Reconstruction surgery in head and neck cancer patients amidst the COVID-19 pandemic: Current practice and lessons for the future.

The coronavirus disease 2019 (COVID-19) pandemic has imposed a radical change in daily life and work routine. In this context, health systems have suffered important and serious repercussions in all fields. Among the changes brought about by the state of global health emergency, adjustments to guidelines, priorities, structures, professional teams, and epidemiological data stand out. In light of this, the oncological field has witnessed several changes in the approach to cancer, whether due to delay in diagnosis, screening deficit, personnel shortage or the psychological impact that the pandemic has had on cancer patients. This article focuses on the management of oral carcinoma and the surgical approaches that oral and maxillofacial specialists have had at their disposal during the health emergency. In this period, the oral and maxillofacial surgeons have faced many obstacles. The proximity of maxillofacial structures to the airways, the need of elective and punctual procedures in cancerous lesions, the aggressiveness of head and neck tumors, and the need for important healthcare costs to support such delicate surgeries are examples of some of the challenges imposed for this field. One of the possible surgical 'solutions' to the difficulties in managing surgical cases of oral carcinoma during the pandemic is locoregional flaps, which in the pre-COVID-19 era were less used than free flaps. However, during the health emergency, its use has been widely reassessed. This setback may represent a precedent for opening up new reflections. In the course of a long-term pandemic, a reassessment of the validity of different medical and surgical therapeutic approaches should be considered. Finally, given that the pandemic has high-lighted vulnerabilities and shortcomings in a number of ways, including the issues of essential resource shortages, underinvestment in public health services, lack of coordination and versatility among politicians, policymakers and health leaders, resulting in overloaded health systems, rapid case development, and high mortality, a more careful analysis of the changes needed in different health systems to satisfactorily face future emergencies is essential to be carried out. This should be directed especially towards improving the management of health systems, their coordination as well as reviewing related practices, even in the surgical field.

eHealth, telehealth, and telemedicine in the management of the COVID-19 pandemic and beyond: Lessons learned and future perspectives.

In this article, we discuss evidence supporting the effective implementation of eHealth, telehealth, and telemedicine during the coronavirus disease 2019 pandemic, with a view towards its permanent future integration in healthcare. We performed a literature search for articles describing the use of telehealth/ telemedicine in the pandemic context using five databases. The articles selected describe the use of telemedicine as its advantages in terms of practicality and cost-effectiveness. This synthesis of articles is applicable to high-, middle- and low-income countries. Some of the notable benefits include breaking down geographical and time barriers, reducing waiting lists and crowding in healthcare facilities, and saving on national healthcare expenditure. However, there are a number of difficulties with the widespread implementation of telemedicine services that mainly relate to bureaucratic and regulatory concerns. Moreover, it is also important to make healthcare professionals and providers aware of the limits of this tool to avoid potential cases of negligence. Patients in turn will have to be made aware of and be educated on the use of this new healthcare modality before it is accepted by them. In the current socio-economic climate, it is therefore essential to implement a telehealth model aimed at efficiency and continuity of healthcare, as well as leading to an improvement in the quality of life of patients, whilst optimising existing resources and reducing costs. In that regard, the adoption of eHealth, telehealth, and telemedicine services should be considered highly timely, despite current existing limitations.

Gastrointestinal Infection Could Be New Focus for Coronavirus Diagnosis.

