Unnatural Death Among Covid-19 Tested Positive Individuals: A Retrospective Study

Introducction:-Covid 19 started out as a fast-spreading viral disease, in Wuhan in 2019. Soon, it spread across the globe and WHO declared it a Pandemic. Various countries took various measures to control its spread and transmission. By the time, countries recovered from it, a new wave would come along with different expressions and pathophysiology. When Covid 19 began, various health agencies in India started making protocols and standard ooperating procedures including conducting autopsies in COVID-19 infected bodies. Aims and Objectives:-Aim of our study is to analyze cause of death among all covid 19 positive cases brought for medicolegal autopsies from the time of lockdown for a period of one year. Our aim is to see if there were any factors which could have prevented these deaths. Material(s) and Method(s): A retrospective study of 1 year conducted from 25th March 2020 to 24th March 2021, (1st wave of Covid 19) was done in a tertiary care hospital in Bangalore. (Bowring and Lady Curzon hospital) Results: 39 Covid-19-positive unnatural deaths were handled with the youngest being 18 years old and the oldest beings 83. The majority turned out to be suicides (51.28%), then RTAs, falls, and natural death. The commonest method of suicide was hanging (35.89%), followed by poison consumption, and falling from a height. Conclusion(s): COVID-19 is a viral infection with variable clinical signs and variable fatality rates. There is much to learn about it. However, suicides in COVID-19 cases might not have ended death if some care, timely diagnosis, and treatment were provided.Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.

Mind-body and creative arts therapies for people with aphasia: a mixed-method systematic review

Background: In the context of aphasia rehabilitation, there is a perceived need for interventions with a reduced linguistic demand targeting well-being. Mind-body and creative arts approaches are holistic and person-centred approaches, primarily relying on means other than verbal exchanges and promoting self-regulation strategies. Aim(s): This mixed-method systematic review aimed to evaluate the availability, feasibility and effectiveness of mind-body and creative arts therapies in promoting well-being for people with aphasia. Eight databases were searched using subject headings and keywords. Full-text screening, critical appraisal and data extraction were conducted independently by two reviewers. A segregated synthesis approach was used (i.e., Revised Effect Direction Plot technique and Thematic Synthesis approach). Findings are presented in a narrative and visual form. Main Contribution: Twenty-two studies were included (Mind-body: n = 11;Creative arts: n = 11). Heterogeneity of study design and quality, intervention type, procedures and dosage, outcomes, and level of offered communication support were identified. Improvements were noted across a wide range of well-being outcomes with more consistent positive results for anxiety and communication. One hundred and twenty-eight findings were extracted and synthesised in three broad themes: positive impact on self, empowering multifaceted experience, and relevance of needs-centred adjustments. Conclusion(s): Provisional findings about the benefits of mind-body and creative arts interventions on aspects of well-being for some individuals with aphasia were identified. However, findings are complex and need to be interpreted cautiously. Facilitators and barriers to these therapies are highlighted with related recommendations for practice. This review poses a demand for further research in the field, implementing rigorous methodology and aphasia-specific support to facilitate inclusion and engagement.Copyright © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Pioneering wound treatment in a suffragette military hospital in World War 1

