ABSTRACT
This study is a systematic review of rehabilitation techniques, medical and nursing care, and heart monitoring in patients with lung involvement and fractures and multiple traumata. The lung is one of the main organs affected by the corona virus. According to the guidelines published in March 2020 for physiotherapists in the treatment of patients with COVID-19, cardiopulmonary physiotherapy focuses on the treatment and rehabilitation of acute and chronic respiratory conditions of patients, and the goal is to improve the physical strength of people following the disease. Based on this, physiotherapy can play an effective role in respiratory treatment and physical rehabilitation of patients with COVID-19. Dr. Kia added: People who have underlying risk factors and heart problems are more exposed to Covid-19, and of course, this virus itself can cause heart disease in people who do not have heart disease. A significant number of hospitalized corona patients suffer from myocardial damage, which is associated with an increased risk of death in these people. Myocardial damage can be caused in two ways: myocarditis or heart failure, which can be measured by echocardiography or blood markers. Another damage that the corona virus causes to the heart is the blockage of the coronary arteries in the form of MI or acute heart attacks. Another damage is cardiac arrhythmias or disturbances in the normal rhythm of the heart with the mechanism of the virus attack on the conduction system of the heart, which causes the person to experience an increase or decrease in the heart rate. Another complication of this virus is thrombosis or blood clots in the body or lung embolism or strokes. One of the symptoms that patients report these days when visiting doctors or medical centers is the feeling of pain while lying down, and in fact, it is most likely inflammation of the pericardium or pericarditis, which is caused by the attack and attack of the corona virus on the heart. The person becomes inflamed and it is one of the common symptoms of this disease.
ABSTRACT
Background: Abusive Head Trauma (AHT) is a syndrome of life-threatening intracranial injuries. The COVID-19 pandemic imposed new stresses upon socially vulnerable populations, but the relationships between social vulnerability, COVID-19 and AHT outcomes are not known. We investigated whether patient or social factors predicted survival after AHT and whether these factors and outcomes were modified during COVID-19. Methods: A single-institution database was queried for all admissions of children with a confirmed diagnosis of AHT from 2018-2021. Clinical information, radiographs and clinic follow-up data were reviewed. Social vulnerability index (SVI) was calculated based on published methods (atsdr.cdc.gov). Univariate and multivariate analyses were performed. Results: One hundred and three cases of AHT were reviewed. Median age at presentation was 4 months (IQR 2-10) in the overall cohort, males outnumbered females overall (76 males, 27 females). 18 patients died (17.5%), higher than previously reported rates. Nonsurvivors had higher social vulnerability index (.867 vs .719, p=0.004);71% had high social vulnerability compared to 39% of survivors. There was no difference in fatality rate before (19%) or during (15%) COVID-19. All nonsurvivors were intubated on admission, compared to 36% of survivors (p<0.001) and all nonsurvivors were comatose compared to 29% of survivors (p<0.001);61% of nonsurvivors had cardiac arrest on admission compared to 3% of survivors (p<0.001). The injury severity score of nonsurvivors was higher than that of survivors (27 vs 17, p=0.02 in univariate analysis). Nonsurvivors were less likely to have multiple fractures (11% vs. 43%, p=0.01). Nonsurvivors were more likely to have bilateral hypoxic ischemic injury (HII, 89% vs 29%, p< 0.001, Crude OR for survival 0.33, p<0.001, p=0.017 in multivariate analysis). There was no difference in rates or types of neurosurgical intervention, intracranial hemorrhage location, or presence of spinal hemorrhage between nonsurvivors and survivors. Discussion: Mortality from AHT in our series was higher than previously reported: more than one out of six children in our series did not survive. Although nonsurvivors were more likely to live in highly vulnerable social settings, COVID-19 did not change survival rate. Nonsurvivors are more likely to present in coma requiring intubation and in cardiac arrest. Subdural hematomas are seen in survivors and non-survivors but surgical mass lesions are rare and surgery does not improve survival. We identify a strong association between completed bilateral HII on admission and fatality in AHT. The high mortality of AHT in association with HII, and the low efficacy of intervention after completed HII supports a public health effort towards treatment and prevention focusing on socially vulnerable communities.