MUSCULOSKELETAL DISORDERS DURING COVID-19 INFECTION: A SURVEY OF HEALTHCARE WORKERS

BackgroundCOVID-19 infection has revealed a considerable number of extra-pulmonary manifestations, especially rheumatological. The detection of these manifestations, which herald the infection, is of great value in the early diagnosis of the disease, especially in health care workers (HCWs) who are at considerable risk of infection. Although myalgia is a common clinical feature of COVID-19, other musculoskeletal disorders (MSDs) have been rarely described.ObjectivesTo describe MSDs during SARS-COV2 infection in HCWs.MethodsProspective descriptive study conducted at the department of occupational pathology and fitness for work of Charles Nicolle Hospital in Tunis, having included the HCWs affected by COVID-19 during the period from 01 September 2020 to 28 February 2021. Data collection was carried out by regular telephone follow-up during the containment period using a pre-established form.ResultsDuring the study period, 656 HCWs were infected with SARS COV 2, of whom 134 (20.4%) had at least one musculoskeletal event. The mean age was 42±9 years with a sex ratio (M/F) of 0.2. The most represented occupational category was nurses (33.6%) followed by health technicians (23.1%). The median professional length of service was 12 [7;20] years. The presence of comorbidity was noted in 58.2% of HCWs. A pre-existing osteoarticular disease was found in 8.2% of cases. Obesity was noted in 25.4% of the population. Active smoking was reported by 14.3% of respondents. A known vitamin D deficiency was noted in 16.5% of patients. Spinal pain was the most reported MSD, present in 87.3% of cases. Low back pain was the most frequent spinal pain (56.7%) followed by back pain (37.4%) and neck pain (5.9%). MSDs of the lower limbs were found in 12.7% of patients. They were represented by gonalgia in 11.9% of cases, ankle pain in 5.2% of cases and hip pain in 4.3% of cases. MSDs of the upper limbs were described by 7.5% of the patients, 92.5% of whom presented with shoulder pain. The median duration of MSDs during COVID-19 was 5 [3;8] days. These manifestations were persistent on return to work in 21.1% of cases.ConclusionKnowledge of the frequency and consequences of musculoskeletal manifestations related to COVID-19 infection is of great importance, particularly in HCWs, in order to optimise management and ensure a rapid return to work.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Fulminant varicella infection complicated by disseminated intravascular coagulation following influenza-A case report

Objectives: Varicella is common infectious disease mainly in childhood, usually is a mild, self-limited illness and complications are usually rare. The incubation period for this disease is generally 14- 16 days but may vary from 7 to 21 days. Varicella in the adults with comorbidities or immunosuppressed children may be severe and prolonged with complications. Method(s): A case report of a 6-year-old girl hospitalized for new-onset manifestations of disseminated vesicular exanthema, the manifestations of which occurred mainly on the chest, back, capillitium, oral cavity, and genital area. The child was suffering from abdominal, knee and lumbosacral pain at that time. The patient's history revealed that 10 days prior to the cutaneous manifestations, she had influenza with bronchopneumonia requiring oxygen therapy, steroids and antibiotics. Result(s): The condition progressed within 48 h, complicated by the development of multi-organ failure, coagulopathy with the development of disseminated intravascular coagulopathy over the course of antiviral, antibiotic and antifungal therapy. Laboratory parameters included high elevation of C-reactive protein, il-6, leukocytosis, neutrophilia and highly elevated liver enzymes. Varicella infection was confirmed by detection of herpes zoster virus - polymerase chain reaction (PCR) from vesicles. The patient received intravenous immunoglobulin therapy at a dose of 2 g/L and fresh frozen plasma, thrombocyte concentrate. The girl was intubated with analogization. Laboratory parameters subsequently revealed high anti CoV-2 positivity, high CoV-2 IgG positivity and negative CoV-2 IgM. The patient's condition did not preclude the course of multisystem inflammatory syndrome in children (MIS-C) corticosteroids were added to the treatment at a dose of 1 mg/kg weight. Patient's condition stabilized after 1 month. Discussion(s): Our case report presents an example of fulminant complicated life-threatening course of varicella. Even in common respiratory infections, we must think about the risk and consequences of coinfections and post-infectious complications such as in our case especially influenza and COVID-19.

BERTOLOTTI SYNDROME: AN UNDER RECOGNIZED CAUSE OF INFLAMMATORY BACK PAIN?

