.     

Bioorganic stereochemistry. A study of the peptide oxazolones from Z-(Aib)n-OH (n = 2–4) in the solid state*

An investigation of the preferred conformations and modes of self-association of the peptide oxazolones from Z(-Aib-)_n-OH (n = 2–4) in the solid state has been performed by infrared absorption. More detailed information on the peptide oxazolone from Z(-Aib-)₃ OH (2) has been obtained using X-ray diffraction. In this compound the conformations of the first two Aib residues differ substantially, only the N -terminal one being found in the usual 3_10- (or α-) helical region of the Ramachandran map. The C=N-bond of the oxazolone group is not conjugated with the lactone moiety. A very weak intermolecular interaction occurs between the urethane N-H and the carbonyl group of the oxazolone ring.     

Effects of bromocriptine on adenylate cyclase and phosphodiesterase activities of rat striatum

The activity of 2-bromo-α-ergokryptine (bromocriptine) (5 mg kg^?1, i.p.) on adenylate cyclase and on phosphodiesterase (PDE I-PDE II) of rat striatum, has been examined both in vitro and in vivo. In vitro and in vivo bromocriptine stimulated adenylate cyclase activity, but reduced the stimulating effect of dopamine on adenylate cyclase activity. Bromocriptine showed a dose-dependent biphasic action on phosphodiesterases in vitro while in vivo it stimulated them. The results obtained proved bromocriptine to have an agonist-antagonist action at striatal dopamine receptor level, with a relevant effect on the cAMP system.