Weekly screening of youth male football players: a 14-week longitudinal investigation of interactions between groin pain and long lever adductor squeeze strength.

OBJECTIVES: To explore relationships between groin pain and adductor squeeze strength in male academy football players over a 14-week period. DESIGN: Longitudinal cohort study. METHODS: Weekly monitoring of youth male football players consisted of reporting groin pain and testing long lever adductor squeeze strength. Players who reported groin pain at any time during the study period were stratified into the "groin pain" group while players who did not report pain remained in the "no groin pain" group. Baseline squeeze strength was retrospectively compared between groups. Players that developed groin pain were examined via repeated measures ANOVA at four timepoints: baseline, last squeeze before pain, pain onset, and return to pain-free. RESULTS: 53 players were included (age 14.4 ±â€¯1.6 years). Baseline squeeze strength was not different between players in the "groin pain" (n = 29, 4.35 ±â€¯0.89 N/kg) versus "no groin pain" group (n = 24, 4.33 ±â€¯0.90 N/kg, p = 0.83). At a group level, players with no groin pain maintained similar adductor squeeze strength throughout 14 weeks (p > 0.05). Compared to baseline (4.33 ±â€¯0.90 N/kg), players with groin pain had decreased adductor squeeze strength at the last squeeze before pain (3.91 ±â€¯0.85 N/kg, p = 0.003) and at pain onset (3.58 ±â€¯0.78 N/kg, p < 0.001). Adductor squeeze strength at the point where pain subsided (4.06 ±â€¯0.95 N/kg) was not different from baseline (p = 0.14). CONCLUSIONS: Decreases in adductor squeeze strength manifest one-week prior to groin pain onset and further decrease at pain onset. Weekly adductor squeeze strength may be an early detector for groin pain in youth male football players.

SARS-CoV-2 Antibody and T Cell Response After Vaccination with or without Intensified Immunosuppression Among Pediatric Renal Transplant Recipients

Purpose: Recent data has shown poor antibody response to SARS-CoV-2 vaccination among adult kidney transplant (tx) recipients, with seroconversion ranging between 22%-58% after two mRNA vaccine doses. Here, we evaluated the antibody and T cell response to SARS-CoV-2 vaccination and evaluate the effects of intensified immunosuppression on such response in pediatric (ped) kidney tx recipients. Method(s): Between April and November 2021, 31 ped renal tx patients (pts)aged 13-22 years old had SARS-CoV-2 spike IgG assessment after receiving 2 doses of SARS-CoV-2 mRNA or 1 dose of viral vector vaccine. Pts were evaluated by their level of immunosuppression: A) standard immunosuppression (tacrolimus, mycophenolate mofetil +/- steroids) or B) intensified immunosuppression (standard immunosuppression + solumedrol pulse, IVIG, rituximab, and/or tocilizumab within 11 months prior to and up to 5 months after SARS-CoV-2 vaccination). A subgroup of 18 pts had SARS-CoV-2 Tc assessment post-vaccination. Result(s): 23 of 31 (74.2%) pts seroconverted at a median assessment time of 83 days (IQR 43-124) post-vaccination. There was no difference in the use of steroid-based or steroid-free immunosuppression between the two groups or the type of vaccine received (Table 1). 15 of 17 (88.2%) of those who received standard immunosuppression seroconverted post-vaccination compared to 8 of 14 (57.1%) in those who received intensified immunosuppression (Table 1;p = 0.10). In a subgroup of pts who had SARS-CoV-2 spike-specific Tc testing, 7 of 7 (100%) in the standard immunosuppression group had positive Tc compared to 7 of 11 (63.6%) in the intensified immunosuppression group (Table 1, p = 0.12). There was no leukopenia or difference in the WBC count in either group at the time of Tc testing (Table 1;p = 0.97). No pts developed symptomatic SARS-CoV-2 infection. Conclusion(s): Ped renal tx recipients appear to have higher rates of seroconversion after the standard 2-dose mRNA or 1-dose viral vector SARS-CoV-2 vaccination compared to adult renal tx recipients. The intensified immunosuppression group appears to have a trend towards lower SARS-CoV-2 spike IgG and Tc conversion, however, results are limited by the small sample size. Larger studies are needed to better understand the humoral and cellular response to SARS-CoV-2 vaccination in this group. (Figure Presented).