BackgroundBertolotti syndrome describes a lumbosacral transitional vertebra (LSTV) which causes symptoms, usually low back pain. LATV is a congenital anomaly where the L5 vertebra has an unusual morphology. Bertolotti syndrome is an under-recognised condition by clinicians.ObjectivesTo clarify the presentation of Bertolotti syndrome, whether there are features of inflammatory back pain (IBP) and the effect on quality of life.MethodsIn this pilot study, 62 patients with LSTV were identified on imaging (plain x-ray). Imaging was performed for a variety of indications, predominently for back pain. In total, 34 patients agreed to take part, with 18 returning questionnaires. Questionnaires were selected for face vailidity and included: Calin IBP Questionnaire, EQ-5D Questionnaire, Visual analogue pain scale (VAS-P). In view of Covid restrictions all contact was by phone and questionnaires were completed online or returned via post.Plain X-rays visualising the lumbar spine were assessed for radiological features of LSTV.ResultsSeventeen (94%) of the participants (n=18) recorded a VAS-P score >3, indicating a clinically significant level of pain. The mean VAS-P score was 6 (range of 2-9). 89% of respondents scored at least 3/5 in the Calin questionnaire. Of the 5 features of inflammatory back pain in the Calin questionnaire, 4 out of the 5 were reported by most respondents. The exception was ‘improvement on exercise', which was only reported by 18% of respondents. Quality of life was impaired-EQ-5D (mean: 0.503, range -0.074 to 0.796).The commonest radiological abnormality was enlarged transverse process (100%) followed by pseudoarticulation with the sacrum (83%) and scoliosis (33%). Presence of sclerosis and/or osteoarthritis at the pseudoarticulation was associated with worse pain scores. Female respondents reported worse pain.ConclusionThese results suggest Bertolotti syndrome is associated with pain in the majority of patients and affects quality of life,. The character and site of the pain suggests that Bertollotti syndrome should be considered in the differential diagnosis of spondyloarthritis.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsSimon Stebbings Consultant of: Abbvie.Janssen, Ciara White: None declared, Terence Doyle: None declared.

Real-time vibration monitoring and analysis of agricultural tractor drivers using an IoT-based system

Agricultural tractor drivers experience a high amplitude of vibration, especially during soil tillage operations. In the past, most research studied vibration exposure with more focus on the vertical (z) axis than on the fore-and-aft (x) and lateral (y) axes. This study examines how rotary soil tillage affects the vibration acceleration and frequency, and the power spectral densities (PSDs) at the seat pan and head along three translational axes in a real-field multiaxis vibration context. Moreover, this study aimed to identify the characteristics of the seat-to-head transmissibility (STHT) response to identifying the most salient resonant frequencies along the x-, y-, and z-axes. Nine (9) male tractor drivers operated the tractor with a mounted rotary tiller throughout the soil tillage process. In the event of a COVID-19 pandemic, and to respect social distancing, this study developed an Internet of Things (IoT) module with the potential to integrate with existing data loggers for online data transmission and to make the experimentation process more effective by removing potential sources of experimenter errors. The raw acceleration data retrieved at the seat pan and the head were utilized to obtain daily exposure (A(8)), PSDs, and STHT along the x-, y-, and z-axes. The vibration energy was found to be dominant along the z-axis than the x- and y-axes. A(8) response among tractor drivers exceeds the exposure action value explicitly stated by Directive 2002/44/EU. PSDs along the x-, y-, and z-axes depicted the low-frequency vibration induced by rotary soil tillage operation. The STHT response exhibited a higher degree of transmissibility along the y- and z-axes when compared with that along the x-axis. The frequency range of 4-7 Hz may plausibly be associated with cognitive impairment in tractor drivers during rotary soil tillage.

A prolonged pandemic impacts the mental health of orthopaedic patients

Background and aimsMajority of elective orthopaedic operations are postponed to accommodate the reallocation of healthcare resources to combat the pandemic. The aim of this paper is to evaluate the mental state of orthopaedic patients amidst limited orthopaedic management options. The secondary aim of this paper is to identify areas of significant stressors and to provide avenues for improvements.MethodsA survey was administered on patients in outpatient clinics within a tertiary institution from 31 May to 13 June 2021 where government interventions prevented elective orthopaedic surgeries from being performed. Individuals' fatigue level were assessed with Chalder fatigue scale (CFS) and they were surveyed on their areas of stressors.ResultsA total of 160 orthopaedic patients (67 males and 93 females) were surveyed with an average age of 48.3 years old (range 17-88). 65 out of 160 (40.6%) were deemed to be severely fatigued (CFS > 4) with a higher prevalence amongst females than males (47.3% vs 31.3% respectively.) The top three areas identified as stressors included transmitting to family/friends, travel restrictions/quarantine orders and limitation on recreational/social activities (67.5%, 45.6% and 57.5% respectively). 25.6% of the patients indicated that the increased difficulty in accessing healthcare was a stress factor.Discussion and conclusionThere is a high proportion of severe fatigue amongst orthopaedic patients. Combined with postponement of orthopaedic care and treatment, the detrimental effects of a prolong pandemic can be more pronounced on orthopaedic patients. Identified areas of stressors provide avenues for improvements to safeguard the mental health of orthopaedic patients.

