Handball concussion case series in a Brazilian Team

Neurology ◽  
2020 ◽  
Vol 95 (20 Supplement 1) ◽  
pp. S13.1-S13
Author(s):  
Carlos Pinheiro ◽  
Mariana Maciel Fejio
Keyword(s):  
Motor Coordination ◽  
Case Series ◽  
Head Impact ◽  
Published Data ◽  
Symptom Scale ◽  
Cervical Injury ◽  
Brain Concussion ◽  
Single Task ◽  
Falling Asleep ◽  
And Performance

ObjectiveTo analyze the history of self-reported head impacts, prevalence of post-concussion symptoms and performance in motor coordination tests in amateur handball athletes.BackgroundHandball is a contact sport where athletes can suffer collisions through different mechanisms and there are few published data about brain concussion in handball, mainly in Brazilian athletes.Design/MethodsAmateur male athletes aged between 18 and 35 years, with 4–6 hours of training per week and an average of 12.5 games in the last 6 months were evaluated regarding to the head impact history during handball games and practices. The athletes were also evaluated regarding of the most common kind of impact mechanism, loss of consciousness (LOC), reported cervical injury (pain and decreased range of motion), symptoms prevalence and their severity using the Post Concussion Symptom Scale (PCSS), time to execution of single-task tandem gait (TG) and performance in the Finger-to-Nose test (>4 seconds to perform five successive finger to nose repetitions was considered abnormal).ResultsSix athletes reported direct impacts on the head while playing handball. Falls, elbow to the head, trunk to the head and hit by the ball were the most reported mechanisms of head impact in handball athletes. Two athletes reported LOC and all of them denied cervical injury after trauma. Regarding the PCSS score, three athletes had a score between 6-21 and five athletes had a 22–84 score. The most reported symptoms were sleeping more than usual, drowsiness, fatigue, changes in behavior (nervousness, feeling more emotional and irritability), trouble falling asleep and dizziness. However, athletes shown a normal performance in the single task TG (14.6–17.2 seconds) compared to normative data and three athletes shown altered performance on the Finger-to-Nose test.ConclusionsAmateur handball athletes had significant scores of PCSS mainly related to sleep, emotional and possibly to the vestibular function.

Reversal of DIRECT-ACTING Oral Anticoagulants in Urgent Surgery of the Proximal Aorta: case Series and Review of the literature

2019 ◽  
Vol 24 (38) ◽  
pp. 4534-4539 ◽  
Author(s):  
Eric Zimmermann ◽  
Fawzi Ameer ◽  
Berhane Worku ◽  
Dimitrios Avgerinos
Keyword(s):  
Oral Anticoagulants ◽  
Aortic Surgery ◽  
Management Strategies ◽  
Case Series ◽  
Published Data ◽  
Review Of Literature ◽  
Clotting Factors ◽  
Urgent Surgery ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

Introduction: Proximal aorta interventions impose significant bleeding risk. Patients on concomitant anticoagulation regimens compound the risk of bleeding in any surgery, but especially cardiothoracic interventions. The employment of direct-acting oral anticoagulants (DOAC), namely those that target clotting factors II or X, has expanded at a precipitous rate over the last decade. The emergence of their reversal agents has followed slowly, leaving clinicians with management dilemmas in urgent surgery. We discuss current reversal strategies based on the available published data and our experience with proximal aortic surgery in patients taking DOACs. Literature Search: We performed a review of literature and present three cases from our experience to offer insight into management strategies that have been historically successful. A review of literature was conducted via PubMed with the following search string: (NOAC or DOAC or TSOAC) and (aorta or aortic or (Stanford and type and a)). Case Presentation: We present three case presentations that illustrate the importance of DOAC identification and offer management strategies in mitigating associated bleeding risks in urgent or emergent surgeries. Conclusion: Treatment teams should be aware of the technical limitations of identifying and reversing DOACs. In view of the tendency toward publishing positive outcomes, more scientific rigor is required in the area of emergency DOAC reversal strategies.

scholarly journals Neoplastic lesions in domestic pigs detected at slaughter: literature review and a 20-year review (1998–2018) of carcass inspection in Catalonia

