ABSTRACT
Background/Purpose: Self-medication (SM) has many risks especially in the older people, due to the high probability of polypharmacy. In this study, we aimed to assess the prevalence of self-medication and to investigate associated factors in older people, who requested home vaccination in Istanbul. SM during SARS-CoV-2 (COVID-19) pandemic was also evaluated in the study. Method(s): This descriptive study was carried out on elderly adults who requested to receive COVID-19 vaccination service at home in a medium-sized district of Istanbul, Turkey between February 22 and March 19. Study data were collected by a questionnaire through face-to-face interviews in the mandatory waiting period after vaccination. Result(s): We observed that 48.7% of the older people used SM. The use of auxilary equipment, especially use of canes/crutches significantly increased the prevelance of SM. SM was significantly higher in the older people who forget drug use, confuse medication time, recommend drugs for others and keep unused/unfinished drugs at home. The most effective factor in choosing SM was that they had used it before. The most common reason for preffering SM was thought of the disease is mild. A 20% of the participants used SM to prevent COVID-19 pandemic. Vitamins (16.4%) were mostly used for SM during COVID-19 pandemic. Conclusion(s): This study shows that the older people had a high rate of self-medication during COVID-19 pandemic. We think that targeted health education and preventive initiatives may be benefical. Copyright © 2022, Full Universe Integrated Marketing Limited. All rights reserved.
ABSTRACT
Introduction: Transient synovitis is a common cause of hip pain in children. Patients present with acute limp, hip pain or referred pain to the knee. The mainstay of treatment consists of antiinflammatory medications and activity limitations. While the exact etiology of transient synovitis is unknown, there has been a noted relationship with an antecedent viral illness. We present one of the first reported cases of transient synovitis caused by COVID-19. Case Description: A 10-year-old male presented with concerns for left knee pain and limp. Five days prior, the patient developed general URI symptoms and was diagnosed with COVID-19, via rapid testing. His maximum temperature was 38.5°C at home and his respiratory symptoms resolved. Two days prior to presentation, he complained of left knee pain, which progressed to limp, and refusal to bear weight. He denied known injuries, trauma, visible bruising, swelling, redness, or warmth. He was afebrile and non-weight-bearing on his left leg, otherwise in no apparent distress. On physical exam, he exhibited full, painless range of motion of left knee, no bony tenderness, effusion, or cutaneous changes. There was refusal to bear weight on left leg, and significant pain with internal rotation of left hip. Lab work revealed there was no leukocytosis. C-reactive protein level and sedimentation rate were unremarkable. Radiographs of bilateral hip and pelvis, and left knee were obtained, which revealed no osseous abnormalities or significant effusion. Patient was given ibuprofen and on follow up exam he exhibited improved discomfort and willingness to bear weight. With a negative workup and clinical improvement, he was discharged with crutches, instructions for supportive care, and outpatient follow-up. Mother reported no complications during his recovery. He was able to wean from the crutches within a few days and returned to his usual gait within 3 weeks. Discussion: Transient synovitis can be clinically distinguished from septic arthritis with features of overall well appearance, lack of swelling or redness to the joint, and normal range of motion with mild pain. For our patient, Kocher criteria were helpful in distinguishing transient synovitis from septic arthritis, as well as the clinical improvement with NSAIDs. A clinical dilemma could occur if elevated inflammatory markers were present, as one might expect with acute COVID-19. Though transient synovitis is thought to be related to a viral etiology, there does not appear to be an increase in cases amidst the pandemic described in published literature. Conclusion: This case illustrates a patient who had COVID-19 with transient synovitis, a previously unreported sequela. When evaluating similar patients, providers should consider the possibility of COVID-19 and ensure appropriate testing and isolation.