A descriptive study of older medical cannabis users in medical cannabis clinics

Introduction: There is a dearth of information on older users (65+ years) of medical cannabis, who may face unique challenges due to altered metabolism with aging, concurrent medication use, and risk of adverse effects. This observational study aimed to describe a large cohort of older medical cannabis users in Canada. Method(s): From Oct 2014 to Oct 2020, a commercial medical cannabis provider based in Canada collected anonymized data for research purposes from patient volunteers. Data included demographic, social, and health details (at intake) and cannabis products, self-perceived changes in symptoms and change in medications (at follow-up, variable duration). Cannabis products were categorized as cannabidiol (CBD) only, tetrahydocannabinol (THC) only or mixed CBD/THC. Of the mixed, formulations could be in 1:1 ratios (CBD+/THC+), predominantly CBD (CBD+/THC-) or predominantly THC (CBD-/THC+). Result(s): In total, 9766 subjects in the older cohort (65+ years old) completed the entire questionnaire (mean age (SD) = 73.6 (6.8) y, 60% female). They represented 23.1% of the total dataset (N = 42,267, mean (SD) =51.5 (16.8) y). The proportion of adults in the older cohort tended to increase over time (pre-2018: 17.6%;2018: 26.7%;2019: 31.2%;2020: 22.7%, when the overall intake decreased from 8869 to 5644). Among the older cohort, 15.5% were previous cannabis users and 67.7% were referred for chronic pain (mainly arthritis, chronic pain, lower back pain). Concomitant analgesic use was common (over-the-counter analgesics: 44.5%;opioids: 28.3%;NSAIDs: 24.5%). 7.9% of the sample (compared to 19.9% in the whole sample) were referred for psychiatric disorders, though 21.4% indicated antidepressant use and 12.3% indicated benzodiazepine use. Another 7% were referred for neurological disorders. Follow-up data were captured in visits (11,992) from 4698 older patients, averaging 2.5 visits per patient. The type of medical cannabis used changed over time, with increasing use of cannabis oil compared to herbal cannabis. In 2020, of 2478 visits, 78.9% use was cannabis oil and 6.7% was herbal forms (pre-2018: 57.6% vs 36.2%). The composition of cannabis oil demonstrated a preference for cannabinoid oil (CBD+) over tetrahydrocannabinol (THC+) in 6043 visits: 45.2% were using CBD+ preparations, only 3.2% were using THC+ preparations, and for CBD/THC combinations, CBD predominated (CBD+/THC-: 30.5%;CBD+/THC+: 16.8%;CBD-/THC+: 4.3%). Adverse-effects (7062 visits) included dry mouth (15.8%), drowsiness (8.6%), dizziness (4%) and hallucinations (0.6%). Patients reported improved pain, sleep and mood over time, though 15-20% reported no improvement or worsening. Medication use was mostly unchanged, though 40% of opioid users reported requiring reduced dosages. Conclusion(s): These data were drawn from a large convenience sample. The data suggest an increasing proportion of older users of medical cannabis, though COVID-19 may have affected recent use. Female users comprised a higher proportion, and cannabis oil containing CBD was preferred. Systematic studies of effectiveness and safety in older users of cannabinoids are needed given its increasing use. Funding(s): No funding was received for this work.Copyright © 2021

New Zealanders with low back pain seeking health care: a retrospective descriptive analysis of Accident Compensation Corporation-funded low back pain healthcare service usage

Introduction. Most New Zealanders experience low back pain (LBP) at least once throughout their lifetime and many seek help from the large range of health providers in primary care. Accident Compensation Corporation (ACC) funds a significant proportion of those claims, but which services are they funding and what are the costs? Method. This was a retrospective audit and descriptive analysis of ACC-funded, non-public hospital healthcare service use by people with LBP in New Zealand (NZ). Outcome measures were the healthcare services accessed by people with ACC-funded LBP,the claims (all occurrences for a service that has generated a payment/ year), single contact (with a service), and costs (NZ$) for services between 2009 and 2020. Results. The number of claims for services were 129 000 for physiotherapy, 105 000 for general practitioner and 59 000 for radiology services. Per single contact, elective surgery and radiology services were the most expensive. During 2009-2020, there were 3.3 million ACC claims for LBP with a total cost of NZ$4 billion. Over this time, there was an increase in claims, costs and single contacts. Costs decreased slightly during 2010 due to changes in healthcare funding and in 2020 due to the COVID-19 pandemic. Discussion. Consumers have considerable choice in where they access health care for ACC-funded LBP services. This study shows the services they use most frequently and the cost to NZ for those services. These data can inform service planning for ACC-funded LBP health care in NZ.