It's not news to tell you that the coronavirus, known as COVID-19, is a worldwide pandemic. The initial outbreak of this novel virus in Wuhan in the Hubei province of China, first described in December 2019, has since moved on to being declared a pandemic by the World Health Organization. The classic description of COVID-19 is a respiratory illness that manifests with fever, dry cough, and dyspnea on exertion. However, gastrointestinal (GI) complication of COVID-19 is emerging as well. This was observed with similar viral respiratory illnesses, such as severe acute respiratory syndrome (SARS), which emerged in 2003, and the Middle East respiratory syndrome (MERS), which emerged in 2012. In a recently published, single-center case series of 138 consecutive hospitalized patients with confirmed COVID-19, investigators reported that approximately 10% of patients initially presented with GI symptoms, prior to the subsequent development of respiratory symptoms. Common and often very subtle symptoms included diarrhea, nausea, and abdominal pain, with a less common symptom being nonspecific GI illness. New studies are expanding our understanding of the possible fecal transmission of COVID-19. Assessment by polymerase chain reaction (PCR) has provided evidence of the virus in the stool and the oropharynx outside the nasopharynx and respiratory tract. Virus in the stool may be evident on presentation and last throughout the course of illness resolution for up to 12 days after the respiratory virus evidence is gone. In fact, in one of the most recent studies looking at 73 patients, approximately 24% remained positive in their stool for evidence of the virus, though not necessarily infection, after showing negative in respiratory samples. The Centers for Disease Control and Prevention (CDC) recommends that after two negative respiratory tests separated by ≥ 24 hours, patients can be dismissed from having transmissibility infection risk for COVID-19. The potential for fecal-oral transmission of COVID-19 needs to be strongly considered. Considering these cases and the lessons from SARS, many authors recommend that real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from feces should be performed routinely in SARS-CoV-2 patients.

The Effect of High Velocity Low Amplitude Cervical Manipulations on the Musculoskeletal System: Literature Review.

In manual therapy, high velocity low amplitude (HVLA) cervical manipulation techniques are frequently used, but often the physiological and biomechanical effects that can be obtained are not completely clear. The techniques are mostly used for the treatment of biomechanical joint dysfunction, but little is yet known about the possibility of using them in order to achieve better performance on healthy subjects. The objective of the study is to describe how cervical manipulation can impact on a musculoskeletal disorder. A systematic search was carried out on the Pubmed electronic database from the beginning of January to March 2020. Two independent reviewers conducted the screening process through the PRISMA diagram to determine the eligibility of the articles. The inclusion criteria covered randomized controlled trial (RCT) manuscripts published in peer-reviewed journals with individuals of all ages from 2005 to 2020. The included intervention was thrust manipulation or HVLA directed towards the cervical spine region. After reviewing the literature, 21 of 74 articles were considered useful and relevant to the research question. The results of the research show that HVLA techniques, on subjects with musculoskeletal disorders, are able to influence pain modulation, mobility and strength both in the treated area and at a distance. Cervical manipulations are effective in management of cervicalgia, epicondylalgia, temporomandibular joint disorders and shoulder pain. With regard to results on strength in healthy subjects, given the divergent opinions of the authors, we cannot yet state that manipulation can significantly influence this parameter. Cervical manipulations can also have risks for the patient if applied when not appropriate but the frequency of complications due to vertebral manipulation are very low. However, the manipulation techniques might be limited by low patients tolerance or the presence of contraindications. In addition, the optimal number of manipulations to be performed and the long-term benefits produced are unknown.

The Physiotherapy Intervention for Shoulder Pain in Patients Treated for Breast Cancer: Systematic Review.

Pain and joint dysfunction of the upper limb following treatment for mammary carcinoma are defined as the most frequent side effects of surgery for mammary carcinoma by calculating a prevalence range in the USA that varies between 12% and 51% with regard to pain and between 1.5% and 50% for joint dysfunction. This objective of this study was to describe physiotherapy interventions that demonstrate efficacy based on the type of pain present in patients with shoulder pain who have been treated for breast cancer. We conducted a search for relevant publications in the last 10 years (2009-2019) on the PubMed, Medline, CINAHL, and Cochrane databases. The articles obtained were selected on the basis of correlation criteria, with themes concerning shoulder pain after mammary carcinoma and physiotherapy performed to treat this pain. Studies suggest treating musculoskeletal pain through active exercises, joint and tissue mobilization techniques, with accessory joint mobilization and neurodynamics performed by experienced physiotherapists. In order to treat radio-induced and drug-induced neuropathic pain, both aerobic and strengthening exercises are supervised by an experienced physiotherapist and carried out twice weekly for a total of 150 minutes of exercise. Finally, the treatment suggested to deal with chronic pain uses a multidisciplinary approach, including pain education interventions, pharmacological interventions, psychological interventions, and physiotherapy interventions. To conclude. the classification of different types of shoulder pain following mammary carcinoma treatments requires specific and targeted physiotherapy interventions in which active therapeutic exercise has a central role.