Effect of COVID-19 lockdown on injury incidence and burden in amateur rugby union.

OBJECTIVES: To analyse match and training injury incidence rates and burden from pre-(2019) and post-COVID-19 (2021) seasons; To analyse injury related variables as mechanisms, type, body locations, severity and the differences of the most common injuries according to playing positions. DESIGN: An observational study was performed according to the consensus statement on injury definitions and data collection from World Rugby. Injury variables were collected retrospectively for 2019 season and prospectively during 2021 season. SETTING: Argentinian amateur rugby club. PARTICIPANTS: Male (n = 110) senior amateur rugby players. MAIN OUTCOME MEASURES: Match and training time loss injuries, time of exposures and injury related variables. RESULTS: Training incidence rate during post-lockdown season (4.2/1000 player-training-hours) was significantly higher (p < 0.001) than the pre-lockdown season (0.9/1000 player match hours). Post-lockdown hamstring strain injury (HSI) and concussions match incidence rates were significantly (p < 0.001; p < 0.05 respectively) higher in comparison with 2019 season. Regarding playing positions, backs showed a significantly increase (p < 0.05) in HSI match incidence rate post lockdown. CONCLUSIONS: After the COVID-19 lockdown, training incidence rate was significantly higher than previous season (2019), showing the impact of the lockdown restrictions. Coaches and medical staff must consider that players probably need more lead-in time for conditioning and more monitoring after periods of no rugby.

Risk Factors for Infection of Sutured Maxillofacial Soft Tissue Injuries.

Background: Maxillofacial soft tissue injuries (STIs) are common and frequent in emergency departments. The aim of this study was to analyze factors causing infection of maxillofacial STIs. Patients and Methods: Patients with maxillofacial STIs who received sutures and had complete medical records were evaluated. Gender, age, American Society of Anesthesiologists (ASA) grade, diabetes mellitus, wound age, wound length, wound contamination, wound type, and sites were analyzed using univariable analysis and binary logistic regression. Results: There were 3,276 cases included. In the univariable analysis, there was no significant difference in the infection rate between genders or between the wound age groups. In binary logistic regression, age, wound length, wound type, and physician level were risk factors for infection: age of 18-44 years (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.7-2.9), 44-64 years (OR, 3.1; 95% CI, 2.3-4.3), and ≥65 years (OR, 2.6; 95% CI, 1.7-4.1); wound length of 4-8 cm (OR, 1.7; 95% CI, 1.3-2.2) and >8 cm (OR, 2.4; 95% CI, 1.1-5.1); intra-oral wounds (OR, 1.6; 95% CI, 1.1-2.4) and communicating wounds (OR, 3.2; 95% CI, 2.3-4.4); junior specialists (OR, 1.6; 95% CI, 1.2-2.2); and lip (OR, 3.7; 95% CI, 1.1-12.0) and cheek (OR, 4.7; 95% CI, 2.3-17.1) sites. Wound contamination, ASA grade, and diabetes mellitus were not significantly different from wound infection in binary regression analysis. Conclusions: Age (>18 years old), wound length (>4 cm), intra-oral wounds, communicating wounds, suturing by junior surgeons, and lip or cheek injuries may be risk factors for maxillofacial STI infection. Even if the penetrating wound age exceeds 24 hours, it is meaningful to suture if there is no serious infection. For wounds at high risk of infection, further measures should be considered to reduce the possibility of infection, such as improving the surgical training of junior surgeons and improving the patient's wound care.

