The impact of the COVID-19 pandemic on functional and mental health outcomes after trauma.

BACKGROUND: The COVID-19 pandemic has led to decreased access to care and social isolation, which have the potential for negative psychophysical effects. We examine the impact of the pandemic on physical and mental health outcomes after trauma. METHODS: Patients in a prospective study were included. The cohort injured during the pandemic was compared to a cohort injured before the pandemic. We performed regression analyses to evaluate the association between the COVID-19 pandemic and physical and mental health outcomes. RESULTS: 1,398 patients were included. In adjusted analysis, patients injured during the pandemic scored significantly worse on the SF-12 physical composite score (OR 2.21; [95% CI 0.69-3.72]; P = 0.004) and were more likely to screen positive for depression (OR 1.46; [1.02-2.09]; P = 0.03) and anxiety (OR 1.56; [1.08-2.26]; P = 0.02). There was no significant difference in functional outcomes. CONCLUSIONS: Patients injured during the COVID-19 pandemic had worse mental health outcomes but not physical health outcomes.

Herpes zoster and COVID-19 infection: a coincidence or a causal relationship?

The first cases of COVID-19 were reported in Wuhan, China, in December 2019. Skin manifestations of COVID-19 vary, among which herpes zoster has recently been found to be associated with the infection. We studied the available literature regarding COVID-19-associated herpes zoster (HZ). We searched the PubMed and Scopus databases for available literature till 20th of May 2021 using the following terms: 'Herpes zoster' or 'Varicella zoster virus' and "COVID-19" or "coronavirus disease" or "SARS-CoV-2". This search revealed 87 publications, of which 29 articles met the inclusion criteria. A total of 29 patients had HZ associated with COVID-19 infection. The patients' ages ranged from 7 to 82 years, averaging 56 years. Thirteen patients (45%) were men and 16 (55%) women. We summarized the demographic data, clinical data, comorbidities, treatment used, lymphocyte count, and distribution and timeline of HZ rash in COVID patients. Lymphopenia was prevalent in 86.6% of patients (where lymphocyte data were available). We discuss possible causes of HZ due to COVID-19. More and larger studies are needed to confirm any relationship between these two infections; however, this study may pave the way for similar studies on this topic.

Impact of the COVID-19 Pandemic on Long-term Recovery From Traumatic Injury.

OBJECTIVE: Determine the proportion and characteristics of traumatic injury survivors who perceive a negative impact of the COVID-19 pandemic on their recovery and to define post-injury outcomes for this cohort. BACKGROUND: The COVID-19 pandemic has precipitated physical, psychological, and social stressors that may create a uniquely difficult recovery and reintegration environment for injured patients. METHODS: Adult (≥18 years) survivors of moderate-to-severe injury completed a survey 6 to 14 months post-injury during the COVID-19 pandemic. This survey queried individuals about the perceived impact of the COVID-19 pandemic on injury recovery and assessed post-injury functional and mental health outcomes. Regression models were built to identify factors associated with a perceived negative impact of the pandemic on injury recovery, and to define the relationship between these perceptions and long-term outcomes. RESULTS: Of 597 eligible trauma survivors who were contacted, 403 (67.5%) completed the survey. Twenty-nine percent reported that the COVID-19 pandemic negatively impacted their recovery and 24% reported difficulty accessing needed healthcare. Younger age, lower perceived-socioeconomic status, extremity injury, and prior psychiatric illness were independently associated with negative perceived impact of the COVID-19 pandemic on injury recovery. In adjusted analyses, patients who reported a negative impact of the pandemic on their recovery were more likely to have new functional limitations, daily pain, lower physical and mental component scores of the Short-Form-12 and to screen positive for PTSD and depression. CONCLUSIONS: The COVID-19 pandemic is negatively impacting the recovery of trauma survivors. It is essential that we recognize the impact of the pandemic on injured patients while focusing on directed efforts to improve the long-term outcomes of this already at-risk population.

Urticaria and COVID-19: A review.

The first cases of the coronavirus disease (COVID-19) appeared in Wuhan, China, in December 2019. COVID-19 was declared a pandemic in March 2020. Cutaneous manifestations are among the heterogenous clinical features of the disease, and urticaria is one of the most common skin manifestations reported in COVID-19. We reviewed the literature available regarding COVID-19-associated urticaria. A literature search in the PubMed and Scopus databases was conducted, till the cut-off date of 24th July 2020, using the following terms: "skin" or "cutaneous" or "urticaria" or "urticarial," and "COVID-19" or coronavirus disease. The search resulted in 502 publications. In this review, 30 articles with a total of 202 patients with COVID-19-associated urticaria were included. Patient age ranged from 2 months to 84 years. Gender was reported in 149 patients; of these 96 (64%) were females, and 53 (36%) were males. Of the 105 patients with a determined onset of the disease, 58 (55%) presented with rash preceding or concurrently with the classic COVID-19 symptoms. Urticarial rash was mainly either generalized or distributed on the trunk. Associated respiratory symptoms, level of care, medications used, comorbidities, and duration, and distribution and timeline of urticarial rash were summarized. In this article, we present a review of literature on COVID-19-associated urticaria, which would enable dermatologists and other clinicians to diagnose COVID-19 early in the onset of disease, and prevent viral spread. Additionally, this may also pave the way for further studies on this topic.

COVID-19 patient bridged to recovery with veno-venous extracorporeal membrane oxygenation.

BACKGROUND: In severe cases, the coronavirus disease 2019 (COVID-19) viral pathogen produces hypoxic respiratory failure unable to be adequately supported by mechanical ventilation. The role of extracorporeal membrane oxygenation (ECMO) remains unknown, with the few publications to date lacking detailed patient information or management algorithms all while reporting excessive mortality. METHODS: Case report from a prospectively maintained institutional ECMO database for COVID-19. RESULTS: We describe veno-venous (VV) ECMO in a COVID-19-positive woman with hypoxic respiratory dysfunction failing mechanical ventilation support while prone and receiving inhaled pulmonary vasodilator therapy. After 9 days of complex management secondary to her hyperdynamic circulation, ECMO support was successfully weaned to supine mechanical ventilation and the patient was ultimately discharged from the hospital. CONCLUSIONS: With proper patient selection and careful attention to hemodynamic management, ECMO remains a reasonable treatment option for patients with COVID-19.