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Background and Aims: The novel coronavirus (COVID-19), discovered in December 2019, has now spread throughout the world. Studies have shown that patients with cancer have a higher risk of COVID-19 and are more likely to develop severe symptoms and progress to exacerbation. Head and neck tumors, as the major disease entities to be encountered in a cancer-specialized hospital, have a large number of cases of complex disorders, and some of them are highly malignant with rapid progress, for which the treatment cannot be delayed. Moreover, the operations involving the mouth, throat and airway are unavoidable during the diagnosis and treatment process of head and neck tumors, which may increase the risk of COVID-19 infection between doctors and patients. Therefore, this study was conducted to mainly investigate the appropriate diagnosis and treatment of head and neck tumors and prevention and control strategies of COVID-19 in a cancer-specialized hospital amid the COVID-19 pandemic. Methods: The clinical data of 38 patients with head and neck malignant tumors admitted for therapy by scheduled appointment in Zhejiang Cancer Hospital from February 1th, 2020 to February 22rd, 2020 were retrospectively analyzed. In our center, the time-phased appointments were implemented, patients were appropriately diverted based on the diagnosis and treatment guidelines and clinical practice, and the hospitalization indications were rigorously adhered to. All admitted patients received surgery or chemotherapy on the premise of exclusion of COVID-19 by detailed epidemiological investigation, nucleic acid detection and chest CT scan. During hospitalization, the epidemic prevention and control measures were strictly implemented, the treatment process was carefully observed, and the temperature monitoring and management were paid particular attention. After discharge, the outcomes of patients were followed up and the patients received medical advice and post-discharge treatment through internet-based hospitals or other online channels. Results: Among the 38 patients with head and neck tumors, 17 cases were males and 21 were females, with an average age of 49 years. There were 21 cases of thyroid cancer, 6 cases of oral malignancies, 3 cases of salivary gland cancer, 2 cases of laryngeal cancer, 2 cases of hypopharyngeal cancer, and 1 case each of cervical esophageal cancer, lymphoma, nasopharyngeal cancer and of angiosarcoma. COVID-19 was excluded in all 38 patients upon admission. Thirty-one patients underwent surgical treatment and the other 7 patients were subjected to chemotherapy. Fever occurred in 3 patients during the process of treatment, which included fever associated with agranulocytosis in 1 case, fever caused by tumor necrosis and infection in 1 case and fever caused by wound infection in 1 case. Patients generally had an uneventful treatment course and recovered well. No COVID-19 infection was found in patients and medical staff during hospitalization and at the end of 2 weeks after discharge from hospital. Conclusion: In the situation of COVID-19 pandemic, rational distribution of patients as well as scientific prevention and control based on the diagnosis and treatment guidelines and clinical practice, making full use of the advantages of "internet + medical service", to protect cancer patients from virus while engage in the fight against the epidemic, providing psychological support to the patients, and minimizing the impact of the epidemic on treatment and ensuring the continuity of treatment are feasible strategies for the clinical treatment of head and neck tumors. © 2020 by the Author(s).
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BACKGROUND CONTEXT: Pediatric spine fractures are an important medical and surgical emergency. PURPOSE: The aim of this study was to assess trends in emergency department visits for pediatric spine fractures. STUDY DESIGN/SETTING: Descriptive Epidemiological Study. PATIENT SAMPLE: A total of 1,930 (national estimate: 49,186) pediatric patients who presented to the emergency room with a spine fracture from 2001 to 2020. OUTCOME MEASURES: Causes of spine fractures, discharge disposition and demographic variables. METHOD(S): The National Electronic Injury Surveillance System (NEISS) database is a probability sample of hospitals in the United States. This sample was stratified and weighted based on ED size, which was used to generate national estimates (NE). The NEISS database from 2001 to 2020 was queried for less than 18 years old who sustained a cervical, thoracic or lumbar spine fracture. The entire cohort was divided by before and after March 11, 2020, which is when the WHO declared the COVID-19 pandemic. RESULT(S): There were 1,930 (NE: 49,186) pediatric patients who presented to the emergency room with a spine fracture from 2001 to 2020. There were 135 (NE:2,807) ED patients in 2020 compared to 110 (NE: 2,161) in 2019 representing a 30% increase compared to the year before. The rate of males with spine fractures decreased (50.88% DC vs. 62.77% BC;p < 0.001). The rate of spine fractures at home increased (30% DC vs. 22% BC;p < 0.001) while rate of spine fractures in a place of recreation decreased (25% DC vs. 34% BC;p < 0.001). Lumbar spine fractures decreased (15% vs. 24%) while cervical and thoracic spine fractures increased (p < 0.001). The amount of ED spine fractures leading to admission decreased (14.69% DC vs 25% BC) while the amount released increased (61% vs. 55%) (p < 0.001). The most decreased three causes of pediatric spine fractures were football (6.84% DC vs. 11.18% BC), stairs (1.72% DC vs. 5.89% BC), and sleds (0.22% DC vs. 4.34% BC) (p < 0.001). The most increased three causes of pediatric spine fractures in the ED were swings (8.57% DC vs. 1.31% BC), horseback riding (10.85% DC vs. 4.35% BC), and ATV vehicles (7.92% DC vs. 1.91% BC) (all p < 0.001). CONCLUSION(S): There was a spike in pediatric spine fractures during the COVID-19 pandemic compared to the year before. Fractures in males, and those related to recreational activities in public places as well as fractures due to football decreased. Fractures at home and in isolated recreational activities such as swings, horseback riding and ATVs increased. FDA DEVICE/DRUG STATUS: This does not discuss or include any applicable devices or drugs. Copyright © 2022
