Incidence and severity of COVID-19 infection post-vaccination: a survey among Indian doctors.

PURPOSE: The rollout of COVID-19 vaccines began in India in January 2021, with healthcare professionals being the first to receive vaccination. The purpose of this research was to study the incidence and severity of COVID-19 infections among Indian doctors, following vaccination with ChAdOx1 nCoV-19 or BBV152. METHODS: We conducted an online voluntary survey among Indian doctors who received one or two doses of ChAdOx1 nCoV-19 or BBV152. Questions pertaining to the incidence and severity of COVID-19 infection following vaccination were asked. Data thus obtained were analysed. RESULTS: 9146 doctors were included in this study. 8301 of these received ChAdOx1 nCoV-19, while 845 received BBV152. 2842 (31.07%) respondents reported having a COVID-19 infection following vaccination. Presence of pre-existing medical comorbidities was associated with a higher incidence, while prior COVID-19 infection and two doses of either vaccine were associated with a lower incidence of COVID-19 infection post-vaccination. Exposure to COVID-19 patients on a daily basis did not increase the incidence of COVID-19 infection among doctors who were vaccinated. Increasing age, male gender, presence of pre-existing medical comorbidities, and daily exposure to COVID-19 patients were associated with increased severity of COVID-19 infection after vaccination. Two doses of either vaccine resulted in less severity of disease compared to one dose. CONCLUSION: ChAdOx1 nCoV-19 and BBV152 confer immunity against severe forms of COVID-19 infections. COVID-19 infections prior to vaccination result in a lower incidence of breakthrough infection. Presence of pre-existing medical comorbidities is associated with increased incidence and severity of breakthrough infections.

Trunnion fracture of femoral prosthesis following a large metal-on-metal uncemented total hip arthroplasty: a case report.

BACKGROUND: Trunnion fracture of the femoral prosthesis is an extremely rare complication following Total Hip Arthroplasty (THA). There are very few reports in literature on trunnion fracture. All previously reported cases are of prostheses with smaller heads, unlike the large metal-on-metal articulation in our case, which is unique. CASE PRESENTATION: A 29-year-old male patient with juvenile idiopathic arthropathy presented to us with a fracture of the trunnion of his left THA, with no history of trauma. He had undergone staged bilateral THA for avascular necrosis of the hips 10 years ago (with AML-A stem and large metal-on-metal articulation bilaterally). We revised the THA and exchanged both femoral and acetabular components. He had a good functional outcome at 3 years' follow up. CONCLUSION: The primary reason for the trunnion fracture in our case was the faulty stem design of the AML [with a small (9/10) taper, and a large head], causing excessive bending moment at the trunnion, worsening the cantilever effect and leading to subsequent cyclic fatigue failure. Whilst gross trunnion failure (GTF) with dissociation of the head from the taper is commonly reported, trunnion fracture per se is a rare and devastating complication. The AML-A stem has since been recalled by the company and there is a need to constantly monitor these patients for potential trunnion-related complications.