A Research of Emergency Service Admission Due To Home Accidents Before and During The Covid-19 (Sars-Cov-2) Pandemic In Ankara (Turkey)

Home accidents can cause serious injuries, disabilities, and deaths. Approximately 40 million people were treated in hospitals annually because of injuries occurring in homes, and these injuries were responsible for approximately 76% of preventable deaths. The aims of this study are to compare the home accidents in the one-year period during the pandemic and the home accidents in the one-year period before the pandemic, and to reveal how the home accidents are affected in which part of the home and in which types of injuries. A retrospective study was made of the records of patients injured in home accidents between pre-pandemic and pandemic one-year periods. The patients were classified according to age groups, gender, season, day and time of the home accident, accident type, part of the home, trauma localization and type, and severity of injuries. While 46.5% of the 581 injured patients were before the pandemic, 53.5% were in the pandemic period. The injuries increased as the number of households staying at home increased compared to the pre-pandemic period. Likewise, there was a significant increase in the number of falls from balconies and windows during the pandemic period. It is still not possible to make a definite prediction about the course of the pandemic. In this context, it is of great importance to provide information on prevention from home accidents, especially in television programs and distance education activities.Copyright © 2023, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.

Histomorphological Spectrum of Lung Lesions at Autopsy-A Tertiary Care Centre Experience

Background and aims: A wide variety of pathological conditions involve the lungs. In autopsy, the lungs are examined for disease, injury and other findings suggesting cause of death or related changes.Aims & Objectives: The present study aimed to study the histomorphological spectrum of lung lesions at autopsy and to assess the frequency of different types of lesions;and to associate histomorphological changes with cause of death.Material and Methods: It was a one-year observational study conducted in the Department of Pathology, Govt. Medical College, Jammu. Lung tissue pieces from all medicolegal autopsies received were fixed, examined grossly, processed;paraffin embedded sections obtained were stained with Hematoxylin and Eosin stain and examined under microscope. Findings were recorded and tabulated. Result(s): Out of 264 cases, males were predominantly affected (84%);median age was 38 years. The various changes observed were congestion (68%), edema (45.4%), pneumonia (5%), granulomatous inflammation (3%), diffuse alveolar damage (1.5%), haemorrhage (14.4%), interstitial changes (60%), malaria (0.4%) and malignancy (0.4%). Natural deaths were the commonest cause (75, 28%) followed by asphyxial deaths (65, 24.6%). Conclusion(s): Histopathological examination of lung autopsies highlights many incidental findings, establishes underlying cause of death, serves as a learning tool and also holds scope for detection of newer diseases.Copyright © 2023 JK Science.

Clinico-Etiological Profile of Children Admitted with Head Injury in a Tertiary Health Care Centre During the COVID Pandemic

Background The mechanism of injury, type of pathology, mode of management and specific problems, in the pediatric age group make these a unique population. The COVID-19 pandemic and lockdown caused a significant reduction in the number of road traffic accidents during the same period and the resultant number of head injuries in children.Methods This was a descriptive study of 76 consecutive pediatric patients admitted with head injury between June and December 2020. Children under 18 years with head injury admitted in our hospital were included.Results The most common etiology of pediatric head injury was found to be fall from height (61.8%) followed by road traffic accidents (27.6%). The most common age group affected was 1 to 5 years with a mean of 6.3 +/- 1 5 years. Road traffic accidents were commonly seen in the 15 to 18 age group. The Glasgow Outcome Score (GOS) of 1 (death) was seen in one patient (1.3%) and low disability in 98.7% of patients.Conclusion Falls formed the most important cause of pediatric head injury during this pandemic, and carefulness on the part of parents can help avoid dangerous consequences for the children. Recovery with minimal disability was observed in approximately all cases in this study. The number of severe traumatic brain injury was very low in this study. This can be attributed to the COVID-19 pandemic causing significant reduction in road traffic accidents and the number of severe head injury Clinicoetiological Profile of Children Admitted with Head Injury During the COVID Pandemic

Social and Environmental Triggers of Multiple Sclerosis onset: A Retrospective Study from Iran