In the face of massive numbers of casualties returning to the UK in World War 1, health services were rapidly reorganized under the leadership of Sir Alfred Keogh. Hundreds of military hospitals were set up. Sir Alfred personally asked two women doctors, both militant suffragettes and members of the British Women's Social and Political Union, to set up and run a hospital in London. This remarkable hospital was to pioneer new antiseptic treatments for wounds. Endell Street Military Hospital was set up in 1915 by doctors Flora Murray and Louisa Garrett Anderson. The hospital was staffed and run solely by women, treating 26 000 patients in 520 beds over the course of the war. One of their most heroic contributions was to the care of wounds in injured soldiers returning from France. Throughout the war wound infections led to the deaths of thousands of soldiers and contributed to significant morbidity such as limb loss in countless others. In 1916 James Rutherford Morrison, Professor of Surgery in Durham, invented bismuth iodoform paste (BIPP) for the treatment of wound infections. The paste has significant antimicrobial properties. The Endell Street doctors contacted Morrison in June 1916 and started using his formulation on injured patients. By early 1917 they had treated > 400 patients with gunshot wounds, compound fractures, septic wounds, through-and-through wounds and foreign body wounds with BIPP, reporting their findings in The Lancet (Garrett Anderson L, Chambers H. The treatment of septic wounds with bismuth-iodoform-paraffin paste. Lancet 1917;189: 331-3). They reported no cases of tetanus or gas gangrene and were able to explain side-effects such as iodine and bismuth poisoning, why it occurred and how it could be avoided. BIPP has been in use constantly since 1916, and is still used today in ear, nose and throat departments, especially for packing nasal cavities. By changing from the traditional eusol (sodium hypochlorite solution) to BIPP Drs Murray and Anderson reduced dressing changes from daily to once every 7-14 days, saving staff time, costs and hugely improving outcomes. These women doctors saved hundreds of lives and pioneered wound treatments that are still used today. Both were awarded the CBE for their services, but sadly the hospital staff were sacked at the end of the war, when the hospital closed. This form of pioneering work, conducted under great strain with limited resources is still to be seen today in the COVID-19 pandemic.

Increased Medical Severity of Trauma Admissions to the Picu during the Covid-19 Pandemic

INTRODUCTION: It has been suggested that the coronavirus-19 disease (COVID-19) pandemic and associated community containment measures led to hesitancy among patients and their parents/guardians to report to hospitals for care. We hypothesized that the clinical condition of trauma patients admitted to the PICU was more severe during the COVID-19 pandemic in 2020 and early 2021 compared to previous years. METHOD(S): We completed a retrospective, crosssectional, study at a tertiary children's hospital by comparing admissions to our PICU between March 2020 - March 2021, during which COVID-19 and community pandemic mitigation measures occurred, to those during the same period in the previous three years. All patients admitted to the PICU for trauma were included. Severity was measured using the pediatric risk of mortality (PRISM) score estimated probability of death. Trauma admissions between COVID-19 and non-COVID-19 epochs were compared using negative binomial regression. Demographic and clinical characteristics of patients admitted during pre-COVID-19 and COVID-19 epochs were compared using Fisher exact and Mann-Whitney U rank sum tests. The normality of data was assessed using the Shapiro-Wilk test. RESULT(S): Total trauma PICU admissions during COVID-19 pandemic months were similar to the same months in the preceding three years (mean 4.5/month, 95%-CI: 3.5 - 5.9/ month vs. mean 3.6/month 95%-CI: 3.0 - 4.3/month, P = 0.133), although overall PICU admissions per month were lower (-19%, P< 0.001). Trauma patients admitted during COVID-19 had estimated median mortality more than twice as high as patients admitted during the non-COVID epoch (1.1%, interquartile range: 0.6 - 1.8% vs. 0.5%, interquartile range: 0.3 - 1.3%, P = 0.002). Age, sex, race and type of trauma (motor vehicle accident/gunshot wound/fall/all-terrain vehicle or bike accident/assault) were similar between the two time periods (all P > 0.05). CONCLUSION(S): These findings suggest that the COVID-19 pandemic was associated with increased severity in pediatric traumatic injuries, and possible hesitation to seek care earlier. These findings add to existing knowledge about increased trauma severity at presentation during a period of communicable disease spread and mitigation measures;these results may provide insight for future outbreak management.

