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Context: The number of pediatric anterior cruciate ligament reconstructions (ACLRs) occurring yearly increased almost 6-fold from 2004-2014. We find it interesting that limited recent data exist on rates of ACL injury and reconstruction in children and adolescents, especially in the context of COVID-19. Objective: Given the effect of the COVID-19 pandemic on youth sports seasons and the postponement of many elective surgeries, we sought to examine the changes in rates of ACLR during this period. Design: Retrospective cohort study. Setting: This study used the Pediatric Health Information System (PHIS) database to identify eligible patients at PHIS-participating hospitals nationwide from January 2016-June 2021, with March 1, 2020, considered the start of the COVID-19 pandemic. Patients or other participants: Using Current Procedural Terminology codes, patients 18 years old and younger who underwent ACLR surgery were identified. Main outcome measure(s): Patient demographics and overall rates of surgery prepandemic and intrapandemic were compared. Data were analyzed using bivariate, mixed-model, and time series analyses. Results: A total of 24 843 ACLRs were identified during this time period. In total, 1853 fewer surgeries than expected were performed after March 2020 given prepandemic trends. Intrapandemic demographics revealed an increase in the proportion of patients who identified as White and with private insurance and a decrease in the proportion who identified as Black and with public insurance. Also, the proportion of ACLRs by region shifted, with more surgeries performed in the Midwest and fewer in the Northeast. In the model adjusted for hospital-level variability, only race and insurance status remained significant. Conclusions: Based on prepandemic trends, fewer patients than projected underwent ACLR once the pandemic began, likely due to a combination of decreased rates of injury and delayed surgery.
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Background: Pulmonary Rehabilitation is a high-impact intervention for IPF but access is limited in India, a problem exacerbated by the pandemic which has seen HBPR become a necessity. Aim(s): To explore the lived experiences of people living with IPF to inform HBPR in Delhi, India. Method(s): Ten semi-structured interviews with Adults with IPF. Data were analysed using thematic analysis. Result(s): Five key themes were developed (Figure): (1) Diagnosis Journey: Experiences before and during diagnosis, including misdiagnosis, and how family, friends and colleagues reacted to diagnosis. (2) Impact of IPF: The physical and psychological impacts on their life. (3) Non-IPF Impact: The impact of COVID-19 infection and restrictions and previous/existing comorbidities. (4) Management of IPF: Strategies to manage symptoms, including exercise and relaxed breathing. (5) HBPR: Perspectives of HBPR, including its advantages and challenges, their goals if they were to participate, and suggestions to the development of a paper HBPR manual. Conclusion(s): Patients living with IPF were positive about HBPR and the development of a paper-based manual to facilitate HBPR. The content of HBPR should be sensitive to the previous negative experiences of diagnosis, the additional impact of non-IPF health issues and challenges of reduced interactions with healthcare professionals.
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Mucormycosis or zygomycosis is a life threatening invasive fungal infection, usually seen in patients with alteration of their immune system. It is a lethal and an aggressive fungal infection caused by the fungi of the order Mucorales. The angioinvasive property of mucormycosis can lead to fatal complications such as intracranial bleed. Acute pancreatitis refers to inflammation of the pancreas which presents mainly as acute pain in the abdomen and is a potentially fatal condition. The association of mucormycosis with acute pancreatitis is rare but dangerous. This case report highlights a case of 32-year-old male patient, with no co-morbidities, who was admitted to an rural central Indian hospital with four days of abdominal pain and two days of headache. Patient appeared to be in good health prior to this event. He was ultimately diagnosed with mucormycosis of paranasal sinus with acute pancreatitis. The patient was treated with intravenous antifungals, antibiotics and fluid therapy along with other supportive measures. Patient later developed intracranial bleed five days after admission, and ultimately succumbed on day seven of admission. After an extensive review of literature it was found that this is the first article to report mucormycosis, acute pancreatitis and intracranial bleed all occurring at once in an immunocompetent male.