Introduction: Multiple sclerosis (MS) is an often-disabling disease of the central nervous system (CNS). The possible triggers of its first presentation such as stressful events, viral infections, vaccinations, and labor are still a matter of debate among scientists. Considering the possible role of infections in MS onset and the reported cases of CNS demyelination following COVID-19 infection and variety of COVID-19 vaccines, this study was conducted to investigate and compare the possible social, environmental, and physical triggers of MS onset before and during the COVID-19 pandemic. Material(s) and Method(s): A cross-sectional study was conducted from 28 February 2022 to 9 June 2022. A researcher-made questionnaire was designed in MS research center of Iran and distributed as an online google form on social media among 1340 Iranian MS patients. Demographic information, MS disease-related data, possible MS triggers (stressful life events, COVID-19 and other infections, COVID-19 and other vaccines, pregnancy or labor, head trauma, surgery, weight loss) were recorded. Patients were divided into two groups regarding the time of MS diagnosis (before and during the COVID-19 pandemic). Binary logistic regression method was used to determine the possible association between patient-reported triggers and diagnosis time (before and during the pandemic) adjusting for possible confounders. Result(s): Of 920 participants, 670 (72.8 %) were female, and the mean age (SD) was 35.63 (+/-8.1). The majority of participants 637 (69.2%) had non-progressive forms of MS, and only 70 (7.6 %) needed assistance for ambulation. The time of MS diagnosis was before the start of the COVID-19 pandemic in 635 (69 %) participants. The differences between the most common first symptoms which led to MS diagnosis, visual type (n: 317 (49.9 %)) before the pandemic and sensory type (n: 170 (59.6 %)) after the pandemic were significant (p-values: 0.008 and <0.01 respectively). A stressful life event was the most common patient-reported MS trigger in both groups, (n: 356 (56.1%)) in patients who were diagnosed before the COVID-19 pandemic, and (n: 156 (54.7%)) in the latter group. Comparing two groups (MS diagnosed before and during the pandemic), economic problems (AOR: 1.81;95%ACI: 1.23-2.65) and job loss (AOR: 2.89;95%ACI: 1.37-6.08) were significantly more frequent stressful life event which trigger MS onset in the latter group while, the stress of occupational or educational exams (AOR: 0.52;95%ACI: 0.34-0.79) was more prevalent in the first group. Conclusion(s): Social triggers such as stressful life events are closely associated with MS onset that had been increased in some categories after the COVID-19 pandemic. If truly recognized, they could be used to prevent the development and exacerbation of the disease.Copyright © 2022

Nasopharyngeal Myiasis in Intensive Care Unit (ICU) Patients: Report of Two Cases

Nosocomial myiasis is a rare event that has a higher incidence in the hospitals of poor and developing countries. The presence of nosocomial myiasis reflects the need for improved medical facilities and increased awareness among healthcare personnel. Severely ill patients are more susceptible, such as those with impaired consciousness, paralysis, and underlying diseases. The two cases here in described represent the first report of nosocomial myiasis in the Kurdistan Province, in Western Iran and one of them is the first report of myiasis involving a COVID-19-infected patient. The causal agent was Lucilia sericata. The taxonomical identification of the larvae of the second and third instar was based on the morphology of the cephaloskeleton, anterior spiracles, and peri-treme plaques.Copyright © 2023 Zobairy et al.

Changes in sport-related concussion and traumatic brain injury in New Zealand during the first two years of the COVID-19 pandemic.

OBJECTIVES: To quantify changes in sport-related concussion and traumatic brain injury claims in New Zealand during the first two years of the COVID-19 pandemic (i.e., 2020 and 2021). DESIGN: Population-based cohort study. METHODS: This study included all new sport-related concussion and traumatic brain injury claims that were registered with the Accident Compensation Corporation in New Zealand during 1 January 2010 to 31 December 2021. Annual sport-related concussion and traumatic brain injury claim rates per 100,000 population from 2010 to 2019 were used to fit autoregressive integrated moving average models, from which forecast estimates with 95 % prediction intervals for 2020 and 2021 were derived and compared against corresponding observed values to obtain estimates of absolute and relative forecast errors. RESULTS: Sport-related concussion and traumatic brain injury claim rates were 30 % and 10 % lower than forecasted in 2020 and 2021, respectively, equating to an estimated total of 2410 fewer sport-related concussion and traumatic brain injury claims during the two-year period. CONCLUSIONS: There was a large reduction in sport-related concussion and traumatic brain injury claims in New Zealand during the first two years of the COVID-19 pandemic. These findings highlight the need for future epidemiological studies examining temporal trends of sport-related concussion and traumatic brain injury to account for the impact of the COVID-19 pandemic.

Cycling-Related Injuries During COVID-19 Lockdown: A North London Experience.