TOGETHER FOR THE LONG HAUL: DEVELOPMENT AND UTILIZATION OF A POST-ACUTE COVID- 19 RECOVERY PROGRAM EMBEDDED WITHIN A LARGE, URBAN ACADEMIC GENERAL INTERNAL MEDICINE DIVISION

STATEMENT OF PROBLEM/QUESTION: Post-acute COVID-19 syndrome presents new diagnostic and management challenges for primary care physicians, creating a need for dedicated care for affected patients. DESCRIPTION OF PROGRAM/INTERVENTION: To date, the COVID19 pandemic has infected >300 million people worldwide. It is estimated that more than 50% develop Post-acute COVID-19 syndrome. Symptoms persisting >6 months lead to activity impairment and reduced quality of life. In March 2021, we implemented a Post-acute COVID-19 recovery program embedded in a primary care setting. Using an integrated approach, the program utilizes a patient navigator who performs a standardized intake process and assists with information collection and navigation to specialty care. Social workers assist with mental health/community resource access. Five general internal medicine physicians see referred patients 5 half days a week in multiple locations. Intake visits review patient history, previous testing, and ongoing symptoms, and a standard quality of life evaluation is made with a PROMIS-29 score. Templates use new patient and return visits times of 40 minutes (6 slots) and 20 minutes (2 slots) respectively. Expedited specialty care is achieved through prioritized access within two weeks through collaboration with numerous specialists. Monthly case conferences allow clinicians to connect with specialists, discussing challenging cases and common clinical scenarios (e.g., dysosmia, dysgeusia). Additionally, a support group for patients is being developed, as is an “e-consult” option for primary care physicians to engage with the clinic. MEASURES OF SUCCESS: Referrals to program, patients seen, template fill rate, no show rate, new patient visit lag time, revenue generated, and medical diagnoses treated. Future measures will include interval comparison of PROMIS- 29 scores and utilization of e-consults. FINDINGS TO DATE: There have been 557 formal referrals to the program with 620 total patients seen. 584 (84%) were seen by general internal medicine as first contact. Template utilization: 93% and No-show rate of 7%. Median new patient lag: 28 days. Through December 2021, total charges and payments have been $173,445 and $79,692, respectively. Top 3 procedure codes billed: 99215, 99244, and 99214. Top 5 categories of symptoms by primary diagnostic code billed excluding post viral syndrome (111 patients, 18%): Neurologic (headache, fatigue, inattention, etc) (149 patients, 24%), Respiratory (128, 20%), Cardiac (64, 10%), Psychiatric (59, 9.5%), Loss of taste/smell (24, 4%). Top 5 referrals from program: PT/OT/speech therapy, pulmonary rehab, ENT, sleep medicine, and psychology/psychiatry. KEY LESSONS FOR DISSEMINATION: There is high demand for expertise in treatment of Post-Acute COVID-19 syndrome. Primary care physicians, coupled with dedicated, timely access to specialty care and rehab services can successfully manage patients with post-COVID-19 symptoms.

Afterword

Political philosophy must be rethought as an enterprise and where the world is concerned it simply is untenable with citizens whose worldly interest increasingly spans the globe even from the physical comfort of their homes. The COVID pandemic might mean that people are increasingly isolated in those homes and away from the streets and public forums wherein we typically think that our being with others transpires, but if anything, the way in which we each individually conceive of our existence involves other people ever more intimately than before, as the great majority of people are aware that their own survival now depends on how other people, even halfway around the globe, inhabit physical space. The existential and the psychological are each natural, resulting in the classic conflict between unstoppable force and immovable object. The psychology that metastasizes in terror as well as in more commonplace expressions of narrow self-interest will win out. © 2021 Taylor and Francis.

Single center experience on SARS-CoV-2 testing of symptomatic and asymptomatic pediatric kidney transplant recipients

