Acute hemorrhagic leukoencephalitis after administration of the first dose of ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELDTM) vaccine

Background: Many central and peripheral nervous system complications, following COVID-19 vaccination, have been described. We report an unusual case of central demyelinating disorder, following the administration of the ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELDTM) vaccine. Case-report: The 28-year female developed sudden onset headache followed by weakness of the left upper and lower limbs, and gait ataxia. Neurological symptoms developed two weeks after administration of the first dose of the ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELDTM) vaccine. Magnetic resonance imaging brain revealed T2/FLAIR hyperintense lesions involving bilateral subcortical white matter, splenium of the corpus callosum, and both cerebellar hemispheres. Few lesions showed blooming on gradient echo sequence suggestive of a hemorrhagic component. Post-contrast T1 images showed mild enhancement of demyelinating lesions. The patient was treated intravenously with methylprednisolone. After 12 weeks of follow-up, there was a substantial improvement in her symptoms. She became independent in all her activities of daily living. Conclusion(s): In conclusion, this is an unusual case of acute hemorrhagic leukoencephalitis following ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELDTM) vaccination.Copyright © 2022 The Author(s)

Evaluating the Effectiveness of Extracorporeal Shockwave Lithotripsy (ESWL) for Ureteric Stones During COVID-19 Pandemic - A Single Centre Experience

Aim Reliance on ESWL for treating ureteric stone has increased during the COVID-19 pandemic. We examined the outcomes for ureteric stones treated with our on-site lithotripter to assess the success rate and determine the variables that could affect the outcome results. Method A retrospective review using electronic records and images of patients who underwent ESWL for ureteric stones (January to December 2020). Univariate and multivariate analysis used to determine stone-free rate predictors (Stone Free rate/SFR: No residual stones on post-ESWL imagining). Results A total of 36 patients underwent ESWL for ureteric stones. Mean age was 58 years (21–90), and mean stone size was 8 mm (5–20). Stones were located in the proximal (67%) or lower ureter (33%). Overall SFR was 64% (67% proximal, 33% distal). 64% of patients required only one session to be stone free, with 60% stone free after two sessions. Stones <10mm had a SFR of 67%, compared to 58% for stone >10 mm. The only statistically significant predictor was stone size (longest dimension, p=0.04). No statistical significance with stone location (P=0.09), skin-to-stone distance (SSD) (P=0.7), stone density (P=0.3) or stone volume (P=0.3). In treatment failure, time to definitive ureteroscopy was 4 weeks. Conclusion Our overall SFR was slightly lower than expected but comparable to available literature. This data highlights the importance of patient selection for ESWL and would be useful in counselling about local success rate. More than half of the patients required only one session for stone clearance and stone size was the only significant predictor for successful ESWL.

Management of acute ureteric colic in a large tertiary centre during the initial COVID-19 pandemic - How did our practice change?

Introduction & Objectives: Treatment of acute ureteric colic according to current BAUS guidelines can be challenging, particularly during the COVID-19 pandemic. We aim to audit our practice during the initial COVID-19 pandemic. Materials & Methods: A retrospective analysis of 94 patients admitted with ureteric colic during the initial COVID-19 pandemic (March to June 2020). Data was collected from records and outcomes compared to a pre-pandemic audit of our acute stone service (January to June 2018). Results: Patient demographics were comparable: 33 admissions/month (pre-COVID 37), average age 52 years (pre-COVID 53 years), and median stone size 6 mm (pre-COVID 5mm). Septic patients (23%, pre-COVID 17%) underwent ureteric stenting (23%, pre-COVID 17%) or nephrostomy (10%, pre-COVID <1%). For non-septic patients, 46% underwent primary treatment (ureteroscopy:ESWL = 1:1, pre-COVID = 2:1), 24% ureteric stenting (pre-COVID 31%) and 30% conservative management (pre-COVID 34%). Median time to primary ureteroscopy (94% successful) and ESWL (76% successful;1-2 sessions) was 24 hours (target <48 hours). Median time from stent insertion to definite ureteroscopy was 5.8 weeks (pre-COVID 6.6 weeks, target <4 weeks) and subsequent cystoscopic stent removal was 4 weeks (target <2 weeks). For patients managed conservatively, median time to outpatient review was 7.1 weeks (pre-COVID 5.4 weeks, target <4 weeks) and follow-up imaging 8.2 weeks. Conclusions: These results from one of the largest stone units in the UK show, that despite the pandemic, primary stone intervention was still achievable within 24 hours. There was a greater reliance on ESWL and nephrostomy insertion due to concerns regarding general anaesthesia and COVID-19.