Objectives: There has been a notable surge in cycling injuries during the COVID-19(SARS-CoV-2 virus) pandemic. Cycling in general increased during lockdown as a leisure & fitness activity along with reduction in the use of public transport for commuting. We investigated the bicycle-related maxillofacial injuries & associations presenting through our emergency department(ED) which covers more than 1.6 million of London population. Study Design/Methods: A retrospective observational study was undertaken in the Barnet General Hospital ("hub") which receives all maxillofacial referrals from 6 "spoke" hospitals & other urgent primary/community care practices in North London area between 16 March 2020 & 16 July 2020. All data corresponding to cycling injuries during the lockdown period was analyzed with the aid of trauma database/trust-wide electronic patient records. Results: Twenty-two patients (6.7%) with cycling-related injuries out of a total of 322 patients who attended during the 4 months study period with maxillofacial emergencies were identified. Average age of patient cohort was 35.4 years, mainly consisting of adult males (77%). Seven patients had minor head injury and 1 patient suffered traumatic brain injury. About 59% patients did not wear a protective helmet & 3 patients had heavy alcohol/recreational drug intoxication during the accidents. Four patients needed inpatient admission and treatment under general anesthesia. Conclusions: Based on our humble study, we advocate the need for robust road & personal safety measures with mandatory government legislations, policing of drug intoxication & encouragement of physical & mental health improvement measures during these unprecedented times & beyond.

Effects of the Response to the COVID-19 Pandemic on Assault-Related Head Injury in Melbourne: A Retrospective Study.

Assault is the leading preventable cause of death, traumatic brain injury (TBI), and associated mental health problems. The COVID-19 pandemic has had a profound impact on patterns of interpersonal violence across the world. In this retrospective cross-sectional study, we analysed medical records of 1232 assault victims (domestic violence: 111, random assault: 900, prison assault: 221) with head injuries who presented to the emergency department (ED) at St Vincent's Hospital in Melbourne, Australia, a city with one of the longest and most severe COVID-19 restrictions worldwide. We examined changes in prevalence in the assault group overall and in domestic violence, random assault, and prison assault victims, comparing data from 19.5 months before and after the first day of COVID-19 restrictions in Melbourne. Moreover, we investigated differences driven by demographic factors (Who: age group, sex, and nationality) and clinical variables (Where: assault location, and When: time of arrival to the ED and time from moment of injury until presentation at ED). Descriptive statistics and chi-square analyses were performed. We found the COVID-19 pandemic significantly affected the Where of assault-related TBI, with a shift in the location of assaults from the street to the home, and the increase at home being driven by random assaults on middle-aged adults. Overall, we observed that 86% of the random assault cases were males, whereas 74% of the domestic assault cases were females. Meanwhile, nearly half (44%) of the random assault victims reported alcohol consumption versus a fifth (20%) of domestic violence victims. These findings will have direct implications for developing screening tools and better preventive and ameliorative interventions to manage the sequelae of assault TBI, particularly in the context of future large-scale health crises or emergencies.

Mineralizing angiopathy: an underrecognized clinicoradiologic entity

Case Report: Initial History/Presentation: A term vaccinated 7-month-old male with a history of eczema presents with two hours of right-sided hemiplegia and hemidystonia. Parents deny loss of consciousness, altered mental status, or facial symptoms. He has no known history of recent or remote head trauma. Patient may have had COVID two months prior when he had upper respiratory symptoms, with his mother testing COVID+ at that time. Of note, he received a Moderna COVID vaccination one day prior to onset of symptoms. Physical Exam: Pertinent exam findings include CN II-XII intact, right-sided upper and lower extremity strength 3/5, sensation intact, and truncal ataxia while seated. Physical exam is otherwise unremarkable. Diagnostic Evaluation: Initial lab work revealed leukocytosis (20.9), but otherwise a reassuring CMP, triglycerides, HDL, and LDL. PTT was elevated, but normal on recheck. Protein C antigen and activity were low, but deemed non-concerning by hematology. All other hypercoagulable labs were normal. On imaging, CT Brain showed linear calcifications in bilateral basal ganglia suggestive of mineralizing angiopathy. HisCTA head/neckwas negative.MRI Brain revealed an acute infarct of the body/tail of the left caudate nucleus, posterior limb of internal capsule, and posterior putamen. Clinical Course/Follow-up: Our patient was started on Aspirin 4 mg/kg daily. Throughout the course of his 3-day inpatient stay, he had mild improvement of right-sided strength and function, and continued improvement upon follow-up with his pediatrician. Given the short interval between receiving his COVID vaccination and onset of symptoms, his case was reported to the Vaccine Adverse Event Reporting System. Conclusion(s): From a radiological perspective, mineralizing angiopathy is an uncommon but familiar finding seen in up to 5% of all neonatal head ultrasounds and increasing to nearly 20% in preterm infants. It is most commonly associated with infection, hypoxia, and chromosomal abnormalities but is usually of minimal clinical significance. However, there are numerous reports of basal ganglia and thalamic strokes following minor head trauma in children with mineralizing angiopathy. For radiologists, this association is important to recognize and relay to the primary team so targeted history and MRI, if indicated, may be obtained to expedite definitive diagnosis and initiation of treatment to preserve precious brain tissue. Without a history of head trauma, in this case, stroke provocation is unclear, and other infectious or inflammatory disorders could appear similarly if they induced vasospasm or blood pressure lability. A short-interval timeframe between COVID vaccine administration and symptom onset is likely incidental, but research to exclude or illicit any link may be of benefit. Findings of mineralizing angiopathy on CT in the appropriate clinical setting should prompt further evaluation with emergent MRI to determine the presence of basal ganglia or thalamic stroke. Copyright © 2023 Southern Society for Clinical Investigation.