Purpose: As of late November 2020, there have been 61.5 million cases of SARSCoV- 2 (COVID-19) worldwide resulting in 1.44 million deaths. Despite the outstanding number of cases there is limited data on the incidence of SARS-CoV-2 infection, both symptomatic and asymptomatic, among pediatric (ped) kidney transplant (KTx) patients (pts) and their outcomes. Methods: Between March and November 2020, 33 SARS-CoV-2 RNA RT-PCR tests were performed among 23 ped KTx pts who were maintained on mycophenolate mofetil, tacrolimus, +/- steroids. Pts were tested for SARS-CoV-2 if they had any COVID-19 symptoms, had positive COVID-19 contact, or needed SARS-CoV-2 testing for admission to the hospital or for pre-procedural clearance. No pts were tested more than once during each encounter. Results: Of the 33 SARS-CoV-2 tests performed, 7 (21.2%) were due to pts having one or several COVID-19-like symptoms, while 26 (78.8%) were for pts who had positive COVID-19 contact or needed SARS-CoV-2 testing for admission to the hospital or for pre-procedural clearance. Of the 33 tests performed, there were 3 (9.1%) confirmed cases of COVID-19. Two of the 3 SARS-CoV-2 positive cases had symptoms consistent with infection, compared to one asymptomatic case (p = 0.11). The two positive cases with symptoms were on steroid-free immunosuppression, had estimated GFR (eGFR) of 101 and 60 ml/min/1.73m2, and were 0.9 and 3.1 years post-Tx, respectively. The one asymptomatic case was on steroid-based immunosuppression, had eGFR 85, and was 0.9 years post-Tx. No pts who tested positive for SARS-CoV-2 required hospitalizations. Five of the 7 pts (71.4%) with symptoms consistent with COVID-19 were eventually diagnosed with a different infection (bacterial and/or viral) and all required admission for management. Conclusions: There is a low rate of asymptomatic SARS-CoV-2 (COVID-19) infection among our ped KTx cohort. When infected with SARS-CoV-2, ped KTx pts tend to present with minimal symptoms. In this small cohort, there appears to be no correlation between the time since Tx, eGFR, and the maintenance immunosuppression in relation to whether or not pts were more likely to have symptoms or have more severe disease if infected with SARS-CoV-2. Ped KTx pts with symptoms concerning for COVID-19 with clinical indications for admission were more likely to have alternative diagnoses. Larger studies are needed to understand the prevalence and impact of SARS-CoV-2 infection in the ped KTx population.

Subretinal gene replacement rescues retinal phenotype in BBS10 mouse

Purpose : To assess toxicity and efficacy of subretinal gene replacement in BBS10 mice. Overexpression toxicity in BBS1 mice occurred with gene therapy;BBS1 is part of the BBSome, while BBS10 is part of the BBS/CCT chaperonin complex. Methods : A knock out mouse model of Bardet Biedl Syndrome type 10 (BBS10) was developed. AAV2/5-Bbs10FLAG and AAV2/Anc80-Bbs10FLAG vectors were created. Subretinal 2 ul injections of 1E12, 2E12 or 4E12VG/ml were performed in 62 Bbs10-/-and 12 WT mice. Immunoblotting and immunohistochemistry were utilized to assess protein production and restoration of Bbs10 gene function. ERG, OCT, and visually guided swim assay (VGSA) were used to assess efficacy. Due to COVID-19, long term data was collected only for 12 mice treated with 2E9 or 4E9 AAV2/Anc80-Bbs10FLAG and 3 controls. Results : Neither AAV2/5-Bbs10FLAG nor AAV2/Anc80-Bbs10FLAG were toxic in WT or Bbs10-/-. One month after injection, FLAG was detected in treated, but not untreated Bbs10-/-eyes, documenting presence of BBS10 protein.BBS7,undetectable or barely detectable within photoreceptor cilia in untreated Bbs10 eyes,was present in photoreceptor cilia in treated Bbs10 eyes.VGSA was partially rescued via either AAV2/5 or AAV2/Anc80 treated at P30-P60 when tested in the dark at age 3.5 months(p= 1.36E005)and in both light and dark at age 7 months (p=. <0.0001 light;p= 0.0094 dark). VGSA improvement endured in AAV2/Anc80 treated mice at 9-12 months old(p=0.0113). Treated eyes had higher amplitude ERG than untreated fellow eyes at 10-11.5 months old (highest p=0.0425). OCT at 11-14 months demonstrated presence of outer nuclear layer in 5/11 treated eyes compared to 0/11 untreated fellow eyes and 0/6 untreated control eyes. 5Hz flicker response was not present at any age in untreated Bbs10 (n=18 eyes), but developed in 9 of 12 eyes treated before 4 months old. 4 of 12 treated eyes still had recordable 5 Hz at 11-14 mos, all treated with 4E9. Histology at 11 months demonstrated robust ONL, inner and outer segments with numerous cones, and normal localization of STX3 adjacent to the injection site in 2 treated eyes. Conclusions : In the Bbs10 mouse subretinal gene therapy with AAV2/Anc80-Bbs10FLAG rescues retinal phenotype . Lack of 5 Hz flicker ERG response in untreated eyes was rescued with early high titer gene therapy suggesting that BBS10 plays an early role in cone development and/or function. Human BBS10 clinical trials are needed.