Chicago Pediatric Firearm Deaths During the COVID-19 Pandemic

Background: Pediatric firearm injuries are a major cause of morbidity and mortality. Due to the COVID-19 pandemic, residents of Chicago were placed under a “stay at home” order during the Spring of 2020. The full impact of these “stay at home” orders is unknown, but previous social and economic stressors have been associated with increased rates of violence. Additionally, studies demonstrate increased firearm purchases during this time period, a known risk factor for homicide and suicide. We sought to describe pediatric firearm associated deaths in Chicago during the COVID-19 pandemic and “stay at home” order. Methods: We conducted a retrospective review of the Cook County Medical Examiner's database from January 2016 through December 2020. We collected information on all firearm associated deaths for persons less than 18 years old and compared deaths from 2020 during the COVID-19 Pandemic and Chicago's “stay at home” order to deaths from the previous 4 years to determine if there were differences that occurred during these time periods. Results: During the 5 year period, there were a total of 221 pediatric firearm deaths, 285 firearm homicides and 29 firearm suicides. 2020 had a similar number of pediatric firearm homicides, 67, compared to prior years, range 47-82. The majority of these firearm homicides occurred in Black (76%) children aged 15-17 (74%). There were more firearm homicides in persons aged 1-14 (14) in 2020 compared to prior years (range 3-10). June and July 2020 saw the highest number of firearm homicides per month, 9 and 11. The months during Chicago's “stay at home” order did not see an increase in firearm homicides compared to prior years, 11 compared to range 0-19. 2020 had a greater number of pediatric firearm suicides, 11, compared to prior years, range 2-7. There were more firearm suicides in Black children in 2020, 5, compared to prior years, range 1-2. The majority of firearm suicides occurred in children aged 15-17 (73%). Additionally, 2020 saw more firearm suicides in children aged 10-14, 3, compared to prior years, range 0-2. The months during Chicago's “stay at home” order did not see an increase in firearm suicides compared to prior years, 0 compared to range 0-3. Conclusion: Firearm injuries are a leading cause of death in children. Changes in the epidemiology of pediatric firearm injuries during the 2020 COVID-19 pandemic in Chicago include a similar number of firearm homicides and an increased number of firearm suicides. Black male adolescents continue to be disproportionately affected by both firearm homicide and firearm suicide. There did not appear to be an increase in firearm homicides or firearm suicides during Chicago's “stay at home” order.

SIGNIFICANT CK ELEVATION IN HEAT-EXPOSURE ADULT RHABDOMYOLYSIS WITH CONCURRENT ASYMPTOMATIC SARS-COV2 INFECTION

CASE: A 59 years old male with past medical history of type 2 diabetes presented in August of 2020 after 2 weeks of leg cramps, nausea, and dark urine that followed several weeks of poor fluid intake during his job as a construction worker. Patient reported that he had a similar episode in 2011, and was diagnosed with rhabdomyolysis with a CK value of 3442. Physical examination revealed a blood pressure of 138/79 mmHg, a pulse of 99 beats/min, respiratory rate of 16 breaths/min, temperature of 36.9 °C, and oxygen saturation of 96% on room air. He was alert and oriented, able to ambulate with pain, and no other significant cardiovascular, pulmonary, neurologic, and gastrointestinal findings. Notable elevation of plasma creatinine of 10.23 mg/dL, BUN of 90mg/dL, sodium of 123 mmol/L, potassium of 5.4 mmol/L, bicarbonate of 15 mmol/L, CRP of 115.4, D-dimer of 4305, Ferritin of 7927, Serum myoglobin of 5320 mcg/L, and total CK of 365148 U/L were noted. Nasopharyngeal swab at presentation was positive for Sars-CoV-2. Patient's urine drug/toxicology screen were negative. The patient was placed on intermittent hemodialysis, and IV fluids were administered. Given his unusually high CK level and COVID-19 positive status, viral myositis associated with COVID-19 was initially suspected. Muscle biopsy showed necrotizing myositis, and ANA titer and myositis specific antibodies were negative. Patient's sole complaint continued to be bilateral lower extremity spasm that gradually improved. The patient was discharged 13 days later with improving kidney functions and total CK of 1683. Patient did not follow up until January of 2021 when he presented to our emergency department for a gunshot wound. His kidney function was back to his baseline at the time. IMPACT/DISCUSSION: Multiple reports in the past 2 years have noted some relationship between rhabdomyolysis and SARS-CoV2 infection, including cases of rhabdomyolysis as a presenting and late complication of severe and mild COVID-19 pneumonia (Valente-Acosta et al, Min et al, and Suwanwongse et a). This case shows both an non- respiratory COVID-19 patient presenting with rhabdomyolysis as well as extremely high presenting CK of 365148 in a non-exercise associated adult rhabdomyolysis. While there are studies that suggests SARS-CoV2 can cause a direct viral injury on muscles, patient's muscle biopsy showing necrotizing myositis rather than direct viral injury suggests that this is not the likely mechanism that aggravated the disease. Rather, given that patient had significantly elevated d-dimer, ferritin, and CRP at presentation, the mechanism may be due to the significant inflammatory responses seen in COVID-19 patients. CONCLUSION: COVID-19 infection, regardless of severity, can significantly exacerbate rhabdomyolysis. Proper inpatient management in such cases can lead to no lasting musculoskeletal or renal complications despite severity. The relationship between COVID-19 infection and severe rhabdomyolysis may be based on the inflammatory responses.