COVID-19 Pandemic Lockdown: A Cloud with a Silver Lining for the Road Traffic Accidents Pandemic.

Context: Effects of coronavirus disease 2019 (COVID-19) pandemic lockdown on road traffic accidents (RTAs) in Chhattisgarh, India. Background: Most neurosurgical emergencies are from brain and spine trauma. RTA is the leading cause of such injuries. While the nationwide lockdown was an extreme measure to control the COVID pandemic, it influenced the overall road traffic dynamics and neurotrauma. Objective: This study aims to assess the impact of the lockdown on neurotrauma. Methods and Materials: This retrospective study included all patients with brain and spine injuries who were admitted between January 17th and May 31st, 2020. The study population was divided into prelockdown (PL) and lockdown (L) groups. Results: Of the 668 patients, 436 were placed in the PL and 232 in the L group. The mean ages were 36.34 (SD = 17.96) and 35.98 (SD = 16.93), respectively. Male to female ratios were 82.3:17.7 in the PL group and 79.7:20.3 for the L group. RTA-related injuries were significantly lower during the lockdown period (n = 335 PL vs. 162 L [P = 0.048]). During the lockdown, there were more mild injuries (25.91% PL vs. 36.63% L) and less severe injuries (33.25% PL vs. 18.96% L [P = 0.0002]). Mortality was significantly less (P = 0.029) during the lockdown (n = 48 L vs. 124 PL). The proportion of RTA-related neurotrauma cases increased (33.33% L1, 57.14% L2, 73.13% L3, and 80.39% L4) with each phase of lockdown (L1-L4). Conclusions: During the lockdown period, the number of trauma cases had decreased, with a significant decrease in RTA-related admissions, along with their severity and mortality. The number of trauma cases and their severity increased gradually with each phase of lockdown.

Kidney Transplantation from Covid-19 Deceased Donors

Purpose: Transplant volumes decreased significantly during the first months of global pandemic of COVID-19, followed by a shift in the standard of care of transplant medicine. It has become widely accepted to rigorously screen and test donors and recipients for COVID-19 before proceeding with transplant. Discarded kidneys due to positive COVID-19 testing in potential donors is a new challenge for transplant centers. The emerging vaccines and lines of therapy have given us tools that could be utilized to re-balance the shift in practice and maximize organ utilization. Method(s): In this we present two cases of kidney transplantation from a COVID-19 positive deceased donor. The first recipient was a 40-year-old female who has been vaccinated with two doses of mRNA-1273 vaccine five months before transplant. The second patient was a 41-year-old male without a prior COVID-19 vaccine, he had a natural infection with COVID-19 about 10 months prior to transplant, and antibody was positive for anti-nucleocapsid IgG at the time of transplantation. Both recipients had negative SARS-CoV-2 nasopharyngeal swab PCRs prior to transplantation, and both received induction with anti-thymocyte globulin 5mg/ kg. Both recipients received their transplanted kidneys from the same donor, who tested positive by RT-PCR for COVID-19 from a nasopharyngeal swab three days prior to procurement (Roche Cobas Liat PCR, single cycle threshold). On the following day, the donor's bronchial washing was negative. At the day of procure662 Kidney Deceased Donor Selection ment, repeated PCR from a nasopharyngeal swab was negative, and COVID-19 antibody was positive for anti-nucleocapsid IgG (AbbottTM ARCHITECTTM). The donor cause of death was head trauma with a terminal serum creatinine of 0.3mg /dL Chest imaging did not demonstrate COVID-19 pneumonitis. Casirivimab 600mg and imdevimab 600mg were administered 24 hours after the last dose of anti-thymocyte globulin as post-exposure prophylaxis. Result(s): Both recipients had an appropriate renal allograft function. Casirivimab 600mg and imdevimab 600mg were administered 24 hours after the last dose of anti-thymocyte globulin. Both recipients demonstrated no signs or symptoms of COVID-19 infection during their hospitalization and were instructed to maintain 14 days of COVID-19 exposure precautions post-discharge. At 12 weeks from transplant, both patients had no symptoms of COVID-19 infection. SARS-CoV-2 RNA has been detected in several organs including kidney, but there was no proof of infective virus in extrapulmonary organs. Conclusion(s): These two cases may broaden the scope of accepting organs from COVID-19 positive deceased donors and the use of casirivimab and imdevimab for immediate post-transplant surgery prophylaxis. While we are not sure if the monoclonal antibodies did offer any benefits here, we think that this report may throw the light on its potential use in post-transplant surgery prophylaxis. Further studies are warranted to examine the benefits of such practice.

