Background/Objective: The COVID-19 pandemic has led to a significant increase in the workloads of healthcare workers (HCWs). The fear of contracting the new virus with the frequent medical consequences has affected their mental health. As a result, they are at high risk of compassion fatigue (CF). In this multicentric study, as a primary objective, we evaluate the incidence and/or prevalence of CF in a cohort of Italian nurses and HCWs (hospital-based clinical social workers of neurological patients) who have contracted SARS-CoV-2 infection. Our secondary aim is to evaluate the difference in experiencing CF between subjects with and without long-term COVID. Methods: In this study, 101 HCWs attending three different neurorehabilitation settings (the Neurorehabilitation Unit of the “Bonino Pulejo” Neurolesi Center of Messina, the Neurorehabilitation Department of Crotone, and the Psychiatric Unit of the University Hospital of Messina) were enrolled from May 2021 to May 2023. Data were collected through self-administered semi-structured interviews. Results: We observed high percentages of CF difficulties in both nurses and HCWs, related to mood alteration in 57.7%, headaches in 44.4%, and fatigue in 62%. Higher percentages were found in individuals with long-term COVID-19, including mood alteration in 93.9%, headache in 88.6%, and memory-related problems in 98.5%. Conclusions: The complexity of a patient’s care pathway, especially in chronic disease situations, requires an enormous commitment that can lead to burnout and CF, which should be considered to initiate preventive interventions aimed at helping “those who help”, for the well-being of patients, healthcare teams, and healthcare organizations.

Background/Objectives: Cranioplasty (CP) is the main surgical procedure aiming to repair a morphological defect in the skull. It has been shown that early CP is useful for patients with traumatic brain injury (TBI) to achieve functional recovery, whereas few studies have investigated the clinical effects of ultra-late CP on TBI outcomes. Methods: Here, we describe the clinical course over 2 years of a TBI patient who underwent CP 19 months after fronto-parietal decompressive craniectomy (DC) of a limited size. Results: We found that after ultra-late CP, a meaningful functional recovery (cognitive and motor), with emergence from a minimally conscious state and recovery of functional communication, was revealed. Conclusions: Our preliminary findings contribute to the actual debate on the timing of CP for this neurosurgical procedure’s therapeutic success, as early CP has already been shown.

Gastrocolic fistula is a rare complication of the percutaneous endoscopic gastrostomy (PEG) placement procedure. This complication occurs due to penetration of interposed colon when a PEG tube is placed into the stomach. It can go unrecognized, becoming evident only when a tube replacement is performed or tube migration occurs. We report a case of severe, intractable diarrhea occurring about one month after the PEG procedure in a patient with severe traumatic brain injury. We present our case and discuss its significance with the aim of raising clinicians’ awareness of this rare condition.

Venous thromboembolism (VTE) (deep vein thrombosis and its complication, pulmonary embolism) is a major cause of morbidity and mortality in hospitalized patients and about 7% of these cases are due to immobility secondary to a neurological impairment. Acquired brain injury (ABI) has also been recognized as one of the main risk factors for VTE. Numerous epidemiological studies have been conducted to assess the risk factors for VTE in institutionalized polytrauma patients, although there is a lack of information about neurorehabilitation wards. Since VTE is often undiagnosed, this prospective study aimed to determine the prevalence and clinical characteristics of lower-limb deep venous thrombosis (DVT) in ABI patients at neurorehabilitation admission. Methods: ABI patients were screened for DVT on admission to the intensive rehabilitation unit (IRU) with compression ultrasonography and basal D-dimer assay and were daily clinically monitored until discharge. A total of 127 consecutive ABI patients (mean age: 60.1 ± 17.6 years; 63% male; time from event: 30.9 ± 22.1 days; rehabilitation time in IRU: 84.6 ± 58.4 days) were enrolled. Results: On admission to the IRU, the DVT prevalence was about 8.6%. The mean D-dimer level in patients with DVT was significantly higher than in patients without DVT (6 ± 0.9 vs. 1.97 ± 1.61, p-value = 0.0001). ABI patients with DVT did not show any significant clinical characteristics with respect to ABI without DVT, although a prevalence of hemorrhagic strokes and patients originating from the Intensive Care Unit and Neurosurgery ward was revealed. During the rehabilitation period, patients with DVT showed a significant difference in pharmacological DVT prophylaxis (high prevalence of nadroparin with 27.3% vs. 1.7%, p-value = 0.04) and a prevalence of transfers in critical awards (36% versus 9.5% of patients without DVT, p-value = 0.05). The mortality rate was similar in the two groups. Conclusions: Our research offers a more comprehensive view of the clinical development of DVT patients and confirms the prevalence rate of DVT in ABI patients as determined upon IRU admission. According to our findings, screening these individuals regularly at the time of rehabilitation admission may help identify asymptomatic DVT quickly and initiate the proper treatment to avoid potentially fatal consequences. However, to avoid time-consuming general ultrasonography observation, a more precise selection of patients entering the rehabilitation ward is required.

Iliacus muscle hematoma is a very rare condition in rehabilitation wards. A 35-year-old pregnant woman at seven months with cerebellar hematoma with signs of compression underwent a cesarean procedure together with neurosurgical decompression of the posterior cranial fossa procedure. After a period in an intensive unit without any complications, she was admitted to our neurorehabilitation ward and treated with antihypertensive therapy, heparin, and anti-seizure drugs. During a rehabilitation session, after a bed–wheelchair transfer, she was feeling very unwell suffering from severe right leg pain radiating to the mid-face leg. Despite unremarkable physical evidence (skin appearance, temperature, and peripheral arterial pulse in both legs), imaging data (ultrasound, CT, and MRI) confirmed the presence of a right iliac muscle hematoma (IMH). Enoxaparin was immediately stopped, and bed rest was prescribed in an antalgic position with tramadole acetaminophen for pain control. After a few days, the patient felt well and was discharged without any additional symptoms. Our study demonstrates that, when a sudden severe leg pain develops, IMH should be considered in the differential diagnosis. This finding suggests further research and tailored protocols for rehabilitation in patients at high risk for iliacus muscle hematoma.

Objective: In the last year, a large amount of research has investigated the anti-spike protein receptor-binding domain (S-RBD) antibody responses in patients at high risk of developing severe acute respiratory syndrome because of COVID-19 infection. However, no data are available on the chronic disorder of consciousness (DOC). Methods: Here, we evaluated anti-S-RBD IgG levels after vaccination in chronic DOC patients compared with demographically matched healthy controls (HC) by indirect chemiluminescence immunoassay. All individuals completed a two-dose-cycle vaccination with Pfizer mRNA vaccine (BNT162b2), and antibody responses were evaluated at 30 and 180 days after the administration of the second dose of vaccination. Results: We compared 32 DOC patients with 34 demographically matched healthy controls. Both DOC and HC groups showed a similar antibody response at 30 days, whereas at follow-up (180 days) DOC patients were characterized by lower S-RBD IgG levels with respect to controls. Additional multiple regression analyses including demographical and clinical comorbidities as predictors revealed that age was the only factor associated with the decrease in S-RBD IgG levels at follow-up (180 days). Elderly individuals of both groups were characterized by a reduction in the antibody responses with respect to younger individuals. Conclusions: Our results show an efficacy seroconversion in DOC patients in the first period after vaccination, which significantly declines over time with respect to healthy controls.