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Background: Recreational swimming/diving is the most common physical activity among US children and a significant cause of preventable morbidity across the United States. There are an estimated 50 million Americans that participate in swimming per year, 16 million of whom are children. Despite the popularity of swimming and diving, there are few up-to-date national divingrelated injury analyses, and no comprehensive injury analysis has been performed since the institution of International Swimming Pool •Spa Code (ISPSC) in 2012, which regulate diving equipment and design. This study offers a much-needed update on the national epidemiology of diving-related orthopedic injuries. Methods: The Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) database was queried for patients aged 0-18 from 2008- 2020 who presented to any of the approximately 100 NEISSparticipating emergency departments (EDs) for a diving-related injury. The patient cohort was identified using a search for consumer product code-1278 (diving). Injuries involving diving accessories, running, hitting, or tripping over the diving board, and injuries resulting from contact between two or more divers, were excluded. Infections were excluded. Dive characteristics such as dive height, dive skill, dive direction, and dive sequence were determined from case narratives. Descriptive statistical analysis was performed using Stata 16. Results: From 2008-2020 there were 1,157 cases of diving-related injury corresponding to a national estimate of 35,648 injuries (CI=28,067 - 43,230;Table 1). Children aged 10-14 accounted for 42% of all injuries, while adolescents aged 15-19 accounted for 38%. Nearly twice as many injuries occurred in boys compared to girls (64.2% vs 35.8% of total injuries, respectively). From 2008-2012, there were an average estimated 3,191 injuries per year. From 2013-2019, the yearly average decreased to 2,633 injuries (Figure 1). Due to the COVID-19 pandemic, there were relatively few (1,261) injuries in 2020. Compared to 2012, there were an estimated 1,081 fewer diving injuries in 2013, the first year the ISPSC codes were widely adopted. Lacerations were the most reported diagnosis for all years (24.9% of injuries). The head and neck were the mostinjured body parts (46.4% of injuries), followed by the face (17.4% of injuries), and lower extremities (16.6% of injuries). Concussions and nerve injury accounted for 6.7% and 0.1% of injuries, respectively. When the mechanism of injury was reported, unintentional contact with the diving board or platform was the most common cause (27.2% of injuries). Conclusion: Diving injuries are common in children and adolescents, especially in boys aged 10-19. Since the 2012 adoption of international safety standards for swimming pool design and operation, the average number of yearly divingrelated injuries has fallen by nearly 600 injuries/year. There was a significant reduction in diving-related injury corresponding with the COVID-19 pandemic.
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COVID-19 (Coronavirus infectious disease 2019) denotes an ever changing and varied disease which has crippled the health care systems throughout the world. There have been studies conducted across the globe to establish the important factors for severity and mortality associated with COVID-19. We tried to study the effect of chronic obstructive pulmonary disease (COPD) on the severity as well as outcome of COVID-19. Material and methods: A total of 180 patients with COVID-19 were enrolled in this study and were then screened for history of COPD. There were 49 patients with history of COPD and 131 patients with no history of COPD. Inflammatory markers and HRCT scores were assessed for all the patients and they were followed up to study the outcome. Result: COPD was significantly associated HRCT Score, inflammatory markers and outcome. The mean HRCT Score for patients with COPD was more in COPD group (15.39 +/- 4.65) when compared with Non-COPD group (9.39 +/- 3.98). Mortality was also significantly higher in patients with COPD (67.3%) when compared to the patients without COPD (3.3%). Conclusion: We conclude that COPD is an important factor which has to be considered while treating the patients of COVID-19 especially in the rural India where lockdown restrictions and lack of knowledge have provided hinderance in achieving optimal follow up as there is increased severity and mortality associated with it.
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Background: The use of nebulizers is an important and useful method for delivering drugs to the lungs in patients with various airway and lung parenchymal disorders. Use of nebulization had markedly increased during the COVID-19 pandemic. This had raised concerns about the potential spread of infection to others in the surroundings exposed to the virus dissemination through aerosolized particles. We considered it necessary to ensure appropriate use of nebulizers by primary care physicians and therefore developed a simple nebulization score to decide when to use nebulizers. Methods: An expert working group (EWG) of pulmonologists was formed who using a semi-Delphi method developed a list of variables and a cut-off score. The EWG started with 55 variables developed through an exhaustive review of literature. These were further reduced to smaller number that had the maximum score as well as concordance with the EWG. The scores ranged from 1-10 (completely disagree to completely agree) and only those above 7.5 were selected. Results: A total of 8 variables with the highest scores were selected [Table 1] which had a total maximum score of 40. A score of <15 was suggested to indicate not-to use and >20 to suggest a definite-use of nebulizer. A score between 15-20 was suggested to use as per physician judgement. A separate table of 12 conditions was made where use of nebulizers was mandatory. Conclusion: This first of its kind nebulizer score should be used by primary care physicians to decide which patients should be put on nebulization treatment.
