Bilateral Harvesting of a Fibula Free Flap: Assessment of Morbidity.

PURPOSE: To investigate morbidity related to harversting of bilateral fibula free flap for head and neck reconstruction using subjective and functional tests. METHODS: Patients were retrospectively evaluated using point evaluation system (PES) and balance evaluation systems test (BESTest) questionnaires to assess morbidity related to surgery. RESULTS: Five patients were enrolled in the study. Mean PES scores was 22.2 over 24. Mean overall function assessed with BESTest was 77.6%, and the results were poorest for section I. Sections V and VI had scores of 88% and 83%, respectively, indicating that the sensory balance and gait stability of the patients were compromised only minimally. CONCLUSION: Bilateral harvesting of the fibula free flap is not associated with an increase in long-term morbidity and does not lead to significant functional impairments. Therefore, this procedure should be considered safe, and can be performed without concern regarding morbidity, when bone reconstruction with a fibula free flap is indicated.

Post-COVID-19 Ongoing Symptoms and Health-Related Quality of Life: Does Rehabilitation Matter?: Preliminary Evidence.

OBJECTIVE: Individuals with persisting symptoms after coronavirus disease 2019 have reported a decrease in health-related quality of life. This study explores the outcome of 50 subjects with post-coronavirus disease 2019 ongoing symptoms including "long COVID"(symptoms lasting over 3 mos), after a rehabilitation program focused on three symptoms: fatigue, breathlessness, and pain. The aims were as follows: to assess the feasibility of the program, to observe a possible change in symptoms and quality of life (null hypothesis: no differences in variables before and after treatment), and to investigate a possible relationship between symptoms and quality of life. DESIGN: This is a retrospective observational study. RESULTS: Symptoms intensity measured with numeric rating scale decreased. Mean differences are as follows: breathlessness, -2.91; fatigue, -2.05; and pain, -2.41 ( P > 0.001). Quality of life measured with Euroqol-5D improved. Mean differences are as follows: Euroqol-5D index, 0.104, and Euroqol-5D visual analog scale, 19.21 ( P < 0.001). Effect size of these changings is classifiable as large (Cohen d > 0.8 and <1.3) except for Euroqol-5D index (Cohen d = -0.575), resulting medium (>0.5 and <0.8). Correlation (Pearson r ) between symptoms and Euroqol-5D resulted moderate for pain and fatigue (-0.609 and -0.531, P < 0.001) and low for breathlessness (-0.533, P < 0.001). CONCLUSIONS: Rehabilitation can be feasible and may improve symptoms and quality of life. Further research is needed.

Rehabilitative treatment of patients with COVID-19 infection: the P.A.R.M.A. evidence based clinical practice protocol.

BACKGROUND: The impact of the SARS-CoV-2 on the National Health System (NHS) required a reorganization of the various levels of care, which also involved the rehabilitation reality. AIM OF THE WORK: A clinical practice review of the literature was conducted to provide operational-rehabilitation guidelines adapted to the local reality and to the recent corporate reorganization in the context of the COVID-19 emergency. METHODS: A practice review of the available scientific evidence was regularly conducted from the start of the COVID-19 pandemic to periodically update the clinical practice guidelines. Articles that met the following inclusion criteria were included: studies conducted on human adult subjects with COVID-19 infection, undergoing rehabilitation in any hospitalization setting. RESULTS: The results of this clinical practice update were periodically discussed with colleagues and collaborators in a multi-professional team, in order to guarantee a good clinical practice protocol, named P.A.R.M.A. CONCLUSIONS: The P.A.R.M.A. protocol is the result of a periodic review literature update, which has allowed us to take charge of patients affected by COVID-19 according to the most up-to-date clinical evidences, guaranteeing a shared and uniform treatment within a local reality in an era of health emergency.

Subarachnoid hemorrhage and extrapyramidal symptoms: a case report.

INTRODUCTION: Parkinsonism may occur after brain lesions such as subarachnoid hemorrhage (1), hydrocephalus (2,3), slit ventricle (4), or shunt revision (5).Until now, pathogenesis remains unclear. METHOD: Case Report. RESULTS: We described the case of a 53 years Caucasian male with subarachnoid hemorrhage after anterior communicating artery aneurysm rupture, with subsequent complications and early development of bilateral extrapiramidal symptoms. A DatSCAN showed an impairment of the nigro-sytriatal dopaminergic way. Levodopa therapy induced complete symptoms remission. CONCLUSIONS: Patient developed Parkinson Disease responding to Levodopa. Subarachnoid hemorrhage itself, shunt placement and revision, hydrocephalus, slit ventricle: all of these complications occurred and could be possible causes of shear, torsion, and ischemia of the nigrostriatal projection fibres.