ABSTRACT
Background: Acute Transverse Myelitis (ATM) is a very uncommon neurological syndrome, characterized by acute or subacute spinal cord dysfunction that can lead to paresthesias, sensory/autonomic impairment and paralysis. The aetiology is often unclear, but infectious, para-infectious, systemic autoimmune diseases, paraneoplastic, ischemic diseases and drugs are potential causes. Vaccine administration can also trigger an immune response and induce an autoimmune response;however, ATM has rarely been reported as a complication of COVID-19 infections or vaccination. The treatment mainly consists of steroids and plasmapheresis, which often reverses any neurologic symptoms. The therapeutic plasmapheresis is a highly complex procedure. It separates the patient's blood components replacing the plasma removed by solution that can be fresh frozen plasma or albumin, allowing the removal of the autoantibody, immune complex, lipoprotein or endotoxin that's causing the pathology. Aims: Clinical case report. Methods: A 46-year-old male patient, with personal history of hypertension and obesity, 3 weeks after COVID-19 vaccination, presented to the emergency department due to urinary complaints (urgency and pollakiuria), progressive numbness, paresthesias and decreased muscle strength in the lower limbs and decreased sensibility in the perineal region. Physical examination revealed total gait disability, decreased sensation and strength in the right lower limb, loss of sensation and plegia in the left lower limb and urinary incontinence. Initial laboratory workup and CT imaging of the brain, cervical, dorsal and lumbar spine were normal. The patient was admitted to Neurology internment for further study and treatment. During hospitalization, lumbar puncture and MRI of the dorsal and lumbosacral neuraxis were performed, but only allowed us to exclude infectious and compressive etiologies. The inflammatory aetiology was assumed as the most probable, so acute therapy with pulses of methylprednisolone was initiated. In the remaining study, weakly positive anti-MOG (Myelin Oligodendrocyte Glycoprotein) antibodies were detected in the serum. Therapeutic plasmapheresis using a cell separator (which use centrifugal force to separate components according to their density) was proposed as additional therapy. Seven sessions were performed without intercurrences. Results: During acute therapy, there was a partial improvement in sensitivity and strength in lower limbs. The patient started a rehabilitation program with favourable neurological recovery. At the time of hospital discharge, he still needed crutch support for walking and had muscle strength grade 4-/5 bilaterally. Summary/Conclusions: Although the patient maintained some functional limitation and there was not a complete resolution of the neurological symptoms, he showed a good response to acute therapy. The plasmapheresis, by permitting the antibody to be removed faster than would occur by its endogenous clearance, proved to be fundamental in the clinical recovery of the patient. No relationship between COVID-19 vaccination and the event was established.
ABSTRACT
Objective: Whole body electrical garment - Mollii suit delivers sensory input to improve sensorimotor organisation, balance muscle tone, facilitate muscle contraction and reduce pain experience. The aim of this study was to evaluate 4 weeks of Mollii intervention on lower limb strength, gait speed, lower back pain, quality of life and fatigue in a female person with Multiple Sclerosis (pwMS). Methods: Mollii was programmed by physiotherapist and subsequently worn at home for 60 minutes for 4 weeks every second day, by a female participant with primary progressive MS. Participant was walking with 2 elbow crutches. Stimulation parameters: pulse width 25-175 microseconds, constant current at 20 Hertz. Usability and perceived effects were monitored by a weekly phone call. Five time sit to stand (5xSTS) was used for functional lower limb strength, Timed Up and Go test (TUG) to evaluate gait speed, Visual analogue scale 0-10 (VAS) for the perceived back pain, Multiple Sclerosis Impact scale (MSIS29v2) for the quality-of-life and Modified Fatigue Impact scale (MFIS) for patient reported fatigue. Data was collected at baseline (T1) and 4 weeks (T2) later. Results: No adverse effects were reported. Compliance was 100% (14 sessions in 4 weeks). T1: 5xSTS was 20.73 seconds and T2: 12.76, change of 7.97sec., T1: TUG 29.09 sec. T2: 19.97, change of 9.12sec. VAS for pain T1: 6 points, T2: 0, change of 6 points: T1: MSIS29v2 total 86 points), T2: MSIS29v2 total 57 change of 29 points, T1: MFIS total 68 points, T2: 36 points, change of 32 points. Conclusion: This case study provides preliminary evidence of the effect of Mollii treatment for pwMS. High compliance and home usability are additional benefits in the Covid times. Larger studies that include muscle tone assessment will be particularly interesting as Mollii intervention might be an alternative approach to baclofen or surgical interventions.