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Antonia Morey-Matamalas ◽  
Enric Vidal ◽  
Jorge Martínez ◽  
Jaume Alomar ◽  
Antonio Ramis ◽  
...  
Keyword(s):  
B Cell ◽  
Case Series ◽  
B Cell Lymphoma ◽  
Support Network ◽  
Published Data ◽  
Nerve Sheath Tumor ◽  
Lymphoid Leukemia ◽  
Lymphoid Neoplasms ◽  
Neoplastic Lesions ◽  
Slaughtered Pigs

Abstract Background The present paper reviews the occurrence of neoplasms in swine and presents a case series of 56 tumors submitted to the Slaughterhouse Support Network (Servei de Suport a Escorxadors [SESC] IRTA-CReSA]) from slaughtered pigs from 1998 to 2018 (April) in Catalonia (Spain). The aim of the study was to describe the spectrum of spontaneous neoplastic lesions found in slaughtered pigs and to compare the reported tumor cases with previous published data. Lymphoid neoplasms were characterized and classified using the WHO classification adapted for animals. Results The most reported neoplasm during this period was lymphoma (28). Within lymphomas, the B-cell type was the most common, being the diffuse large B-cell lymphoma (15/28) the most represented subtype. Other submitted non-lymphoid neoplasms included melanoma (7), nephroblastoma (3), mast cell tumor (2), liposarcoma (2), osteochondromatosis (2), papillary cystadenocarcinoma (1), peripheral nerve sheath tumor (1), lymphoid leukemia (1), fibropapilloma (1), hemangiosarcoma (1), hepatoma (1), histiocytic sarcoma (1), pheochromocytoma (1) and osteosarcoma (1). Conclusions The existence of a well-established Slaughterhouse Support Network allowed the compilation of comprehensive data for further epidemiological and pathological studies, particularly about less commonly reported lesions in livestock such as neoplasms in pigs.

scholarly journals Characteristics and Outcomes Among Hospitalized COVID-19-Positive Patients in a Nonurban Environment

2021 ◽  
Author(s):  
Robert P Lennon ◽  
Theodore J Demetriou ◽  
M Fahad Khalid ◽  
Lauren Jodi Van Scoy ◽  
Erin L Miller ◽  
...  
Keyword(s):  
New York ◽  
Medical Center ◽  
Academic Medical Center ◽  
Military Medicine ◽  
Case Series ◽  
Outcome Data ◽  
Urban Environments ◽  
Urban Setting ◽  
Published Data ◽  
Retrospective Case

ABSTRACT Introduction Virtually all hospitalized coronavirus disease-2019 (COVID-19) outcome data come from urban environments. The extent to which these findings are generalizable to other settings is unknown. Coronavirus disease-2019 data from large, urban settings may be particularly difficult to apply in military medicine, where practice environments are often semi-urban, rural, or austere. The purpose of this study is compare presenting characteristics and outcomes of U.S. patients with COVID-19 in a nonurban setting to similar patients in an urban setting. Materials and Methods This is a retrospective case series of adults with laboratory-confirmed COVID-19 infection who were admitted to Hershey Medical Center (HMC), a 548-bed tertiary academic medical center in central Pennsylvania serving semi-urban and rural populations, from March 23, 2020, to April 20, 2020 (the first month of COVID-19 admissions at HMC). Patients and outcomes of this cohort were compared to published data on a cohort of similar patients from the New York City (NYC) area. Results The cohorts had similar age, gender, comorbidities, need for intensive care or mechanical ventilation, and most vital sign and laboratory studies. The NYC’s cohort had shorter hospital stays (4.1 versus 7.2 days, P < .001) but more African American patients (23% versus 12%, P = .02) and higher prevalence of abnormal alanine (>60U/L; 39.0% versus 5.9%, P < .001) and aspartate (>40U/L; 58.4% versus 42.4%, P = .012) aminotransferase, oxygen saturation <90% (20.4% versus 7.2%, P = .004), and mortality (21% versus 1.4%, P < .001). Conclusions Hospitalists in nonurban environments would be prudent to use caution when considering the generalizability of results from dissimilar regions. Further investigation is needed to explore the possibility of reproducible causative systemic elements that may help improve COVID-19-related outcomes. Broader reports of these relationships across many settings will offer military medical planners greater ability to consider outcomes most relevant to their unique settings when considering COVID-19 planning.

scholarly journals Return to Sport After Hip Resurfacing Arthroplasty

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110035
Author(s):  
Kyle W. Morse ◽  
Ajay Premkumar ◽  
Andrew Zhu ◽  
Rachelle Morgenstern ◽  
Edwin P. Su
Keyword(s):  
Case Series ◽  
Hip Resurfacing ◽  
High Impact ◽  
Professional Athletes ◽  
Hip Resurfacing Arthroplasty ◽  
Resurfacing Arthroplasty ◽  
Elite Level ◽  
Performance Statistics ◽  
And Performance ◽  
End Stage

Background: Femoroacetabular impingement and degenerative hip osteoarthritis (OA) affect athletes across a wide variety of sports. Hip resurfacing arthroplasty (HRA) has emerged as a surgical treatment for active individuals with end-stage hip OA to provide pain relief and allow return to high-impact activities. Return to professional sports after HRA has not been well characterized. Purpose/Hypothesis: The aim of this study was to report on a series of elite athletes in a variety of sports who underwent HRA. We hypothesized that professional and elite-level athletes would be able to return to sports after HRA for end-stage hip OA. Study Design: Case series; Level of evidence, 4. Methods: A retrospective case series was conducted on professional athletes who underwent HRA at a single institution between 2007 and 2017. All surgeries were performed by a single surgeon using the posterolateral approach. Athletes’ return to play and sport-specific performance statistics were obtained using self-reported and publicly available data sources. Athletes were matched to an age- and performance-based cohort to determine changes in performance-based metrics. Results: Eight professional athletes were identified, including 2 baseball pitchers, 1 ice hockey defenseman, 1 foil fencer, 1 men’s doubles tennis player, 1 basketball player, 1 ultramarathoner, and 1 Ironman triathlete. All 8 patients returned to sports; 6 of 8 (75%) patients were able to return for at least 1 full season at a professional level after surgery. There were no significant differences between performance statistics for athletes who returned to play and their preoperative performance measures for the years leading up to surgery or the age- and performance-matched cohort. Conclusion: HRA remains a surgical alternative for end-stage hip OA in young, high-impact, active patients. While the primary goals of surgery are pain control and quality of life improvement, it is possible to return to elite-level sporting activity after HRA.

Tildrakizumab Inadequate Responders Switching to an Alternative IL-23 Inhibitor: A Case Series

2021 ◽  
pp. 247553032110373
Author(s):  
Eingun James Song ◽  
Audrey Jia Shin Wong
Keyword(s):  
Adverse Events ◽  
Expert Opinion ◽  
Case Series ◽  
Tnf Alpha ◽  
Published Data ◽  
Inadequate Response ◽  
Limited Time ◽  
Case Description ◽  
Single Institution ◽  
Inadequate Responders

Background: Biologic switching is not uncommon in the treatment of psoriasis and is most often due to inadequate response of adverse events. Staying within or switching out of the class is still based on expert opinion but there are published data on intra-class switching with TNF-alpha and IL-17 inhibitors. Less is known about the IL-23 inhibitors because of their limited time in the market. We would like to present our experience with inadequate responders to tildrakizumab, a selective IL23 inhibitor, who were switched to an alternative IL-23 inhibitor. Case Description: This is a case series of 6 patients at a single institution considered inadequate responders to tildrakizumab, which included primary failures, secondary failures, and intermediate responders, who were subsequently switched to another IL-23 inhibitor. Conclusion: All 6 patients who were inadequate responders to tildrakizumab showed significant improvement after switching to another IL-23 inhibitor, with 5/6 reaching IGA 0/1 after 16 weeks of treatment.

scholarly journals Football concussion case series using biomechanical and video analysis

Neurology ◽  
2018 ◽  
Vol 91 (23 Supplement 1) ◽  
pp. S2.2-S2
Author(s):  
Mirellie Kelley ◽  
Jillian Urban ◽  
Derek Jones ◽  
Alexander Powers ◽  
Christopher T. Whitlow ◽  
...  
Keyword(s):  
Video Analysis ◽  
Case Series ◽  
Linear Acceleration ◽  
The United States ◽  
Head Impact ◽  
Rotational Acceleration ◽  
Impact Location ◽  
Injury Mechanisms ◽  
The Mean ◽  
Impact Data

Approximately 1.1–1.9 million sport-related concussions among athletes ≤18 years of age occur annually in the United States, but there is limited understanding of the biomechanics and injury mechanisms associated with concussions among lower level football athletes. Therefore, the objective of this study was to combine biomechanical head impact data with video analysis to characterize youth and HS football concussion injury mechanisms. Head impact data were collected from athletes participating on 22 youth and 6 HS football teams between 2012 and 2017. Video was recorded, and head impact data were collected during all practices and games by instrumenting players with the Head Impact Telemetry (HIT) System. For each clinically diagnosed concussion, a video abstraction form was completed, which included questions concerning the context in which the injury occurred. Linear acceleration, rotational acceleration, and impact location were used to characterize the concussive event and each injured athlete's head impact exposure on the day of the concussion. A total of 9 (5 HS and 4 youth) concussions with biomechanics and video of the event were included in this study. The mean [range] linear and rotational acceleration of the concussive impacts were 62.9 [29.3–118.4] g and 3,056.7 [1,046.8–6,954.6] rad/s2, respectively. Concussive impacts were the highest magnitude impacts for 6 players and in the top quartile of impacts for 3 players on the day of injury. Concussions occurred in both practices (N = 4) and games (N = 5). The most common injury contact surface was helmet-to-helmet (N = 5), followed by helmet-to-ground (N = 3) and helmet-to-body (N = 1). All injuries occurred during player-to-player contact scenarios, including tackling (N = 4), blocking (N = 4), and collision with other players (N = 1). The biomechanics and injury mechanisms of concussions varied among athletes in our study; however, concussive impacts were among the highest severity for each player and all concussions occurred as a result of player-to-player contact.

Surgical Drilling: Design and Performance of an Improved Drill

1982 ◽  
Vol 104 (3) ◽  
pp. 245-252 ◽  
Author(s):  
S. Saha ◽  
S. Pal ◽  
J. A. Albright
Keyword(s):  
Compact Bone ◽  
Helix Angle ◽  
Rake Angle ◽  
Peak Temperature ◽  
Published Data ◽  
Drill Bit ◽  
Effective Removal ◽  
Split Point ◽  
And Performance ◽  
Twist Drills

The majority of twist drills used in orthopaedics are very similar to chisel pointed metal drilling bits. Modifications usually observed are reduction of the point angle to 90 deg and sometimes grinding of the entire cutting lip at 0 deg rake angle, which appeared to have been made arbitrarily without any advantage. We have attempted to design a surgical drill bit with the objective of minimization of the drilling thrust and temperature and effective removal of bone chips. Our results showed that the presence of the chisel edge was mainly responsible for increasing the thrust force and the temperature developed. The effects of a constant feed rate and thrust on the peak temperature were also examined. The combined effect of the helix and the point angles on the rake angle which in turn determines the cutting efficiency was analyzed for various types of surgical bits. Based on our results and previously published data from the literature an optimized drill bit was designed with a split point, a point angle of 118 deg, a parabolic flute, and a helix angle of 36 deg and its performance was compared with other existing surgical drill bits. For drilling in compact bone, the new design decreased the thrust load by 45 percent and the peak temperature rise by 41 percent. Simlar improvements were also recorded for drilling bone cement. The time of drilling a bone cortex was also significantly reduced and “walking” on the curved bone surface was eliminated and dimensional tolerance on hole sizes was improved. The new design is likely to reduce the time of surgery and also minimize the tissue damage.

Psychotic disorders in young adults with perinatally acquired HIV: a UK case series

2020 ◽  
pp. 1-7
Author(s):  
I. Mallik ◽  
T. Pasvol ◽  
G. Frize ