Post-COVID-19 vaccine uveitis: A case series.

OBJECTIVE: With the recent emergence and worldwide distribution of COVID-19 vaccines, many side effects may be underreported and possibly unknown. Cases of vaccine-associated uveitis have been linked to almost all vaccines administered in the past; however, there is scarcity of literature providing insight into post-COVID-19 vaccine-associated uveitis. This case series documents patients presenting with uveitis after administration of the Pfizer and Moderna mRNA vaccines, in hope of advancing our current understanding of potential ocular complications of COVID-19 vaccines. METHODS: Patients with ocular symptoms consistent with uveitis within 14 days after administration of the Pfizer or Moderna COVID-19 vaccines were included in this case series. RESULTS: Eight patients with a mean age of 44.4 years (range, 19-83) were included. Six patients received a Pfizer, and 2 received a Moderna vaccine. Four patients presented after their first dose, 3 after their second dose, and 1 after both doses. The mean onset of ocular symptoms after the vaccine was 5.19 days (range, 1-14), and the mean BCVA was 0.678. Patients were diagnosed with bilateral anterior granulomatous uveitis (case 1), unilateral non-granulomatous anterior uveitis (case 2, 5-8), and bilateral non-granulomatous anterior uveitis (case 3-4). CONCLUSIONS: The pathogenesis of vaccine-induced uveitis is not properly understood; however, the outcomes of this case series will aid in establishing a temporal association between the Pfizer and Moderna COVID-19 vaccines and the onset of uveitis. As the rate of COVID-19 vaccinations increases globally, it is imperative for physicians to be aware of the possible association and presentation of these ocular findings and diagnoses in order to treat patients effectively.

Dorsal bridge plating or transarticular screws for Lisfranc fracture dislocations: a retrospective study comparing functional and radiological outcomes.

Aims: The aim of this retrospective study was to compare the functional and radiological outcomes of bridge plating, screw fixation, and a combination of both methods for the treatment of Lisfranc fracture dislocations. Patients and Methods: A total of 108 patients were treated for a Lisfranc fracture dislocation over a period of nine years. Of these, 38 underwent transarticular screw fixation, 45 dorsal bridge plating, and 25 a combination technique. Injuries were assessed preoperatively according to the Myerson classification system. The outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) score, the validated Manchester Oxford Foot Questionnaire (MOXFQ) functional tool, and the radiological Wilppula classification of anatomical reduction. Results: Significantly better functional outcomes were seen in the bridge plate group. These patients had a mean AOFAS score of 82.5 points, compared with 71.0 for the screw group and 63.3 for the combination group (p < 0.001). Similarly, the mean Manchester Oxford Foot Questionnaire score was 25.6 points in the bridge plate group, 38.1 in the screw group, and 45.5 in the combination group (p < 0.001). Functional outcome was dependent on the quality of reduction (p < 0.001). A trend was noted which indicated that plate fixation is associated with a better anatomical reduction (p = 0.06). Myerson types A and C2 significantly predicted a poorer functional outcome, suggesting that total incongruity in either a homolateral or divergent pattern leads to worse outcomes. The greater the number of columns fixed the worse the outcome (p < 0.001). Conclusion: Patients treated with dorsal bridge plating have better functional and radiological outcomes than those treated with transarticular screws or a combination technique. Cite this article: Bone Joint J 2018;100-B:468-74.

Evaluation of Musculoskeletal Disorders in Dentists and Application of DMAIC Technique to Improve the Ergonomics at Dental Clinics and Meta-Analysis of Literature.

INTRODUCTION: Musculoskeletal disorders (MSD) result in discomfort, pain and illness that can result in disruption or impairment of dental practice. MATERIALS AND METHODS: A cross-sectional study consisting of 60 dentists was carried out to determine musculoskeletal work related pain in major cities of Northern India. The study was planned in two phases. In the first phase, the subjects were given questionnaire related to the musculoskeletal pain happened over the last twelve months. In the second phase of study, improvement was carried out by recommending the subjects to implement ergonomics at their workplace. After three months subjects were again approached and given questionnaire about the musculoskeletal disorders. DMAIC (define, measure, analyse, improve and control) methodology of six sigma strategy was used to access the MSDs. Chi-square test was used for the analysis and a p-value of less than or equal to 0.05 was considered statistically significant. RESULTS: The overall prevalence of musculoskeletal problems in the present study was found to be 68.3%. After three months only 23 respondents applied ergonomics at their work place, prevalence of pain was reduced in neck from 47.8% to 21.7% out of total 23 respondents, shoulder pain 39.1% to 17.3%, pain in elbows from 26% to 21.7%, as well as in other locomotor organs. The p-value was significant with p <0.05. CONCLUSION: MSD represents a major occupational health issue for dentists in India as well as worldwide and result revealed necessitates the need of workshops to create awareness of ergonomics as effective measures for reducing MSD among dentists.