A New Chapter in an Evolving Pandemic: Successful Pediatric Liver Transplantation with COVID+ Donors

Purpose: We report the first two pediatric liver transplants utilizing allografts from COVID+ donors, infected at time of organ procurement, demonstrating a pivotal step toward donor pool maximization amid a viral pandemic with poorly understood transmissibility in the pediatric patient. Method(s): This is a prospective and retrospective review of two pediatric liver transplants and their donors who tested positive for SARS-CoV-2 at time of procurement. Data was obtained through the electronic medical record system and UNet DonorNet platform. Result(s): The first donor is a 3-year-old male succumbing to head trauma. 1 of 5 nasopharyngeal swab RT-PCR tests demonstrated COVID-19 positivity while 1 of 3 bronchoalveolar lavage RT-PCR tests indicated SARS-CoV-2 infection. Preceding procurement in the second donor, a 16-month-old male with unknown etiology of cardiorespiratory arrest, 2 nasopharyngeal swab RT-PCR tests and 1 bronchoalveolar lavage RT-PCR test failed to detect SARS-CoV-2 infection. Diagnosis was not made until the Medical Examiner's office repeated a nasopharyngeal swab RT-PCR and archive plasma RT-PCR which were both positive for SARS-CoV-2. The two 2-yearold pediatric liver recipients underwent transplantation in November 2021. Continued follow-up demonstrates successful transplant void of viral transmission or hepatic artery thrombosis as liver chemistries have anticipatorily normalized with excellent graft function. One recipient experienced early portal vein thrombosis treated by interventional radiology with discharge on postoperative day 20. Conclusion(s): This report is the first to describe successful pediatric liver transplants from COVID+ donors. This data reinforces case reports in the adult transplant population of successful use of COVID + donor organs and further supports the judicious use of COVID+ donors for extrapulmonary pediatric organ transplant. The concern for donor-derived transmission must now be weighed against the realized benefit of successful, life-saving transplantation for end stage liver disease in the pediatric patient. (Figure Presented).