Low back pain, lower physical activity, and loneliness associated with decreased frequency of going out during COVID-19 in Japanese older adults

Background: This study investigated the association of frequency of going out with physical activity, low back pain, and loneliness among urban Japanese community-dwelling older adults affected by the coronavirus disease 2019 pandemic. Methods: This cross-sectional study recruited older adults aged 65 and over residing in apartment buildings in an urban area of Japan as participants. The questionnaire comprised items on participants' frequency of going out, musculoskeletal pain, physical activity, mobility, loneliness, and sociodemographic characteristics. Multiple logistic regression analysis was performed to explore the associations of decreased frequency of going out (less than once a week) during the pandemic with musculoskeletal pain, physical activity, and loneliness after controlling for age, sex, living alone, comorbidity, and social activity as confounding factors. Results: This study analyzed 236 older adults (mean age: 75.5 years;females 54.2%) whowent out more than two to three days a week before the pandemic. Participants who went out less than once a week during the pandemic (14%) had more arthritis than those who went out more. They also had a higher prevalence of reduced physical activity, low back pain, gait disability, and loneliness. Additionally, decreased frequency of going out was associated with lower physical activity [adjusted odds ratio (OR) = 3.91, 95% confidence interval (CI): 1.78-8.61], low back pain (OR = 2.79, 95% CI: 1.08-7.24), and loneliness (OR = 1.50, 95% CI: 1.14-1.98). Conclusions: This study indicated that reduced physical activity, loneliness, and low back pain are associated with a decreased frequency of going out during the pandemic among older adults.

THE EFFECTS OF SPINAL STABILIZATION EXERCISES VIA TELEREHABILITATION ON INDIVIDUALS WITH CHRONIC LOW BACK PAIN: A RANDOMIZED CONTROLLED STUDY

BackgroundChronic low back pain is a very common problem worldwide. Reasons such as repetitive problems and lack of a clear treatment cause low back pain to be a serious burden for society [1]. Telerehabilitation provides remote application of rehabilitation services with the developing technology. Especially in the COVID-19 pandemic, the problems experienced in health services have increased the popularity of telerehabilitation services [2].ObjectivesAim in this study is to investigate the effects of spinal stabilization exercises performed remotely with asynchronous video clips on pain, disability, quality of life, trunk flexion range of motion and gait parameters.MethodsA total of 20 individuals with chronic low back pain were included in the study. After recording demographic information, pain levels were evaluated with the Visual Analogue Scale (VAS), disability levels were evaluated with the Oswestry Disability Index (ODI), and quality of life was evaluated with the Nottingham Health Profile (NHP). Trunk flexion range of motion was evaluated with the Valedo ® system (Hocoma, Switzerland), and the spatiotemporal parameters of the gait (step time, cadance) were evaluated with the OPTOGAIT system (OPTOGait, Microgate, Italy). After the evaluation, the individuals were divided into 2 groups. One group did face-to-face progressive spinal stabilization exercises in the clinic, while the other group did the same exercise program remotely with asynchronous videos. The exercise program was 8 weeks, 3 days a week.ResultsThe mean age of the telerehabilitation group (4 M, 5 F) was 41.44 ± 9.74, and their body mass index (BMI) was 26.34 ± 3.1. The mean age of the clinical group (1 M, 8 F) was 41.0 ± 13.0, and their BMI was 27.64 ± 3.55. All parameters were similar in the two groups before treatment. There was a significant difference in parameters except gait parameters in both groups after treatment (p<0.05). In the evaluation between the groups after treatment, the results of the two groups were similar in all parameters (p>0.05) (Table 1).Table 1.Baseline and after treatment characteristics of telerehabilitation and face to face group and comparison of with-in group and between groupTelerehabilitationFace to FaceBaselineAfter Treatmentp valueBaselineAfter Treatmentp valueBetween GroupVAS6.51±1.612.41±1.170.00*6.62±0.952.33±1.980.00*0.79ODI20.66±9.9413.55±100.00*30.22±15.517.11±120.02*0.54NHP131.51±121.2934.0±29.610.01*203.55±60.0763.08±76.240.00*0.66Trunk Flexion Range of Motion99.55±12.24106.55±7.510.04*88.11±15.2694.11±15.180.00*0.09Step length (cm)60.67±9.0764.35±9.580.5153.82±2165.95±9.410.170.54Step Time (sec)0.55±0.040.51±0.080.260.40±0.120.34±0.180.130.06Cadance105.67±9.17106.13±17.460.44103.37±8.64105.31±9.450.670.73ConclusionAccording to the results of our study, it is seen that both methods did not provide any change in gait parameters. However, it has similar effects in reducing pain and disability, improving quality of life, and increasing trunk range of motion. For individuals with chronic low back pain, it seems that remote exercise with asynchronous videos can be as effective a treatment as face-to-face exercise. There is a need for studies to be conducted in a larger population with longer follow-up.References[1] Anderson GB. epidemiological features of chronicles low back pain _ the lance _ 1999;354(9178):581-5.[2] Turolla A, Rossettini G, Viceconti A, Palese A, Geri T. Musculoskeletal physical therapy during the COVID-19 pandemic: is telerehabilitation the answer? Phys. ther. 2020;100(8): 1260-4.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Care seek behavior for low back pain in southern Brazil during the COVID-19 pandemic: a panel data analysis.