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The year 2019 witnessed a pandemic named COVID-19 caused by infection severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It emerged in Wuhan, China, in December 2019 and has affected millions since then. It led to a global cry for vaccine development. Scientists arrayed the SARS-CoV-2 genome within a month of the outbreak. They used the parallels between SARS-CoV-1 and SARS-CoV-2 to speed up the vaccine preparation. As of now, different types of COVID-19 vaccines are prevailing. © 2022 Biomedical and Biotechnology Research Journal (BBRJ).
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Introduction: Favipiravir has shown promising results for COVID-19 globally. Though many Indian patients have received favipiravir, there is a lack of realworld data for its clinical use by the practicing physicians. Hence, a qualitative survey was conducted to understand real-world use of favipiravir in management of COVID-19. Methods: A cross-sectional, web-based, qualitative survey was conducted between September 2020 to October 2020, among Indian physicians from various specialties involved in COVID-19 care and using favipiravir in their practice. Physicians were provided survey link having a structured questionnaire with 32 questions. They were enquired on- 1) demographics,practice information, 2) place of favipiravir in clinical practice, 3) treatment protocol for mild to moderate COVID-19, 4) dosage and duration of favipiravir, 5) effectiveness of favipiravir, 6) tolerability of favipiravir 7) global efficacy and safety assessment of favipiravir. Results: A total of 500 physicians were contacted, of which 50 physicians completed the questionnaire. 25(50.0%) were from south zone followed by 12(24.0%) from west. . Majority physicians (47, 97.9%) stated that favipiravir was used for COVID-19 in outpatient setting. Favipiravir was considered as the current drug of choice for ' mild COVID-19 with fever(86.6%). All physicians agreed that favipiravir was being used as per the recommended dose.. A total of 75% & 62.5% physicians agreed to observed clinical improvement by around 3-5 days & 5-7 days in symptomatic mild & moderate COVID-19 respectively. Conclusion: Majority of the physicians considered favipiravir to be safe and effective in treatment of mild to moderate COVID-19. © 2021 Journal of Association of Physicians of India. All rights reserved.
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With increasing incidence of Severe Acute Respiratory Distress Virus 2(SARS -CoV -2) in India, there has been growing reports of super infections in post covid 19 period. Long COVID refers to persistence of COVID19 symptoms for weeks to months. While most common manifestation of long COVID is fatigue and ill health, it may lead to development of life-threatening complications like Pulmonary Mucormycosis. We report a case of 54 year young, non-diabetic previously healthy male who had moderate COVID19 treated with low dose steroids and recovered completely, only to present with hemoptysis 3 months later on High Resolution Computed Tomography Scan of the Chest and Rhizopus fungi on bronchoalveolar lavage confirming Post Covid Pulmonary Mucormycosis in non-immunocompromised host. Patient was managed with dual antifungal therapy intravenous Liposomal Amphotericin B and Posaconazole for 3 weeks, followed by oral Posaconazole.
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Ferritin overload is a frequent problem encountered in patients with beta thalassemia amounting to various complications. One of rare but important complication of ferritin overload is ferritin overload induced toxic encephalopathy. Serum ferritin has been recognised as a important marker of inflammation and cytokine storm in COVID19.We present a case of Long COVID syndrome presenting as toxic encephalopathy in a case of beta thalassemia in spite of the patient being compliant to desferroxamine therapy.This report highlights the synergistic effect of Severe Acute Respiratory Syndrome Coronavirus. 2(SARS CoV 2) mediated neuroinflammation through direct viral invasion and the release of inflammatory cytokines including ferritin resulting in toxic encephalopathy in a beta thalassemia major patient who was already prone to develop hyperferritenemia.Ferritin functions as a pro-inflammatory cytokine and it's level increases in both thalassemia and COVID-19 and the index case presented here had both the conditions predisoposing him to develop toxic encephalopathy even after being compliant to deferoxamine therapy. It is important to recognise and treat this condition in order to prevent mortality and morbidity in patients of beta thalassemia who contract COVID19.