SUPERIOR SAGITTAL SINUS THROMBOSIS PRESENTING AS DETERIORATING RESIDUAL WEAKNESS

SESSION TITLE: Imaging, ECMO, and other Procedures in the ICU Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Superior sagittal sinus (SSS) thrombosis is a rare cause of stroke that is difficult to identify due to various clinical presentations. It is the most common form of dural sinus thrombosis, and common risk factors include hypercoagulable state, traumatic head injury, pregnancy/postpartum, and malignancy. More than 85 percent of adult patients have at least one risk factor for cerebral venous thrombosis. Some patients with SSS thrombosis do not have clearly identifiable risk factors, and this case highlights one such patient. CASE PRESENTATION: A 60-year-old Caucasian male with hypertension, hyperlipidemia, and a recent intracranial hemorrhage with residual left-sided weakness, presented to the emergency department with worsening left-sided weakness. Upon admission, his physical exam was notable for 4/5 strength in the left upper extremity and 2/5 strength in the left lower extremity. This was a reduction in strength from a baseline of 4/5 in the left upper and lower extremities. Labs on admission were normal except for high-sensitivity troponin of 86 and WBC of 14.5. UA with a small amount of blood. An initial CT brain without contrast showed no acute changes, evolutionary changes in the right frontal temporal lobe, and subtle curvilinear hyperdensity near a site of the intracranial hemorrhage identified in the prior month. This curvilinear hyperdensity was thought to reflect early parenchymal calcification. MRI brain without contrast showed new and evolving areas of abnormal signaling and an evolving hematoma with surrounding vasogenic edema, all of which are in the right lobe. There was no apparent diffusion coefficient correlate. Thus, MRI with contrast and MRV was recommended. EEG showed no evidence of epileptiform activity. Additionally, transthoracic echo demonstrated new non-ischemic cardiomyopathy with an EF of 35-40%. The diagnosis was ultimately made after the patient had a Magnetic Resonance Venography (MRV) which showed evidence of the SSS thrombosis and an indication that the previously visualized curvilinear hyperdensity is suspected to represent slowed flow within a surface vein. Heparin was started to recanalize the sinus and prevent thrombus propagation. After the appropriate treatment was started, the patient's weakness improved dramatically. DISCUSSION: Typically, patients with SSS thrombosis have identifiable risk factors like hypercoagulable states, traumatic head injuries, pregnancy/postpartum, malignancy, and more recently association with COVID-19 infection. In this case, since the patient lacked identifiable risk factors, the MRV played a key role in the diagnosis. CONCLUSIONS: Like our patient, 30-40 percent of patients present with an intracerebral hemorrhage. Differentials of SSS thrombosis should be considered in etiologies for intracerebral hemorrhage, especially when an identifiable cause is lacking, in order to avoid delays in treatment and resolution. Reference #1: Abdalkader M, Shaikh SP, Siegler JE, Cervantes-Arslanian AM, Tiu C, Radu RA, Tiu VE, Jillella DV, Mansour OY, Vera V, Chamorro Á, Blasco J, López A, Farooqui M, Thau L, Smith A, Gutierrez SO, Nguyen TN, Jovin TG. Cerebral Venous Sinus Thrombosis in COVID-19 Patients: A Multicenter Study and Review of Literature. J Stroke Cerebrovasc Dis. 2021 Jun;30(6):105733. doi: 10.1016/j.jstrokecerebrovasdis.2021.105733. Epub 2021 Mar 4. PMID: 33743411;PMCID: PMC7931726. Reference #2: Rehman A, Husnain MG, Mushtaq K, Eledrisi MS. Cerebral venous sinus thrombosis precipitated by Graves’ disease. BMJ Case Rep. 2018 Jun 4;2018:bcr2017224143. doi: 10.1136/bcr-2017-224143. PMID: 29866676;PMCID: PMC5990097. Reference #3: Nakase H, Takeshima T, Sakaki T, Heimann A, Kempski O. Superior sagittal sinus thrombosis: a clinical and experimental study. Skull Base Surg. 1998;8(4):169-74. doi: 10.1055/s-2008-1058178. PMID: 17171061;PMCID: PMC1656696. DISCLOSURES: No relevant rel tionships by Ken Johnson No relevant relationships by Nina Le No relevant relationships by Riaz Mahmood No relevant relationships by Ngoc Phan

DURAL VENOUS SINUS THROMBOSIS: A RARE PRESENTING CONSEQUENCE OF COVID-19

SESSION TITLE: Post-COVID-19 Infection Complications SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: The severe acute respiratory syndrome coronavirus (SARS-COV2) and its resulting coronary virus 2019 syndrome (COVID-19) has resulted in an unprecedented global pandemic affecting more than 250 million people and resulting in at least 5 million deaths worldwide. Clinical manifestations of the Covid-19 disease process include but are not limited to respiratory dysfunction and failure, coagulopathy, malaise and cytokine storm. We report a case of dural sinus thrombosis (DST) as a sequelae to COVID-19. CASE PRESENTATION: A 26-year-old woman with a history of migraines presented with sudden diffuse headache and photosensitivity. She reported no palpitations, oral ulcers, dizziness, diaphoresis, slurred speech, weakness, paresthesias or recent head trauma. Her presenting vital signs were within normal range. Physical exam was negative for focal neurologic deficits, weakness, or sensory loss. A rapid pregnancy test was negative. D-dimer was 7,200 ng/mL (reference <500 ng/mL). A COVID test was positive. A computed tomography (CT) of the head revealed diffuse hypodensity in the torcula and the transverse sinuses bilaterally extending into the cerebellar folia, suspicious for DST, which was confirmed on magnetic resonance venography. A full hypercoagulable panel resulted negative. It was determined that the patient's coronavirus disease infection resulted in a prothrombotic state and her dural sinus vein thromboses. The patient was started on a high intensity heparin drip for seven days, then transitioned to Dabigatran and Topiramate for management of headache upon discharge. DISCUSSION: COVID-19 typically manifests as fever, hypoxia, and dyspnea. If coagulopathy were to occur, the most common of them are deep vein thromboses. Cerebral thrombotic events, specifically, a DST has been underreported in literature. It is suspected that the burden of cerebral thrombosis in COVID-19 patients is 0.08%. In the same study, it was also identified that 31% of those who developed a cerebral thrombosis also had other hypercoagulable risk factors not present in this patient. Advancement in neuroimaging has allowed these thrombotic issues to be identified, however, early recognition, especially with a lack of risk factors, creates a less straightforward management plan. Our patient manifested a DST in the setting of an active COVID-19 infection. Higher levels of evaluation are required in patients who test positive for Covid-19 when clinically indicated. Such indications include headaches that are new in onset, severe in nature, and diffuse. Delayed diagnosis and management can be permanently damaging. CONCLUSIONS: Dural venous sinus thrombosis is a rare, yet deadly complication of COVID-19. All risk factors and other etiologies of hypercoagulable states should be ruled out followed by early detection based on clinical and physical exam, and accompanied by appropriate imaging followed by prompt intervention. Reference #1: Baldini, T., Asioli, G. M., Romoli, M., Carvalho Dias, M., Schulte, E. C., Hauer, L., Aguiar De Sousa, D., Sellner, J., & Zini, A. (2021). Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus-2 infection: A systematic review and meta-analysis. European journal of neurology, 28(10), 3478–3490. https://doi.org/10.1111/ene.14727 Reference #2: Hemasian, H., & Ansari, B. (2020). First case of Covid-19 presented with cerebral venous thrombosis: A rare and dreaded case. Revue neurologique, 176(6), 521–523. https://doi.org/10.1016/j.neurol.2020.04.013 Reference #3: Thompson, A., Morgan, C., Smith, P., Jones, C., Ball, H., Coulthard, E. J., Moran, E., Szewczyk-Krolikowski, K., & Rice, C. M. (2020). Cerebral venous sinus thrombosis associated with COVID-19. Practical neurology, practneurol-2020-002678. Advance online publication. https://doi.org/10.1136/practneurol-2020-002678 DISCLOSURES: No relevant relationships by Steven Douedi No relevant relationships by slam Elkherpitawy No relevant relationships by Justin Ilagan No relevant relationships by David Kountz No relevant relationships by Anton Mararenko No relevant relationships by Mihir Odak