BACKGROUND: During the COVID-19 pandemic, people with low back pain (LBP) might have avoided seeking care for their pain. We aimed to investigate how the COVID-19 pandemic has affected LBP care seeking behavior among adults. METHODS: Data from four assessments of the PAMPA cohort were analyzed. Participants who reported experiencing LBP during wave one both before and during social restrictions (n = 1,753 and n = 1,712, respectively), wave two (n = 2,009), and wave three (n = 2,482) were included. We asked participants about sociodemographic, behavioral, and health factors and outcomes related to LBP. Poisson regression analyses were conducted, and data are presented as prevalence ratios (PR) and respective 95% confidence interval (95%CI). RESULTS: Overall, care seeking behavior decreased by half in the first months of restrictions, from 51.5% to 25.2%. Although there was an increase in care seeking behavior observed in the other two assessments (nearly 10 and 16 months after restrictions), it was insufficient to reach pre-pandemic levels. In the first months of restrictions, a similar scenario was observed for specific care, such as general practitioner and exercise professional care, with proportions of pre-pandemic levels reached after 10 and 16 months. Women were more likely to seek care for LBP 10 and 16 months after restrictions (PR 1.30 95%CI 1.11; 1.52, PR 1.22 95%CI 1.06; 1.39, respectively). Also, those participants who worked, were physically active, and reported pain-related disability and high pain levels were more likely to seek care at all time points assessed. CONCLUSION: Overall, care-seeking behavior for LBP significantly decreased in the first months of restrictions and increased in the following months; however, this behavior remained lower than pre-pandemic levels.

A Thorn in his Side

History: A 20 year old D1 men's basketball player with a history of COVID the month prior presented with worsening low back pain. He denied any injury, but reported the pain started as low back discomfort after a basketball game the week prior. He noted a progression and radiation of pain down his right lower extremity to his toes. He had tried physical therapy and dry needling, as well as cyclobenzaprine and naproxen from team physicians with mild improvement. The pain worsened and he went to the ED for evaluation. He was afebrile and had a lumbar radiograph with no acute fracture, grade 1 anterolisthesis of L5 on S1. He was discharged home with norco. Over the next 2 days, he developed chills and in the context of his worsening back pain, his team physicians ordered an MRI. Physical Exam: BMI 26.9 Temp 97.9degree Heart rate: 73 Respiratory rate 14 BP: 124/64 MSK: Spine- Intact skin with generalized pain over lumbar area, worse over the right paraspinal musculature. 5/5 strength of bilateral lower extremity flexion and extension of his hips, knees, and plantar and dorsiflexion of ankles and toes. Bilateral intact sensibility in the sciatic, femoral, superficial, and deep peroneal, sural, and saphenous nerve distributions. Slightly diminished sensibility over the right deep peroneal nerve distribution compared to left. 2/4 patellar and achilles DTRs. No clonus, downgoing Babinski sign. Positive straight leg raise at 45 degrees with the right lower extremity. Differential Diagnosis: 141. Sciatica 142. Lumbar Muscle Strain 143. Disk Herniation 144. Spondylolisthesis 145. Vertebral Osteomyelitis Test Results: CBC:WBC10, HGB13.2, neutrophils 75.7% (red 45%-74%). Unremarkable CMP. CRP =7.31, ESR 23 Blood culture negative, throat culture negative. TB test negative. COVID test negative. Flu test negative. Urine culture and UDS negative. HIV test negative. Procalcitonin of 0.07. IR guided aspiration and bacterial Culture yielded MSSA. MRI w/contrast: showing L1-L4 facet edema concerning for infectious spondylitis, intramuscular, and epidural abscess. Final Diagnosis: Acute intramuscular abscess, vertebral osteomyelitis, with epidural abscess. Discussion(s): Vertebral osteomyelitis is a serious but quite rare disease in the immunocompetent, elite athlete population. Staphylococcus Aureus is the culprit a majority of the time, with only 50% of cases showing neurologic symptoms. This case was unique given the proximity to a dry needling treatment which is the only explainable vector of infection, normal blood cultures in this disease which hematogenously spreads, negativeHIV and other infectious disease testing, and otherwise benign history. Early recognition of this disease yields better outcomes and reduces incidence of severe debility. 5% to 10%of patients experience recurrence of back pain or osteomyelitis later on in life. Outcome(s): Patient was hospitalized and started on Cefepime and Vancomycin. Had an echocardiogram revealing changes consistent with athlete's heart without signs of vegetation on his cardiac valves. Neurosurgery declined to treat surgically. He continued to improve until he was ultimately discharged on hospital day 4 with a picc line and Nafcillin and was later changed to oral augmentin per ID. Follow-Up: By his 6 week follow-up visit with infectious disease and the team physicians, his back pain had completely resolved and was cleared to start a return to play protocol. There was no progression of disease since starting antibiotics, and no recurrence of back pain since treatment.

