Severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) are two previous viral infection outbreaks similar to the current COVID-19 pandemic. Studies that have looked at long-term health problems in survivors of these two outbreaks report reduced lung function and reduced ability to exercise in some survivors up to 6 months after discharge from hospital. Mental health problems including stress, anxiety and depression were observed in up to one-third of survivors at 6 months and beyond. The quality of life was observed to be low even 12 months after discharge from the hospital. Rehabilitation clinicians and services should anticipate similar health problems in survivors of COVID-19, investigate them accordingly and plan suitable and timely treatments to enable best possible recovery and quality of life for them. Objective: To determine long-term clinical outcomes in survivors of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus infections after hospitalization or intensive care unit admission. Data sources: Ovid MEDLINE, EMBASE, CINAHL Plus, and PsycINFO were searched. Study selection: Original studies reporting clinical outcomes of adult SARS and MERS survivors 3 months after admission or 2 months after discharge were included. Data extraction: Studies were graded using the Oxford Centre for Evidence-Based Medicine 2009 Level of Evidence Tool. Meta-analysis was used to derive pooled estimates for prevalence/severity of outcomes up to 6 months after hospital discharge, and beyond 6 months after discharge. Data synthesis: Of 1,169 identified studies, 28 were included in the analysis. Pooled analysis revealed that common complications up to 6 months after discharge were: impaired diffusing capacity for carbon monoxide (prevalence 27%, 95% confidence interval (CI) 15-45%); and reduced exercise capacity (mean 6-min walking distance 461 m, CI 450-473 m). The prevalences of post-traumatic stress disorder (39%, 95% CI 31-47%), depression (33%, 95% CI 20-50%) and anxiety (30%, 95% CI 10-61) beyond 6 months after discharge were considerable. Low scores on Short-Form 36 were identified beyond 6 months after discharge. Conclusion: Lung function abnormalities, psychological impairment and reduced exercise capacity were common in SARS and MERS survivors. Clinicians should anticipate and investigate similar longterm outcomes in COVID-19 survivors.

Background and ObjectiveNeurofeedback (NFB) provides real‐time feedback about neurophysiological signals to patients, thereby encouraging modulation of pain‐associated brain activity. This review aims to evaluate the effectiveness and safety of NFB in alleviating pain and pain‐associated symptoms in chronic pain patients.MethodsMEDLINE, PUBMED, Web of Science and PsycINFO databases were searched using the strategy: (“Neurofeedback” OR “EEG Biofeedback” OR “fMRI Biofeedback”) AND (“Pain” or “Chronic Pain”). Clinical trials reporting changes in pain following electroencephalogram (EEG) or functional magnetic resonance imaging (fMRI) NFB in chronic pain patients were included. Only Randomized‐controlled trials (RCT), non‐randomized controlled trials (NRCT) and case series were included. Effect size was pooled for all RCTs in a meta‐analysis.ResultsTwenty‐one studies were included. Reduction in pain following NFB was reported by one high‐quality RCT, five of six low‐quality RCT or NRCT and 13 of 14 case‐series. Pain reduction reported by studies ranged from 6% to 82%, with 10 studies reporting a clinically significant reduction in pain of >30%. The overall effect size was medium (cohen's d −0.76, 95% confidence interval −1.31 to −0.20). Studies were highly heterogeneous (Q [df = 5] = 18.46, p = .002, I2 = 73%). Improvements in depression, anxiety, fatigue and sleep were also seen in some studies. Common side‐effects included headache, nausea and drowsiness. These generally did not lead to withdrawal of therapy except in one study.ConclusionsNeurofeedback is a safe and effective therapy with promising but largely low‐quality evidence supporting its use in chronic pain. Further high‐quality trials comparing different protocols is warranted to determine the most efficacious way to deliver NFB.SignificanceNeurofeedback is a novel neuromodulatory approach which can be used to reduce the severity of pain and pain‐associated symptoms such as sleep disturbances, mood disturbances, fatigue and anxiety in a number of chronic pain conditions. It has a potential to provide integrative non‐pharmacological management for chronic pain patients with pain refractory to pharmacological agents with high side‐effect profiles. Further high‐quality double‐blinded randomized sham‐controlled trials are needed in order to fully explore the potential of this therapy.

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(1) Objective: The World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) classification is a unified framework for the description of health and health-related states. This study aimed to use the ICF framework to classify outcome measures used in follow-up studies of coronavirus outbreaks and make recommendations for future studies. (2) Methods: EMBASE, MEDLINE, CINAHL and PsycINFO were systematically searched for original studies assessing clinical outcomes in adult survivors of severe acute respiratory distress syndrome (SARS), middle east respiratory syndrome (MERS) and coronavirus disease-19 (COVID-19) after hospital discharge. Individual items of the identified outcome measures were linked to ICF second-level and third-level categories using ICF linking rules and categorized according to an ICF component. (3) Results: In total, 33 outcome measures were identified from 36 studies. Commonly used (a) ICF body function measures were Pulmonary Function Tests (PFT), Impact of event scale (IES-R) and Hospital Anxiety and Depression Scale (HADS); (b) ICF activity was 6-Minute Walking Distance (6MWD); (c) ICF participation measures included Short Form-36 (SF-36) and St George’s Respiratory Questionnaire (SGRQ). ICF environmental factors and personal factors were rarely measured. (4) Conclusions: We recommend future COVID-19 follow-up studies to use the ICF framework to select a combination of outcome measures that capture all the components for a better understanding of the impact on survivors and planning interventions to maximize functional return.

Parry-Romberg syndrome or progressive hemifacial atrophy is vary rare, uncommon, degenerative, poorly understood condition characterized by a slow and progressive atrophy affecting one side of the face. The incidence and the causes of this alteration are unknown. Possible factors that are involved in the pathogenesis include disturbance of fat metabolism, trauma, viral infections, heredity, endocrine disturbances and auto-immunity. The most common complications are: trigeminal neuritis, facial paresthesia, severe headache and epilepsy. Characteristically, the atrophy progresses slowly for several years and become stable after certain time period. After stabilization of the disease multi specialty approach including physician, orthodontic treatment and reconstructive surgery with autogenous fat graft can be performed to correct the deformity. The objective of this article is to accomplish a literature review concerning general characteristics, etiology, physiopathology, differential diagnosis and treatment of progressive hemifacial atrophy.

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Renal arteriovenous malformations are abnormal communications between the intrarenal arterial and venous systems. They are a rare cause of hematuria. Color Doppler ultrasonography, multislice CT angiography, and DSA are important tools for making the diagnosis. We describe the case of a 62-year-old man with renal arteriovenous malformation who presented with gross hematuria.

With a reported incidence of 0.048%, radial artery pseudoaneurysm (PA) is a rare but serious complication of arterial cannulation. We report a case of PA developing after a single puncture of the right radial artery for arterial blood-gas analysis diagnosed by Doppler ultrasound in young male patient. The development of PA after puncture of radial artery for continuous blood pressure monitoring and serial blood-gas analysis has been reported in the past; however, to the best of our knowledge, there is only one case report of development of PA after a single arterial puncture for blood-gas analysis is reported in the past.