Penetrating abdominal trauma: Evaluation in Baghdad during the pandemic Covid-19

Background: Trauma is one of the leading causes of deaths worldwide for all age groups, especially in the younger age group. The purpose of the current study is to assess/analyze the factors for mortality in penetrating abdominal traumas with respect to the total number of intra-abdominal organs injured, related extra-abdominal injuries, gender, type of injury, time of arrival, and amount of blood transfusion needed during the pandemic. Methods: A retrospective study including 523 patients underwent laparotomy in Al-Emamien Al-Kadhimin Medical City from March 2020 to September 2021 for a penetrating abdominal injury due to blast injury, bullet, shrapnel injury, and stab wounds. The study population with penetrating abdominal traumas and indicative abdominal signs was subjected to exploratory laparotomy. Results: In this study, 465 (88.9%) males and 58 (11.1%) females participated;the highest rate was found in small bowel injuries (40.73%) followed by large bowel injuries (21.99%), whereas the lowest rate was found in gallbladder injury (1.34%). Chest injuries represent the highest rate among extra-abdominal injuries (18.36%), whereas head and neck represent the lowest rate (1.34%). Regarding the risk factors affecting the mortality rate, the highest rate of mortality was found in the case of gunshot (13.11%), followed by shrapnel (6.38%) and stab wound injuries (5.26%), which was the lowest. Conclusion: Penetrating abdominal injuries were the most common among males, small bowel injuries are the commonest organs affected by the penetrating abdominal injuries, shrapnel injuries were the commonest causes in our country, and the highest mortality rate was related to gunshot and number of organs affected and delay of arrival to the hospital and number of pints of blood received.

Suicide Among Adults During COVID-19 Pandemic;Rates and Trends

BACKGROUND: Mental health problems were heterogeÂneously increased among the population groups during the COVID 19 pandemic.1 The pandemic promoted existAîng suicide risk factors such as illicit drugs and alcohol use, access to lethal means, and social disconnectedness.2 According to the CDC, 40% of US adults reported sympÂtoms of depression, anxiety, or increased substance use during COVID-19, and 10.7% of the participants reported suicidal ideation.3 OBJECTIVE: This study aimed to compare suicide rates among adult population (18-64 years old) in Marion County, Indiana in 2019 and 2020. METHODS: Data for 2019 and 2020 was ed from coroners' records in Marion County, Indiana. In 2019 and 2020, a cumulative total of 130 and 157 suicide cases were reported, respectively. We identified 104 adult suicide cases in 2019 and 116 adult suicide cases in 2020 with age range of 18 to 64 years. We analyzed the data for age, race, genÂder, job, marital status and the method of suicide. RESULTS: From 2019 to 2020, adult suicides increased by 11.5%, from 104 to 116 cases. In 2019, cases were highest during the month of January (14.4%). Most cases were white (79.8%). The average age was 39.6 years old and male to female ratio was 3.9:1.1. Almost half of the cases (49%) were unemÂployed and 36.5% were employed. Regarding marital status, 47.1% of those died by suicide were never marÂried, 27.8% were married and 19.2% were divorced. Regarding the method of suicide, gunshot wound was the most common method (58.6%), followed by hangAîng (32.6%), drug toxicity, asphyxiation, and sharp force trauma with 1.9% each. In 2020, cases were highest in January (12%) and December (11.2%). In 2019, most cases were white (76.72%). The average age was 35.7 years old and male to female was 8.6:3. About one third of cases (33.6%) were unemployed and 43.1% were employed. Regarding mariÂtal status, the majority (58.6%) were never married, while 23.2% and 13.7% were married and divorced respectively. The most common method of suicide was gunshot wound (63.7%), followed by hanging (24.1%), drug toxicity (4.3%), and asphyxiation (4.3%). CONCLUSION: Suicide rates among adults increased by 11.5% in Marion County, Indiana. While white males had the highest suicide rates during both years, female suicides increased from 20% in 2019 to 26% in 2020. Average age of those who died by suicide was younger in 2020. A rise in suicide was seen in unmarried and employed individuals. Suicide by gunshot wounds and drug toxicity also increased. Our findings echoed the CDC findings.3 Public health measures which target certain population groups such can mitigate suicide rates during a global pandemic.