Factors Related to the Presence of Lowback Pain during Remotework in the Covid-19 Pandemic in Brazil

Objectives: With the new needs that the market and the population presented, there was a need to adopt strategies to make the new work environment as safe and comfortable as possible, preserving the health of workers regardless of the work environment. Given this context, it is extremely important that the workers have knowledge about ergonomics and how environmental factors can affect their work capacity and comfort, factors such as ambient light, noise, air flow, temperature, long period in a static position and inappropriate furniture. The aim of the study was to identify the etiology of low back pain during remote work during the COVID-19 pandemic. Method(s): Two questionnaires were applied, one of them developed by the researchers and the other a disability questionnaire (Roland-Morris Disability Questionnaire-RMDQ) in the form of Google Forms for adults (n = 54) of both sexes, aged over 18 years who were working remotely during the period of the COVID-19 pandemic in Brazil in the year 2021. Result(s): With the application of the questionnaires, it was possible to notice an increase in the emergence and worsening of lowback pain in individuals who performed remote work during the COVID-19 pandemic;this increase related to factors such as: inadequate furniture at home, excessive number of hours in the sitting position using the computer, decrease in regular physical activities and weight gain. Conclusion(s): From the beginning of remote work, during the COVID-19 pandemic, most individuals studied either developed lowback pain or had increased low back pain, resulting in mild disability. These data are preliminary in Brazil;in the future, we seek to expand to a larger number of participants, as well as to create strategies and health-promoting actions for low back pain prevention.

Back pain associated with a new coronavirus infection COVID-19

The article describes a clinical case of a patient with pain in the lower back after suffering a coronavirus infection COVID-19. The purpose of the observation was to study the association of COVID-19 with pain in the lower back, as well as the compliance of complaints and the clinical picture with the criteria for diagnosing postcoid syndrome. Possible therapy strategy developed. The use of NSAID Meloxicam (Amelotex), myoreraxant Tolperisone (Calmirex), and the antioxidant Cytoflavin contributed to a rapid regression of symptoms and an improvement in the patient's general condition. There were no reported side effects or complications of therapy. Additionally, no correction of antihypertensive therapy was required.Copyright © 2022, Media Sphera Publishing Group. All rights reserved.

Some key aspects of telemedicine development to support human illness: a systematic review

The aim of this research is to describe the use of telemedicine applied to patients characterised by a particular state of illness, which often drives them toward a frail and chronic status, in a systematic manner. This work employed the Tranfield approach to carry out a systematic literature review (SLR), in order to provide an efficient and high-quality method for identifying and evaluating extensive studies. The methodology was pursued step by step, analysing keywords, topics, journal quality to arrive at a set of relevant open access papers that was analysed in detail. The same papers were compared to each other and then, they were categorised according to significant metrics, also evaluating technologies and methods employed. Through our systematic review we found that most of the patients involved in telemedicine programs agreed with this service model and the clinical results appeared encouraging. Findings suggested that telemedicine services were appreciated by patients, they increased the access to care and could be a better way to face emergencies and pandemics, lowering overall costs and promoting social inclusion.Copyright © 2022 Inderscience Enterprises Ltd.