Utility of CT head in the acute setting: value of contrast and non-contrast studies.

INTRODUCTION: To examine the added diagnostic value of emergent contrast enhanced CT head (CECTH) in patients who present to the emergency department (ED) with acute non-traumatic symptoms referable to the brain, and to assess the financial implications of CECTH in the emergent setting. MATERIALS AND METHODS: We queried healthcare data for head CTs ordered by our ED between January 2008 and December 2010. Those who presented to the ED with non-traumatic neurologic disturbances were included. All traumatic head injury cases were excluded. Two board certified radiologists with fellowship training who were blinded to patient history and physical findings, independently reviewed all non-contrast computed tomography of the head (NCTH) and CECTH images. CECTH's were read following abnormal NCTH's, and findings were recorded as normal or abnormal. RESULTS: In our investigation, 379 patients-210 (55 %) females and 169 (45 %) males-met the inclusion criteria. Common indications for head CT included: headache 183 (48 %); dizziness 73 (19 %); altered mental status 49 (13 %); and seizure 38 (10 %). The mean age of study subjects was 47 (±29) years. Two hundred sixty-one (69 %) of all patients scanned showed no abnormality. One hundred eighteen (31 %) of 379 patients had abnormal scans. We encountered 1 abnormal CECTH on which NCTH was normal. Cost of CECTH was $465 and NCTH was $385. CONCLUSION: Head CT in ED non-traumatic neurological presentations with CECTH is not generally indicated and represents a calculable cost savings in the management of these patients.

Changing Pattern of Alcohol Abuse in the Army before and after AO 3&11/2001.

BACKGROUND: The Army Order 3&11/2001 was introduced to curb alcoholism and to weed out habitual alcoholics. Hence a study was carried out in a zonal referral hospital from 01 Jan 2001 to 30 Jun 2003 to assess its effectiveness. METHODS: The subjects consisted of officers, junior commisioned officers and other ranks who satisfied the International Classification of Diseases (ICD) 10 criteria for alcohol dependence. RESULT: Out of 1023 consecutive admissions, alcohol dependent cases numbered 245 (23.95%). They were disposed as under: 57/ 245 (23.6%) in S1 (fit for all duties), 67/245 (27.35%) in S2 (fit for duties with few restrictions), 72/245 (29.39%) in S3 (fit for duties with more restrictions), and 32/245 (13.06%) in S5 (unfit for further service.). CONCLUSION: The data showed that the percentage of cases disposed under fit for all duties had risen four times (23.80 vs 5.86), those invalided out increased by two times (12.70 vs 6.64) and those retained in S2 had reduced (26.46 vs 41.21) after the new policy.

Proton spectroscopy and diffusion imaging on the first day of life after perinatal asphyxia: preliminary report.

BACKGROUND AND PURPOSE: MR techniques have proved useful in assessing brain injury from perinatal asphyxia when the injury is subacute or chronic. Recent advances in understanding the molecular mechanisms of brain injury have made medical intervention plausible, creating a need for assessment of the brain within the first few hours of life. We report the results of early (first 24 hours after birth) MR imaging in seven patients, including proton MR spectroscopy in six. METHODS: MR studies were performed within the first 24 hours of life in seven consecutive patients who were encephalopathic after complicated deliveries. Standard T1-, T2-, and diffusion-weighted sequences were performed in all patients; single-voxel MR spectroscopy was performed in two locations in six of the seven patients. Follow-up MR studies were performed in four patients at ages 7, 8, 9, and 15 days, respectively. RESULTS: T1-weighted images were normal in all seven patients. T2-weighted images were normal in three patients and showed T2 prolongation in the basal ganglia or white matter in the other four. Diffusion images showed small abnormalities in the lateral thalami or internal capsules in all seven patients. Comparison with clinical course in all seven patients and with follow-up MR studies in four showed that the diffusion images underestimated the extent of brain injury. Proton MR spectroscopy showed substantial lactate elevation in all six of the patients studied. Two patients died in the neonatal period and the other five were left with clinically significant neurologic impairment. CONCLUSION: MR spectroscopy performed in the first 24 hours after birth is sensitive to the presence of hypoxic-ischemic brain injury, whereas diffusion imaging may help identify but underestimate the extent of the injury. Further studies are ongoing in an attempt to expand upon this observation.