Suicide Among the Elderly during the Covid-19 Pandemic

BACKGROUND: Suicide behavior among seniors is conÂsidered a significant public health problem across many countries. Its rates in the United States have increased steadily, especially in the life course of older white men, estimated at 48.7/100,000.1 Studies have described many stressors that play a role in attempting or dying by suicide in this age group, e.g., chronic physical ill-ness, mental illness, and social isolation. However, the influence of pandemics on suicide rates is not fully addressed, particularly those with lockdowns and limited social interactions. OBJECTIVE: We aim to study the impact of the COVID-19 pandemic on the rate of suicide among the geriatric populaÂtion in Marion County, Indiana. METHODS: Data for 2019 and 2020 was ed from coroners' records in Marion County, Indiana. In 2019 and 2020, a cumulative total of 130 and 157 suicide cases were reported, respectively. We identified 22 elderly suicide cases in 2019 and 34 elderly suicide cases in 2020 with age range of 65 to 94 years. We analyzed the data for age, race, gender, job, marital status, and the method of suicide. RESULTS: A total of 17% of elderly suicide cases are identiÂfied in 2019 and 22% of elderly suicide cases are identified in 2020. Elderly suicide cases increased by 55% from 2019 to 2020. In 2019, all elderly suicide cases were white, averAâge age was 76 years old, and male to female was 9:2 ~5:1. Approximately 59% of elderly suicide cases were retired, 27% were employed and only 2% were unemÂployed. Regarding marital status, 36% who died by suiÂcide were married, 32% were divorced and 18% were widowed. Most common method of suicide was gunÂshot wound (73%) followed by drug overdose (9%) and hanging (9%). Cases were highest in August (18%) and September (18%). In 2020, almost all elderly suicide cases were white (except one was black), average age was 75.7 years old, and male to female ratio was 10:1. Approximately 56% of elderly suicide cases were retired, 20% were employed, and 20% were unemployed. Regarding marital status, 35% were widowed, 30% were married, and 26% were divorced. Most common method of suicide was gunshot wound (88%), followed by drug overdose (6%), and hanging (6%). Cases were highest in August (21%), December (15%), June (12%) and July (12%). CONCLUSION: Based on our findings, elderly suicide increased by 55% in 2020 in Marion County, Indiana, compared to 2019. However, the other parameters (e.g., race, employment, marital status) remained relatively unchanged. Although previous studies explained the steady increase in the suicide rate among the elderly,1 we believe COVID-19 pandemic lockdown and the limited social interaction have contributed to the rise seen in 2020. In addition, the geriatric population is growing and expected to outweigh the youth in a few years2;hence addressing suicide among the elderly is an urgent public health problem, requires extra efforts, especially during similar circumstances.

