Spontaneous Avascular Necrosis of the Humeral Head Following COVID-19 Vaccination.

We report a case of a 40-year-old man who presented with left shoulder pain and marked functional impairment two days after receiving the second dose of the Pfizer COVID-19 vaccine. Advanced imaging demonstrated focal avascular necrosis (AVN) of his humeral head. Initial management included simple analgesics, activity modification, and an ultrasound-guided intra-articular hydrodilatation injection. The patient subsequently had an improved range of motion but persistent severe shoulder pain. He has now been offered surgical intervention. Despite having risk factors for developing AVN previously, the patient did not demonstrate any recent risk factors for developing the disease. COVID-19 vaccination is known to cause severe joint pain and stiffness rarely. However, avascular necrosis is not a known or documented side effect. His symptoms arose directly after the administration of the vaccine, with no other demonstrable cause. Therefore, we are reporting COVID-19 vaccination as a potential new risk factor for AVN of the humeral head.

Topical Negative Pressure Wound Dressing and Its Applications in the Hand-A Review of the Literature.

The use of topical negative pressure wound therapy (NPWT) has become increasingly popular in the management of complex wounds. There are many theories as to the mechanism of action of NPWT, but the essential components of the various systems remain consistent. There are many attractive potential properties of negative pressure dressings that lend themselves to the management of upper limb injuries. This article explores the technique of negative pressure wound dressing, the theories pertaining to mechanism of action, and the increasingly broad indications described for the use of NPWT in the hand. The literature pertaining to the efficacy of NPWT in general is also discussed.

Piloting a multidisciplinary clinic for the management of non-alcoholic fatty liver disease: initial 5-year experience.

OBJECTIVE: A multidisciplinary approach is advocated for the management of Non-Alcoholic Fatty Liver Disease (NAFLD), but few clinical data exist to support this. The objective of this study was to investigate the effectiveness of a multidisciplinary NAFLD clinic using surrogate markers of liver injury and cardiovascular risk. DESIGN: Retrospective survey of clinical practice. SETTING: The multidisciplinary NAFLD clinic in a secondary/tertiary care setting with hepatology, diabetology, dietetic and exercise therapy input: initial 5-years' experience (2007-2012). PATIENTS: 180 patients with NAFLD but without hepatic comorbidities were followed up for a median of 19.5 (range 3-57) months. 52% had type 2 diabetes mellitus, 48% were Europoid Caucasian, 17% were South Asian. INTERVENTIONS: Multiple clinical interventions were employed including lifestyle (diet and exercise) advice, pharmacological intervention for cardiovascular risk factors, weight loss and exercise therapy. MAIN OUTCOME MEASURES: Change in alanine aminotransferase (ALT), weight, HbA1c, lipid profile and blood pressure. RESULTS: Median ALT fell from 61 (12-270) U/l to 50 (11-221) U/l, -18%, p<0.001, and weight fell from 90.5 (42.7-175.0) kg to 87.3 (45.9-175.3) kg, -3.5%, p<0.001. There were significant improvements in total cholesterol overall, triglycerides (among dyslipidaemic patients), HbA1c (among diabetic patients) and systolic blood pressure (among hypertensive patients). 24% of patients achieved ≥7% weight loss during follow-up and 17% maintained this weight loss throughout. CONCLUSIONS: Improvement in liver biochemistry and cardiovascular risk factors was seen in patients attending the multidisciplinary NAFLD clinic. Refinement of this approach is warranted in light of these data, novel therapies and a growing evidence base.