Safety and Long-term Improvement of Mesenchymal Stromal Cell Infusion in Critically COVID-19 Patients: A Randomized Clinical Trial. (preprint)

Background: COVID-19 is a multisystem disease that presents acute and persistent symptoms, the PostAcute Sequelae (PASC). Long-term symptoms may be due to consequences from organ or tissue injury caused by SARS-CoV-2, associated clotting or inflammatory processes during acute COVID-19. Various strategies are being chosen for by clinicians to prevent severe cases of COVID-19; however, a single treatment would not be efficient in treating such a complex disease. Mesenchymal stromal cells (MSCs) are known for their immunomodulatory properties and regeneration ability; therefore, they are a promising tool for treating disorders involving immune dysregulation and extensive tissue damage, as is the case with COVID-19. T his study aimed to assess the safety and explore the long-term efficacy of three intravenous doses of UC-MSCs (umbilical cord-MSCs) as an adjunctive therapy in the recovery and postacute sequelae reduction caused by COVID-19. To our knowledge, this is the first report that presents the longest follow-up after MSC treatment in COVID-19 patients. Methods: : This was a phase I/II, prospective, single-center, randomized, double-blind, placebo-controlled clinical trial. Seventeen patients diagnosed with COVID-19 who require intensive care surveillance and invasive mechanical ventilation – critically ill patients – were included. The patient infusion was three doses of 5x10 5 cells/kg UC-MSCs, with a dosing interval of 48 hours (n=11) or placebo (n=6). These evaluations consisted of a clinical assessment, viral load, laboratory testing, including blood count, serologic, biochemical, cell subpopulation, cytokines and CT scan. Results: : The results revealed that in the UC-MSC group, there was a reduction in the levels of ferritin, IL-6 and MCP1-CCL2 on the fourteen day. In the second month, a decrease in the levels of reactive C-protein, D-dimer, and neutrophils and an increase in the numbers of TCD3, TCD4 and NK lymphocytes were observed. A decrease in lung extension was observed at the fourth month. The improvement in all these parameters was maintained until the end of patient follow-up. Conclusions: : UC-MSCs infusion is safe and can play an important role as an adjunctive therapy, both in the early stages, preventing severe complications and in the chronic phase with postacute sequelae reduction in critically ill COVID-19 patients. Trial registration: Brazilian Registry of Clinical Trials (ReBEC), UTN code - U1111-1254-9819. Registered 31 October 2020 - Retrospectively registered, https://ensaiosclinicos.gov.br/rg/RBR-3fz9yr

Pediatric Soft Tissue Injuries During the COVID-19 Lockdown (preprint)

Background. The lockdown due to the COVID-19 pandemic forced the closure of educational centers. This increased the well-known risk factors for pediatric trauma injuries within the household. The aim of this study was to compare common soft tissue injuries of pediatric patients at the emergency department during lockdown to similar injuries in the previous years. We hope that our results may contribute to the development of preventive care programs that may reduce the rate of injuries.Methods. We collected data of patients who arrived to our pediatric emergency department in March of 2018, 2019, and 2020, due to soft tissue injuries. Data retrieved included demographics, time lags, injury characteristics, causes, and the locations of occurrence. Descriptive statistics were performed. Results. Of 1,061 arrivals, 398 (37.5%), 377 (35.5%), and 286 (27.0%) were during 2018, 2019, and 2020, respectively. The year 2020 showed a prolonged time from injury to arrival and the shortest stay in the department, but a higher hospitalization rate. The overall mean arrival time was 173% higher in 2020 than in 2018. Indoor injuries comprised 80% of all injuries during 2020 compared to 55% in 2018. In 2020, significantly lower proportions of injuries were observed from motor vehicle accidents, bicycle accidents, metal objects, wooden objects, and sport activities. Conclusion. The recent increase in indoor injuries during the current pandemic emphasizes the importance of a designated prevention campaign. Aspects of prevention and care to be addressed include environmental factors, patient management, medical staff management, and surgery tactics.

The effect of the COVID-19 pandemic on mental health associated trauma, admissions and fractures at a London major trauma centre.

INTRODUCTION: Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. MATERIALS AND METHODS: We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history. RESULTS: There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture. DISCUSSION: There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. CONCLUSION: While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential 'second wave' of COVID-19.