CLINICAL CASE STUDY: AN OVERVIEW ON LOW MOLECULAR WEIGHT HEPARINS (LMWH) IN PATIENTS

Heparin is a sulphate polysaccharide of glycosaminoglycan that is made predominantly by mast cells of connective tissue. It is used in the management of thromboembolic problems in medicine. Heparin acts as a catalyst for antithrombin III, increasing its activity by thousand times. The larger heparin species catalyses the inactivation of activated factors II and X, in contrast LMWH inactivates the activated factor X. The final effect for both is systemic anti-coagulation. Heparin also produces platelet aggregating antibodies and causes coagulopathy in rare conditions. LMWH especially Enoxaparin (Inj Clexane) proved an effective treatment in patients with Covid -19 infection by preventing thromboembolism and pulmonary embolism thereby, helped in survival of the patients by reducing the risk of death due to coagulation and fibrosis. Hence, clinical trial reports and SOAP analysis of clinical case studies in random subjects and patients reported the over-view of advantages using LMWH heparins in disease management and emergency traumatic injuries produced a beneficial role of using LMWH over unfractioned heparins.

Cause of death and consent rates during the COVID-19 pandemic

Introduction: The COVID-19 pandemic of 2020-21 impacted all aspects of the UK health service. Organ donation acceptance criteria were initially revised to safeguard critical care resources, and prioritised younger donors and donation after brain death (DBD) over donation after circulatory death (DCD).1 These were later returned to the original criteria prior to the second wave in September 2020;yet referrals and donation numbers remained below pre-pandemic levels throughout 2020. This data was further confounded by England changing from an opt-in model to presumed consent for donation.2 Objectives: We aimed to assess the impact of the COVID-19 pandemic on causes of death, and the subsequent effect on numbers of potential donors, referral rates (adjusted for the altered referral criteria during the first wave), and consent rates for donation. Methods: Mortality, referral, and consent rate data were acquired from the Potential Donor Audit (PDA) database held by NHS Blood and Transplant. The two pandemic waves (defined as 11/3/2020-10/08/2020 and 11/08/2020-10/03/2021) were compared to their corresponding periods from 2019-20. Event counts were compared using exact Poisson tests, and proportions using two-sample z-tests. Results: All-cause mortality was higher during both waves (p<0.001) than the previous year, with excess in-ICU non-COVID-19 mortality during the second wave (p=0.024, see figure). Mortality from cardiac arrest (p<0.001), catastrophic brain injury (p<0.001), and head trauma (p=0.280) were reduced in both waves, and deaths in ICU from suicide and self-harm were reduced in the second wave (p=0.002). After accounting for COVID-19 positive patients and those outside of the adjusted age-criteria, there was no difference in referral rates for potential DBD patients (99% in all cases) but fewer DCD patients meeting criteria were referred during both waves (89% vs 93%, p=0.003, and 85% vs 92%, p<0.001). There were fewer eligible donors during both waves (p<0.001). Fewer eligible families were approached during the first wave (42% vs 58%, p<0.001) but more were approached during the second (58% vs 54%, p=0.001) than in the preceding twelve months. There was no significant difference in Specialist Nurse in Organ Donation (SNOD) presence during approaches, nor family consent rates. Additionally, there was no difference in the proportion of patients who subsequently went on to donate. Conclusions: The reduction in donations - and hence transplantation - during the COVID-19 pandemic was multifactorial. There was a significant reduction in causes of mortality that aremost associated with donation, likely driven by an increased number of deaths in the community who never 'made it' to hospital. Potential DCDs were referred less frequently during both waves, although this was secondary to the change in acceptance criteria during the first wave. Additionally, fewer eligible families were approached during the first wave, further reducing donation potential. Despite fewer eligible donors, consent rates, the relationship between SNOD presence and consent, and progression to donation remained unchanged, suggesting that the foundations underpinning the organ donation programme remained resilient. Future work should focus on validating factors predicting family consent3 in the context of COVID-19 and assessing the ongoing impact of presumed consent.

