Managing the Rehabilitation Wave: Rehabilitation Services for COVID-19 Survivors.

The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on the provision of medical care. As the curve progresses and patients are discharged, the rehabilitation wave brings a high number of postacute COVID-19 patients suffering from physical, mental, and cognitive impairments threatening their return to normal life. The complexity and severity of disease in patients recovering from severe COVID-19 infection require an approach that is implemented as early in the recovery phase as possible, in a concerted and systematic way. To address the rehabilitation wave, we describe a spectrum of interventions that start in the intensive care unit and continue through all the appropriate levels of care. This approach requires organized rehabilitation teams including physical therapists, occupational therapists, speech-language pathologists, rehabilitation psychologists or neuropsychologists, and physiatrists collaborating with acute medical teams. Here, we also discuss administrative factors that influence the provision of care during the COVID-19 pandemic. The services that can be provided are described in detail to allow the reader to understand what services may be appropriate locally. We have been learning and adapting real time during this crisis and hope that sharing our experience facilitates the work of others as the pandemic evolves. It is our goal to help reduce the potentially long-lasting challenges faced by COVID-19 survivors.

Effect of Radiofrequency Endometrial Ablation on Dysmenorrhea.

STUDY OBJECTIVE: To examine rates of dysmenorrhea after radiofrequency endometrial ablation in patients with and without known dysmenorrhea symptoms prior to the procedure in a diverse population. DESIGN: Retrospective cohort study (Canadian Task Force classification II-2). SETTING: Academic gynecology practice. PATIENTS: A total of 307 women underwent endometrial ablation between 2007 and 2013 at our institution. Patients who had preoperative and postoperative pain symptom assessments as well as a description of pain timing recorded were included in our analysis. Exclusion criteria were age <19 years and operative biopsy findings consistent with complex atypical hyperplasia. INTERVENTIONS: The difference in preoperative and postoperative rates of dysmenorrhea was evaluated. Demographic information and other outcome variables were used to evaluate factors associated with resolution of dysmenorrhea. MEASUREMENTS AND MAIN RESULTS: A total of 307 patients who underwent radiofrequency endometrial ablation were identified. After exclusions, 296 charts were examined, and 144 patients met our enrollment criteria. The mean age of the study cohort was 45.4 ± 6.2 years; 57 patients (40%) were African American, 16 (11%) had a body mass index (BMI) > 40, and 41 (29%) were of normal weight. Preoperative dysmenorrhea was reported by 100 patients (69%); 48 of these patients (48%) experienced resolution of symptoms postoperatively. Only 3 of the 44 patients (7%) without preoperative dysmenorrhea reported new-onset dysmenorrhea postoperatively. Significantly fewer patients had dysmenorrhea after compared to before radiofrequency ablation (55 of 144 [38%] vs 100 of 144 [69%]; p < .001). Resolution of dysmenorrhea after ablation was associated with reduction in bleeding volume (p = .048) but not with a reduction in frequency of bleeding (p = .12). CONCLUSIONS: Approximately one-half of women who undergo radiofrequency endometrial ablation to treat heavy menstrual bleeding who also have preoperative dysmenorrhea exhibit documented pain resolution after the procedure. Resolution of dysmenorrhea is more likely if menstrual flow volume is decreased postprocedure.

Quintuplets: 5 Cases of NEC. Are There Other Risk Factors?

OBJECTIVE: To review a case of quintuplets with all babies developing necrotizing enterocolitis. METHODS: A retrospective study of preterm quintuplets all developing necrotizing enterocolitis. Clinical outcomes were reviewed. RESULTS: Quintuplets were born at 24 weeks gestation. Each baby developed NEC and was treated. One baby died. Currently the remaining 4 infants are on full enteral nutrition. CONCLUSION: Further studies are needed to better understand this emerging population of multiple birth pregnancy and the frequency of NEC development.

Differential role of temporoparietal junction and medial prefrontal cortex in causal inference in autism: an independent component analysis.

Neuroimaging studies have consistently identified a network of brain regions responsible for making inferences of others' mental states. This network includes the medial prefrontal cortex (MPFC), posterior superior temporal sulcus (pSTS) at the temporoparietal junction (TPJ), and temporal poles. Although TPJ and MPFC are key nodes of the Theory of Mind (ToM) network, their relative functional roles are still debated. This study sought to examine the contribution of these regions in causal attribution and to explore the nature of the ToM network in people with autism spectrum disorders (ASD). Participants watched a series of comic strip vignettes in the MRI scanner, and identified the most logical ending to each vignette, which sometimes required intentional causal attribution. Independent component analysis was done to isolate temporally correlated brain networks. The functional networks for intentional causality included the TPJ and MPFC, with an increased contribution of TPJ. There was also a significant group difference in the TPJ, with reduced response in participants with ASD. These results suggest an increased role of TPJ in intentional causality. In addition, the reduced response in ASD in TPJ may reflect their difficulties in social cognition.