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ECAST Or exercise collapse associated with sickle cell trait is a rare phenomenon associated with sickle cell trait and is an important presentation of sickle cell disease in sports medicine. Collapse is seen following vigorous physical activity, which is due to excessive heat, dehydration and other factors associated with physical exercise. This rare syndrome is often missed by the treating physicians as a result of a lack of knowledge about this rare entity leading to massive underreporting. It is important to identify ECAST as a cause of the collapse in young athletes to prevent mortality and morbidity and in order to provide prompt treatment. We report a case of a 25-year-old young male who was a bodybuilder and reported to the gym after a one-year-long break due to lockdown restrictions of COVID19. After a vigorous exercise session, he collapsed in the gym and was brought to the emergency department. After proper history taking and examination, he was suspected to be a case of ECAST due to a history of a similar episode three years back which was treated as a case of exertional syncope with intravenous fluid therapy and a family history of Sickle cell trait with his mother and father both having sickle cell AS Pattern. Ultimately our patient turned out to be a case of Sickle Cell Trait with evidence of AS pattern on Hb electrophoresis and a small-sized spleen visualized on CT Scan of the abdomen. The patient was managed successfully with intravenous fluids and blood transfusion and was discharged in a stable condition. He was counseled about moderating his exercise and is doing well on follow-up.
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Incidence of Dengue has been on the up rise ever since the second wave of the pandemic of COVID19 has ended introducing an old enemy on the frontline to the health care professionals.A 28 year old Gravida 2 Parity 0 Living 0 Abortion 1 with twin pregnancy presented with fever along with chills and retro orbital pain along with body ache since two days in the emergency department with the gestational age of 36 weeks.She tested positive for Dengue NS1 antigen.Patient was having thrombocytopenia and was managed with intravenous fluids,platelet and blood transfusion and was taken for caesarian section and she delivered twins with normal birth weight.During the post operative period the patient went into dengue shock syndrome and which was managed with fluids and inotropic support and patient ultimately recovered and was discharged on day seventeen of admission .This case report emphasises on the importance of prompt detection and management of dengue in a case of high risk pregnancy such as twin pregnancy.After extensive review of literature we found that this is the first case report to report the association of twin pregnancy with dengue shock syndrome making it an important topic of discussion.
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Since 2019, The Coronavirus Disease (COVID19) has emerged as a global health concern. Various kinds of disorders like the vascular involvement along with neurological complications continue to be reported worldwide. In this case report we describe the case of a 28 year old Female who was antenatal (6.5 months) presented with Genereliazed Tonic Clonic Convulsions of duration more than 30 minutes which upon investigations turned out to be a case of subdural bleed and upon Nasopharyngeal swab testing revealed to be COVID19 positive case. Though the patient underwent urgent craniotomy and evacuation of hematoma was done, the patient ultimately succumbed leading to maternal mortality. Thus, this case report is an attempt to draw attention towards the maternal mortality caused due to COVID19 which we tend to overlook.
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With the rapid spread of severe acute respiratory syndrome SARS-CoV2, the incidence of the disease is increasing each day with a higher infectivity rate and unpredictable morbidity and mortality. The second wave in India has higher morbidity and mortality compared to the previous wave of SARS-Cov2. With the increasing trend of screening hypoxic patients with high resolution computed tomography (HRCT) of thorax, treatment modalities, and investigational approaches have changed drastically. Here we report a case of a 31-year-old female who presented to a tertiary care centre in the rural area with a history of fever five days back and a history of breathlessness of 3 days duration and dry cough of 3 days duration. She was hypoxic on admission and later on diagnosed with SARS-Cov2 infection. HRCT thorax revealed a CT severity score of 25/25. She was treated according to standard treatment protocols. The patient was discharged after 46 days with normal oxygen saturation on room air. The aim of this case study is to emphasize the wholesome approach in the management of COVID-19.