2021 AAP National Conference and Exhibition Meeting Abstracts

The proceedings contain 966 papers. The topics discussed include: impact of COVID-19 on Michigan child care programs: a qualitative analysis;implementation of the TRAIN initiative and its effect on sentinel injury evaluation;exploring access and utilization of early intervention services among families experiencing homelessness: a qualitative study;experiences in telemedicine in developmental-behavioral pediatrics: a Dbpnet mixed-methods study of providers and caregivers;current appraisal of racial and ethnic disparities in suspected child abuse among young children presenting with acute head trauma;opening a digital front door to the emergency department;modeling work intensity in a pediatric training program - a pilot study;in-person follow-up visit attendance after telemedicine visits;and pediatrician's leadership role: evaluation of the needs of children and mitigation after disasters.

Pyro ban on New Year's Eve 2020/2021 - Analysis of firework-related injuries and their treatments

The majority of firework-related injuries in Germany are found at the turn of the year. With regard to hearing, a distinction is made between blast (BT) and explosion trauma (ET). The study examines the prevalence and characteristics of firework-related injuries over the past 11 years on New Year's Eve and compares these with the effects of the pyro ban 2020/21 imposed due to the COVID-19 pandemic. A retrospective chart review of all patients who presented themselves with the diagnosis blast trauma (H 83.3) or explosion trauma (T 70.8) at the Charité emergency service in the last 11 years from December 28 to January 5 was performed. 267 patients were recorded (78 % male). 1/3 each were assigned to the age group 10-19 and 20-29 years. 21 % of the patients were admitted to the hospital. There was an isolated BT of the ear in 66 %, hand injuries in 12 %, head injuries in 8 % and eye injuries in 4 %. 87 % had ear involvement with hearing loss: 83 % with tinnitus, 5.6 % with ET. The tone audiograms of BT and ET show differences only at 6 kHz, but not at 4 kHz. 8.6 % of the patients underwent surgical interventions. The treatment of a tympanic membrane perforation was carried out by: 54 % splinting vs. 38 % tympanoplasty. Therapy with a glucocorticoid was administered i.v. in 48 % and initiated orally in 17 %. Overall, there was a decrease in injuries of almost 90 % in 2020/21 compared to 2017/18. The use of fireworks leads to increased utilization of health care resources. The ban on the sale of pyrotechnics as well as the introduction of pyro ban zones in 2020 led to a relevant decrease in injuries. 2020 was the only year in which there were no injuries in children / adolescents. The BT of the ear is the most common firework-related injury.

COVID-19 AS A CAUSE OF COMA IN ADULT ONSET VANISHING WHITE MATTER DISEASE

A 34 year old female presented with fever, diarrhoea, confusion, and a decline in mobility, having recently tested positive for COVID-19. Her medical history included patent foramen ovale, primary ovarian failure and leukoencephalopathy which had been investigated in her 20s leading to a clinical diagnosis of Vanishing White Matter disease (VWM). On admission she deteriorated rapidly with decreased GCS requiring frequent critical care review. MRI demonstrated mild progression of the cerebral atrophy and slight increase in the 'cystic' changes in the white matter. Lumbar puncture was unremarkable. EEG demonstrated widespread cerebral dysfunction with frontotemporal emphasis but without seizure activity. She was managed with supportive care recovering to her baseline function within days. VWM is a leukodystrophy caused by recessive mutations in eukaryotic initiation factor 2B (eIF2b) complex. Adult onset presentations have been described which have a slowly progressive course. Patients with VWM are known to rapidly decline with fever, and mild head injury occasionally resulting in coma. Our case high-lights the potentially devastating effects of a neurotropic virus such as COVID-19 in VWM, and the need to consider rare genetic disorders in adult patients presenting with extensive white matter abnormalities on MRI and premature ovarian failure.