RATES OF FIREARM-RELATED INJURIES IN CHILDREN DURING COVID

Purpose of Study Firearm violence comprises a large percentage of pediatric injuries within the United States. Among all highincome countries, 91% of childhood firearm deaths occur in US children younger than 14 years. Coronavirus-19 Pandemic is associated with increased firearm violence, but little is known about the impact on children. Our objective is to evaluate the pediatric rates of firearm-related injuries within the state of Connecticut (CT) before- and during-COVID. Methods Used Data was ed from the Connecticut Health Information Management Exchange (CHIME) datasets from 2016-2020. All cases of firearm related injuries were identified by ICD -10 codes. Two study groups were created using events occurring in 2018 and 2019 (before-COVID) and events occurring in 2020 (during COVID). Before and during COVID groups were compared to assess differences in rates of injuries and any associations by age, sex, race, cause of injury, bodily location of injury, and geographic location of event. Summary of Results A total of 188 encounters were identified. The mean age was 14 years (SD+/- 3.5), 20% girls, 80% boys, 43% White, 37% Black, and 12% Hispanic. The overall rate of firearm injuries before COVID was 1.6 per 100,000 and during COIVD was 2.1/100,000 (p<0.01). Adjusting for population changes, the incidence of firearm injuries in CT increased by 33%. White and Black children accounted for similar proportion of injuries in all time periods. In all years, about 80% were unintentional while half were injured in suburban areas compared to urban and rural (p=0.97). Almost half of all injuries involved an extremity. Conclusions The proportion of children with firearm related injuries significantly increased during COVID compared to the preceding two years. The age, sex and race/ethnicity of injured children was similar before and during the COVID-19 pandemic. Unintentional injury accounted for the majority of injuries. Overall the proportion of White and Black children injured by firearms was similar, and children living in suburban areas were injured more than other areas. (Table Presented).

Suicide Deaths in Cook County, Illinois Before and During the COVID-19 Pandemic

Background: To combat the COVID-19 pandemic, the Governor of Illinois signed a stay-at-home order that took effect on March 21, 2020 and extended through the end of May 2020. Mental health was an important consideration during this time as the health impact of the pandemic and the measures taken, including physical distancing and isolation at home, disrupted people's daily lives. Consequently, deaths due to suicide were a concern for public health officials. Design: We performed a retrospective review of the Cook County Medical Examiner's Office electronic database for all suicide cases during the first year of the COVID-19 pandemic (April 2020-March 2021) and compared those findings with the previous corresponding time period (April 2019-March 2020). Patient demographics and mechanism of death were analyzed. Results: A total of 478 and 445 suicide deaths occurred during the time period of 4/1/2019 - 3/31/2020 and 4/1/2020 - 3/31/2021, respectively (Table 1). In the first year of the pandemic, deaths due to gunshot wounds increased by 10%, deaths due to hanging decreased by 6% (Figure 1) and deaths in the Black population increased by 5%. During the stay-at-home order, there was a decrease in overall suicide deaths compared to the previous year (Figure 2). During both time periods, all mechanisms of suicides were markedly higher for men than women, except in the drug/alcohol toxicity mechanism. Deaths due to gunshot wounds increased by 6% in the 18-30 age group during the first year of the pandemic. Deaths due to drug/alcohol toxicity increased by 11% in the Black population, and this involved mostly Black women. Deaths due to impact by a train decreased 12% overall during the first year of the pandemic;however, there was a 10% increase seen both in the Black and Asian populations compared to the previous year. Conclusions: Our study did not find an increase in number of suicide deaths during the first year of the COVID-19 pandemic. However, future suicide prevention requires an assessment of factors that influence suicide risk. In Cook County, there was a significant rise in gunshot suicides in the overall population and an increase in drug/alcohol toxicity suicides among Black women during the first year of the pandemic. Our study shows how changes in lifestyle, access to drugs and transportation method used influence the mechanism of suicide deaths. Future analyses should continue to examine changes in mechanism of death and demographic trends.