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We present a case of term pregnancy which presented with chief complaint of Breathlessness, chest pain as well as a one day history of vomiting. She tested positive for COVID19 through reverse transcriptase polymerase chain reaction of nasopharyngeal swab and the symptoms were attributed to Pneumonia caused due to COVID19.However,the arterial blood gas showed metabolic acidosis with high anion gap. This was a non lactate acidosis with no hypoxemia. Most reasonably the state of pregnancy with increased energy demands along with increased metabolic maternal demand due to infection coupled with maternal starvation had resulted in this Ketoacidosis. In view of non progression of labor caesarian section was carried out and a healthy neonate was delivered. There was an initial improvement in maternal ketoacidosis post partum however optimal management of COVID19 pneumonia required oxygen support and use of corticosteroids. Thus we highlight how an unusual metabolic demands of pregnancy might mimic COVID19.
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The coronavirus disease resulted by infection with severe acute respiratory syndrome-Coronavirus 2 (SARS-CoV-2) was initiated in China in during the end of 2019 and spread exponentially as a global health Pandemic. The current pandemic (COVID-19) caused by SARS-CoV-2 novel coronavirus lead to high mortality and morbidity in terminally ill patients. We present a link between maternal severe acute respiratory syndrome-Coronavirus 2 (SARS-CoV-2) infections in the peripartum period and rapid maternal deterioration with coagulopathy. Also, we wish to draw attention towards the overlap which is significant between the clinical findings of COVID19 and HELLP Syndrome along with importance of persistence of inflammation over 3 months after COVID19 known as "Long COVID".
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Background: A new coronavirus (severe acute respiratory syndrome coronavirus 2;SARS-CoV-2) infection began to spread in China, in early December 2019 and has rapidly spread around the globe. While its effects on respiratory symptoms are well recognized, but its effect on thyroid function test is still unclear. We initiated this study with the aim of comparison of thyroid function of Covid-19 affected individuals with that of unaffected individuals. Methods: Clinical examination, laboratory investigation and computed tomography study (CT severity score) of 50 patients with RT-PCR confirmed covid-19 infection who were tested for thyroid function test during their course of hospitalization in covid positive ward in the department of medicine. Other 50 individual who were admitted in covid negative section of the hospital with acute respiratory symptoms during the same period and were found RTPCR negative were also included in the study as control group. Thyroid profile of these two groups were analysed and compared to each other. Result: During the course of COVID-19, of the patients with COVID-19, 74% (37/50) had more-than normal TSH levels, with a p value of < 0.001. As compared with non-COVID-19 pneumonia patients with the serum TSH levels of the patients with COVID-19 were significantly higher. Conclusion: This supports the effects of SARS-Cov2 on Thyroid gland, thus proving the postulate that COVID19 may be inducing hypothyroidism which is majorly subclinical. None of the patients received thyroid hormone replacement therapy during the course of our study.
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Antibodies against Dengue virus (DENV) have been postulated to act against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV 2) which might reduce the severity of COVID19 in a patient who previously had dengue fever. However, we report a case of 30 year old male who presented with dengue shock syndrome two months after contracting COVID19. The patient had no history of dengue fever in the past and had no IgG antibodies against Dengue Virus whereas he tested positive for IgG SARS CoV 2 antibodies. Therefore, we highlight a rare case of Antibody Dependent Enhancement of Dengue fever as a result of antibodies against SARS CoV2 in a young male which proved to be fatal. In our knowledge this is the first case in the world to report dengue shock syndrome as a result of SARS CoV2 antibodies.
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Deadly secondary infections caused by Rhizopus species leading to mucormycosis have taken the world by storm. Most common presenting features of COVID-19 remain congectival congestion, headache and blurring of vision. However mucormycosis with a fistula manifesting as the primary symptom of COVID-19 is rare and this is the first case report of its kind to best of our knowledge. We report a case of 61 year old female who presented with a pus draining fistula on right side of her face. A Nasopharyngeal swab came positive for COVID-19 by Reverse Transcriptase polymerase chain reaction method. MRI para nasal sinus was suggestive of fungal sinusitis. Debriedment was done for the same and a swab was sent which showed growth of Rhizopus species on culture.