Application of Neoaortoiliac System For Contained Rupture of Mycotic Infrarenal Aortic Aneurysm

Funding: None. Synopsis: 61-year-old male who initially presented to an outside facility with streptococcal pneumoniae meningitis and bacteremia. Of note, he had history of COVID-19 pneumonia a month prior. On hospital day 15, he reported sudden onset lower back pain prompting imaging which demonstrated a contained rupture of an infrarenal aortic aneurysm that had significantly evolved in comparison to admission imaging where his infrarenal aorta had the largest dimension measuring 2.9cm. We present the successful application of neoaortoiliac system (NAIS). Method(s): Proceeding with midline laparotomy we encountered dense adhesive disease due to his history of surgery for colon cancer. After adhesiolysis, we exposed the aorta and aneurysm with severe surrounding inflammatory changes. 20cm of femoral vein was harvested, reversed, and joined for a span of 4cm using an Endo GIA 45mm vascular load to create our neoaorta. Proximal and distal clamp zones were developed. Upon entering the aneurysm, a foul smell was encountered, revealing that the noxious process had destroyed the posterior wall of the aorta and paraspinal tissues. Our neoaorta was anastomosed in end-to-end fashion to the infrarenal aorta and subsequently to the common iliac arteries. Flow was initially restored to the hypogastric arteries and then the external iliac arteries. The retroperitoneum was closed over our repair and covered with omentum. Result(s): On post-operative day 2, he had hematochezia;intraoperatively, the IMA was noted to be 1mm in size, though had brisk back-bleeding and was ultimately ligated. A flexible sigmoidoscopy revealed ischemic sloughing of the sigmoid colon near his previous anastomosis from his colon cancer resection though no transmural necrosis. He remains on high-dose ceftriaxone to complete a 6-week course and metronidazole for 10 days due to his sigmoid mucosal ischemia per infectious disease recommendations. He is now post-operative day 10 and remains in the ICU. Conclusion(s): Mycotic aortic aneurysms constitute 1-1.8% of aortic aneurysms. The standard of treatment is aggressive debridement of involved aortic wall and periaortic tissue, in-situ or extra-anatomic reconstruction, coverage with an omental flap and long-term antibiotic therapy. NAIS is resistant to infection and aneurysmal dilation, however, is a time-consuming procedure with a mean completion time of 8 hours. Dorweiler et al. demonstrated that vascular reconstruction with femoral vein in infected aortoiliofemoral fields has a mortality of 9-10% with negligible rate of late complications (graft stenosis, thrombosis, and dilation) and that venous morbidity after femoral vein harvest is well tolerated. Clagett et al. demonstrated that NAIS fashioned from greater saphenous vein had a failure rate requiring intervention of 64% compared to 0% for those constructed with deep femoral vein. Lastly, it is important to note that our patient was previously COVID-19 positive. This case demonstrates that the sequela of COVID-19 may have been a significant factor in our patient's pathophysiology. As we continue to learn about the effects of COVID-19 on vascular pathology, we must keep a large repertoire of operative techniques at hand in order to treat complex presentations of vascular emergencies. [Formula presented] [Formula presented] [Formula presented] Institution: Orlando Health, Orlando, FLCopyright © 2022

Analysis Factors that Affect Low Back Pain in Medical Students during the Study from Home

Low Back Pain (LBP) is a health problem that affects performance in working. Indonesia is a country affected by the COVID-19 pandemic, so a study from the home policy has been issued. This study aimed to determine the association between the factors that affect LBP in Medical Students at the Faculty of Medicine, University of Mataram during the study from home. This study is an observational analytic study design with the cross-sectional approach. The population of this study is Medical Students, Faculty of Medicine, University of Mataram with total sample of 185 people. Collecting data using questionnaires and analyzed using univariate, bivariate, and multivariate analysis. According to univariate analysis, amount of LBP complaints (53 people). Based on bivariate analysis, the p-value of gender factor (0.000);body mass index factor (0.840);social-economy status factor (0.499);sitting position factors (sitting position while studying factor (0.008), sitting location while studying factor (0.046), chair shape while studying factor (0.286), body position while studying factor (0.037), legs position while studying factor (0.339), back support use while studying factor (0.455), table use while studying factor (0.010), elbows position while studying factor (0.627), stretching between study time factor (0.372), duration in each stretch factor (0.389), time range between stretch factor (0.311)), and sitting duration factor (0.011). Based on multivariate analysis, the strength of the association (OR) to LBP are sitting position factor (sitting position while studying factor) (8.232), sitting duration factor (1.956), and gender factor (0.187). The dominant factors to LBP are gender factor, sitting position factor (sitting position while studying factor), and sitting duration factor. The factor that has the strongest association with LBP is sitting position factor (sitting position while studying factor).Copyright Published by Oriental Scientific Publishing Company © 2023.