Global myocardial revascularization without cardiopulmonary bypass using innovative techniques for myocardial stabilization and perfusion.

BACKGROUND: In off-pump coronary bypass grafting (CABG), invasiveness is reduced but technically perfect anastomosis is jeopardized by cardiac motion and the need to hurry to reduce the time of ischemia. Also, a major cause of postoperative morbidity and mortality is ungrafted circumflex coronary artery disease. We have devised a means of overcoming these shortcomings and performing multivessel CABG. The objective of this study was to assess the safety and efficacy of our technique. METHODS: One hundred patients with severe triple-vessel disease underwent multivessel off-pump CABG. For cardiac stabilization, a combination of local pericardial stabilization sutures and lifting and rotating the heart by means of posterior pericardial sutures were used. For myocardial perfusion, a technique of retrograde coronary sinus perfusion by arterial blood from the ascending aorta was used. RESULTS: Each patient received an average of 3.8 grafts (range 3 to 5). Complications included conversion to cardiopulmonary bypass (CPB) in 1 patient and a perioperative myocardial infarction in the same patient. In all other patients we were able to perform a satisfactory grafting in all territories with no operative mortality. Rapid recovery allowed 95% of our patients to resume normal activity within 1 month. A predischarge graft angiogram in 35 patients showed 97.8% patency. CONCLUSIONS: These results suggest that off-pump CABG with our techniques is effective and safe. Early clinical outcome and excellent patency rates suggest its more widespread use in selected cases.

Osteosarcoma of the scapula arising in osteogenesis imperfecta.

A case of osteosarcoma arising in the scapula of a 37 year old woman with severe congenital sporadic white sclera type osteogenesis imperfecta (OI) is presented. Osteosarcoma occurs as a sporadic rather than a related occurrence in patients with OI. A delay in the diagnosis of osteosarcoma may occur due to the similarity in symptomatology between the two conditions and because of the difficulty in differentiating between hyperplastic callus and tumor using conventional radiographic imaging techniques.

Differences in impulse distribution in patients with plantar fasciitis.

The impulse distribution based upon vertical foot-floor reaction forces and time under the fore-, mid-, and hindfoot was determined using Tekscan's F-Scan system. This was compared in 40 barefoot patients with long-standing plantar fasciitis with an equal number of normal subjects. The patient group tended to load the hind- and midfoot to a lesser extent than the control group. Consequently, a greater proportionate load was borne by the forefoot. This result was highly significant for both the midfoot (P < 0.001) and forefoot (P = 0.002) comparisons. An objective biomechanical method such as this may be useful as a diagnostic aid, to identify individuals predisposed to this condition, and for evaluating the efficacy of various treatment modalities.

An audit of early hospital readmission after primary knee joint replacement.

BACKGROUND: Hospital readmissions following arthroplasty represent a considerable burden to the community. The present study investigates the magnitude of this problem and the reasons for early readmission. METHODS: The medical records of patients who underwent primary knee joint replacements between July 1989 and December 1994 were reviewed retrospectively. Readmission within 12 months of surgery was noted and the prognosis of these patients assessed. RESULTS: A total of 160 patients (180 arthroplasties) were appropriate for review. The readmission rate for knee-related morbidity was 18%. The main reasons for this included pain, stiffness, and the investigation/management of an inflamed joint. Notably, patellofemoral disease was common, particularly in the group without resurfaced patellae, manipulation of a stiff joint was rarely effective unless instituted early and aetiologies aside from sepsis often resulted in the patient returning with an inflamed joint. CONCLUSIONS: Readmission is a significant problem which heralds a poor 12-month prognosis.