The wandering bullet: An unusual case of paradoxical embolization involving the neck, aortic arch, and iliac artery

Paradoxical intravascular bullet embolism involving the aortic arch (AA) is a rare and highly lethal condition. We describe an unusual case of a civilian gunshot injury to the neck. A bullet entered in the neck, injured the internal jugular vein (IJV), and then continued into the lumen of the common carotid artery (CCA). The bullet traveled under its own momentum and against the flow of blood, along the carotid and brachiocephalic vessels, finally lodging in the wall of the lesser curvature of the AA. The injury tract resulted in an arterial-venous fistula between IJV and CCA and a pseudoaneurysm of the AA. Open surgical repair of the neck and AA was complicated by secondary distal embolization of the bullet, requiring an embolectomy.

A uniquely violent year: The impact of social and political events on 2020 urban injury patterns

INTRODUCTION/HYPOTHESIS: 2020 was marked by social and political events that substantially disrupted healthcare. The COVID-19 pandemic, lockdown, public health measures, as well as civic and political unrest over racial tensions during an election year could plausibly impact injury care. We hypothesized that increased injuries related to high-risk activities during 2020 was temporally related to sociopolitical unrest and pandemic public health measures. METHODS: Retrospective data from two Level 1 urban, adult trauma centers in different US states (City A population:1.6M, City B:0.21M) were assessed (1/1/2020- 12/31/2020). Calendar months were divided into quartiles and compared to analogous quartiles in years 2016 -2019. Variables studied (demographics, injury mechanisms and outcomes) were compared between years, and across 2020 quartiles, against a backdrop of key sociopolitical events. RESULTS: More patients presented for injury in 2020 (A: n=1057, B: n= 1053) than in prior years (p< 0.05). Compared to 2016-2019, 2020, patients were more often black (A:63.1% vs. 69.8% p< 0.001;B:31.0% vs. 34.3%, p=0.02). Institution A patients were more likely to be male (p=0.002) & younger (p< 0.001) in 2020 vs. 2016-2019. Both institutions noted a steep rise in gunshot wound (GSW) and motor vehicle collision (MVC) injuries following state lockdowns (Fig A, B) with a persistent rise in GSWs until late fall (Fig C). CONCLUSIONS: 2020 was a unique year of sociopolitical unrest interwoven with a pandemic. Most affected populations were young, black males in two different urban centers and primarily involved GSWs and MVCs. Future disaster response planning should consider the drivers of these trends to mitigate their impact, especially in vulnerable populations.

Effective management of a firearm injury with multiple intestinal perforation in a COVID 19 positive patient: A rare case report.

INTRODUCTION: A challenging situation lies in front of every surgeon to perform emergency surgeries in a pandemic scenario. Gunshot injuries in a COVID-19 affected individual increases the chances of post-operative morbidity and mortality. Such cases require multidisciplinary approach with an advanced COVID care for the satisfactory outcome. CASE PRESENTATION: We present a case of 30-year-old male with an alleged history of an accidental fire arm injury. His rapid antigen for COVID was positive. Contrast enhanced computed tomogram (CECT) abdomen was suggestive of multiple bowel injuries. Emergency exploratory laparotomy confirmed multiple bowel perforations with no associated solid organ injury. Perforated sites were sealed by primary repair and loop ileostomy was performed. Patient was discharged on post-operative Day 17 with satisfactory clinical improvement. DISCUSSION: Deleterious effects of COVID-19 has questioned the reliance on health care system across the globe. Pulmonary complications affect the post-operative course in patients undergoing surgery. However not every patient with peri operatively detected COVID-19 will have complicated post-operative course. Managing such patients with perioperative COVID-19 is an uphill task. Hemodynamic instability and clinical signs of peritonitis mandates the operative management. Multidisciplinary approach with advanced post-operative COVID care is required for satisfactory outcome. CONCLUSION: Management of patients undergoing emergency procedure with peri-operative COVID 19 is challenging for the attending surgeon. Consider all surgical emergencies as COVID positive unless proved otherwise. Multidisciplinary approach for management of COVID-19 infection along with good post-operative care is required.