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Category:: Trauma;Ankle Introduction/Purpose:: It has been suggested that the COVID-19 pandemic has led to patients deferring evaluation and treatment of injuries due to fear of contagion. This, in addition to lockdowns and avoidance of outside activities, may have led to a decrease in the recorded incidence of activity-related injuries. The purpose of this study was to evaluate the effect of the 2020 COVID-19 period on Emergency Department (ED) visits for ankle sprains in the United States, including incidence, demographics, and etiology. Methods:: The National Electronic Injury Surveillance System (NEISS) database was queried to identify patients who presented to EDs in the U.S. for ankle sprains between 2001-2020. Population estimates were derived from the U.S. Census Bureau from 2001- 2020 for calculation of incidence in person-years. Chi-square analysis and Wald chi-square tests were performed to assess differences between pre-pandemic (2001-2019) and during-pandemic (2020) periods. Results:: Between 2001 and 2020, a total of 315,545 actual ankle sprains were identified in the NEISS database for an estimated 11,904,243 ankle sprains (610,445.2 per year) among a population at risk of 6,185,494,962 person-years. The estimated incidence of ankle sprains in the general population presenting to EDs was 1.92 per 1000 person-years. When analyzing pre- and during- pandemic cohorts, ankle sprain incidence was significantly lower during-pandemic (1.98 vs 0.89 per 1000 person-years;P<0.001). Additionally, patients that visited EDs for ankle sprains during the pandemic were older (30.5% vs 27.0%;P<0.001), more likely to be female (57.8% vs 51.8%;P<0.001), and more likely to be Asian (0.83% vs 0.44%;P=0.047), Native American (0.62% vs 0.18%;P=0.001), or of Pacific Islander race (0.13% vs 0.04%;P=0.008). Ankle sprains were due to sport-related activities in 38% of patients pre-pandemic, as opposed to 29% of patients during-pandemic (P<0.001). Conclusion:: The incidence of ankle sprains decreased 65% in 2020, probably owing to activity restrictions during the COVID-19 pandemic. This was further supported by a significant decrease in the proportion of ankle sprains due to sport-related activities. Finally, changes in age, gender, and racial patterns were also identified for this injury type.
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Category:: Ankle Introduction/Purpose:: Ankle fractures are common and can potentially lead to devastating consequences if not treated appropriately. The aim of this study was to assess trends in incidence, presentation, causes, and final disposition of emergency department visits for ankle fractures from 2019 to 2020. Methods:: The National Electronic Injury Surveillance System (NEISS) database is a probability sample of hospitals in the United States. This sample was stratified and weighted based on ED size, which was used to generate national estimates (NE). The NEISS databases contains variables such as age, race, drug use, alcohol use, location, disposition, cause, body part, and injury type. The NEISS database from 2001 to 2020 was queried for patients who sustained an ankle fracture. Two cohorts: before COVID-19 (BC) (July 2019 - Dec 2019) and during COVID-19 (DC) (July 2020 - Dec 2020) were compared. Results:: This study assessed 3,350 (NE: 131, 672) total patients who presented to emergency departments around the United States. 1,683 (NE: 17,936) patients presented BC and 1,667 (NE: 64,380) DC, representing a 4% decrease compared to the year before. The median age was 44 (Interquartile Range (IQR) 24-62), with 60% (NE: 79,051) females. On bivariate analysis, the rate of alcohol related ankle fractures increased (1.9% BC vs. 2.6% DC;p<0.001). Further, the number of ankle fractures at school (3% BC vs. 0.7% DC;p<0.001) and during sports (19% BC vs. 14% DC) decreased. Emergency departments visits leading to hospitalization increased (23% BC vs. 24% DC). The top three causes of ankle fracture during COVID-19 were stairs (NE 18,026, 28%), floors (NE 4,635, 7.2%), and skateboards (4.40%). The three largest increases in ankle fracture etiologies during COVID-19 were skateboards (+2.80%), floors (+1.10%), and powered scooters (+0.80%). Conclusion:: There was a decrease in ankle fractures during the COVID-19 pandemic compared to the year before. Drug related fractures increased as did those resulting in hospitalization. Fractures caused by skateboards, powered scooters, and mopeds experienced an increase during COVID-19.
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Since late 2019, COVID-19 has quickly emerged as the newest biomedical domain, resulting in a surge of new information. As with other emergent domains, the discussion surrounding the topic has been rapidly changing, leading to the spread of misinformation. This has created the need for a public space for users to ask questions and receive credible, scientific answers. To fulfill this need, we turn to the task of open-domain question-answering, which we can use to efficiently find answers to free-text questions from a large set of documents. In this work, we present such a system for the emergent domain of COVID-19. Despite the small data size available, we are able to successfully train the system to retrieve answers from a large-scale corpus of published COVID-19 scientific papers. Furthermore, we incorporate effective re-ranking and question-answering techniques, such as document diversity and multiple answer spans. Our open-domain question-answering system can further act as a model for the quick development of similar systems that can be adapted and modified for other developing emergent domains.