Assessing the Predictive Power of Frailty and Life-Space Mobility on Patient-Reported Outcomes of Disability in Older Adults with Low Back Pain.

BACKGROUND: Frailty and decreased life-space mobility are known as risk factors to develop physical limitations leading to disability in older adults with low back pain (LBP). This cross sectional study aimed to investigate the prevalence and predictive power of frailty and life-space mobility on patient-reported outcomes of disability in older adults with LBP. METHODS: The sample comprised 165 older adults with LBP who visited two tertiary care hospitals between December 2021 and February 2022. The participants responded to structured standard questionnaires. Data were analyzed using descriptive statistics and robust logistic regression. RESULTS: More than two-thirds of participants were classified as non-frail (26.67%) or pre-frail (66.67%). Mobility restrictions and minimal to severe disability were identified. Controlling other variables, frailty (OR = 1.74, 95% CI: 1.14-2.64) and restricted life-space mobility (OR = 0.42, 95% CI: 0.26-0.67) were significantly associated with disability. Integrating frailty with life-space mobility evaluations demonstrated the highest predictive power for disability-related LBP (AUC = 0.89, 95% CI: 0.84-0.93). CONCLUSION: Frailty and restricted life-space mobility significantly predicted disability in older adults with LBP. Healthcare professionals should recognize the critical importance of integrating patient-reported outcomes with screening for frailty and life-space mobility limitation to optimize care or tract symptom progression.

Teleexercise for geriatric patients with failed back surgery syndrome.

Introduction: Failed back surgery syndrome (FBSS) is defined as back pain which either persists after attempted surgical intervention or originates after a spine surgery. There is a high risk of perioperative morbidity and a high likelihood of extensive revision surgery in geriatric patients with FBSS or post-laminectomy foraminal stenosis. Methods: There is a need for less invasive methodologies for the treatment of FBSS, such as patient-tailored exercise training, with attention to the cost and special needs of the geriatric patients with FBSS. This commentary will provide some background regarding teleexercise (utilizing an internet-based platform for the provision of exercise-related care) for FBSS and will propose three exercises which are easy to administer over online-based platforms and can be the subject of future investigation. Results: Given the documented benefits of regular rehabilitative exercises for patients with FBSS, the high cost of face-to-face services, and the need for infection mitigation in the wake of the COVID-19 Pandemic, teleexercise may be a practical and cost-beneficial method of exercise delivery, especially for geriatric patients with limitations in mobility and access to care. It should be noted that, prescription of these exercises should be done after face-to-face evaluation by the physician and careful evaluation for any "red flag" symptoms. Conclusion: In this commentary, we will suggest three practical exercise training methodologies and discuss the benefits of teleexercise for geriatric patients with FBSS. Future research should aim to assess the efficacy of these exercises, especially when administered through telehealth platforms.

Investigation of musculoskeletal disorders, physical activity level, sleep quality, and fatigue in health professionals with and without a history of COVID-19.

BACKGROUND: Healthcare workers belong to an occupational group that is at high risk during the coronavirus 2019 (COVID-19) pandemic. The increased workload of healthcare workers and the accompanying psychosocial stress caused by the pandemic can affect musculoskeletal system disorders, physical activity status, sleep quality, and fatigue in this group. OBJECTIVE: To investigate musculoskeletal system disorders, physical activity level, sleep quality, and fatigue in healthcare workers with and without a COVID-19. METHODS: A total of 200 healthcare professionals aged 18-65 years with and without a history of COVID-19 were in the study. Data were collected between January and March 2021. A "Preliminary Evaluation Form", "Extended version of the Nordic Musculoskeletal System Questionnaire (NMQ-E)", "the International Physical Activity Questionnaire-Short Form (IPAQ-SF)" and "the Pittsburgh Sleep Quality Index (PSQI) were used for data collection". RESULTS: It was determined that musculoskeletal system disorders did not differ significantly between healthcare workers with and without a COVID-19 history (p > 0.05). It was found that the number of people with problems in the low-back region was higher in those with a COVID-19 history (p = 0.002). In the sleep duration component, the scores of those who did not have a COVID-19 history were found to be significantly higher than those who did (p = 0.10). In other comparisons, it was determined that there was no significant difference. CONCLUSIONS: It was found that the number of people with problems in the low-back region was higher in those with a COVID-19 history. Those without a COVID-19 history had higher scores in sleep duration parameter.