Acute management of ureteric colic in a large tertiary centre;A re-audit and comparison to BAUS guidelines

Introduction: Considerable pressure exists to deliver timely treatment for patients with acute ureteric colic. We conducted a re-audit of our practice measured against BAUS guidelines to determine an improvement in our stone service. Patients and Methods: A prospective analysis of 130 patients admitted over 3 months (October to December 2019) with acute ureteric colic. Data was collected from records and outcomes compared to our previous audit (from 2018). Results: Patient demographics were comparable: admissions 43/month, average age 54 years, median stone size 6mm, stone location (45 % distal-, 36 % proximal-,19% mid-ureteric). Sepsis rates were identical (17%) and managed with stent insertion. For non-septic patients, 51 % (previously 59%) underwent primary treatment (36 ureteroscopy/ stent, 18 ESWL) and 49 % (previously 41%) conservative management. In theatre, primary ureteroscopy was attempted in 75% cases (previously 62%) and successful in 81%. Median time to primary ureteroscopy/stent insertion remained 24 hours;primary ESWL improved to 48 hours (previously 72 hours). Median time from stent insertion to definitive ureteroscopy was 8.9 weeks (previously 6.6 weeks). For patients managed conservatively, median time to outpatient review was 6.7 weeks (previously 5.4 weeks). For ureteric stents, 100 % were removed <2 weeks post-ureteroscopy (previously 89%). Conclusions: Increasing emergency slots for acute onsite ESWL, rates of emergency primary ureteroscopy and introducing nurse-specialist stent removal (Isiris system) have enabled us to achieve primary intervention 48 hours and stent removal <2 weeks. Prolonged waiting times for definitive ureteroscopy and outpatient review remain challenging to address, particularly in the era of COVID-19.

Where are we headed? Diagnosing abnormal head shapes through virtual care visits

Background/Purpose: Since the beginning of the COVID-19 pandemic in early March, there has been a push to expand virtual patient care visits instead of in-person clinic visits. Studies have found that telemedicine can provide efficient triaging, reduction in emergency room visits, and conservation of health care resources and personnel. While virtual patient care has been implicated in providing similar outcomes to traditional face-to-face care, there are a lack of studies on the effectiveness of virtual care visits for patients with abnormal head shapes. This study aims to develop an understanding of whether physicians can accurately diagnose pediatric patients with craniosynostosis or deformational plagiocephaly via virtual care visits, and whether they can determine if affected patients will benefit from helmet correction or if surgical treatment is required. Methods/Description: An IRB-approved retrospective chart analysis over a 4-month period (March 1, 2020, to June 30, 2020) was performed analyzing all pediatric patients (<18 years old) who underwent virtual care calls for diagnosis and treatment of abnormal head shape. Patients were referred to UTPhysicians Pediatric Surgery clinic for evaluation by a member of the Texas Cleft-Craniofacial Team (2 surgeons or 1 physician's assistant). Variables such as patient demographics, diagnosis, and need for confirmation were recorded. Results: Thirty-five patients were identified who fit our search criteria. Out of these patients, 11 (31.43%) cases were diagnosed with craniosynostosis and 22 (62.86%) cases were diagnosed with deformational plagiocephaly. Median age at virtual care evaluation was 14.10 months (IQR 5.729, 27.542) for patients diagnosed with craniosynostosis and 6.51 months (IQR 4.669, 7.068) for patients diagnosed with deformational plagiocephaly. All 11 (100%) patients diagnosed with craniosynostosis were referred for a confirmatory CT scan prior to undergoing surgical intervention and saw an alleviation in head shape postoperatively. Eighteen (81.82%) of patients diagnosed with deformational plagiocephaly were recommended to undergo conservative treatment and the remaining 4 (18.18%) were recommended for helmet therapy. Two cases (5.71%) were unable to be diagnosed virtually. These patients needed a follow-up visit in person to establish a diagnosis and plan of treatment. Conclusions: Virtual care visits are increasing in frequency and this includes consultations for abnormal head shapes. Our study underscores the feasibility of virtually diagnosing and recommending a plan for treatment in pediatric patients with abnormal head shapes, with only 5.71% requiring additional treatment or in-person visits to confirm the diagnosis. This information can be implemented to further our knowledge on the accuracy of diagnosis and treatment options for patients with craniosynostosis and deformational plagiocephaly. Further analyses are needed to quantify the financial and patient-reported outcomes of virtual care visits for these patients.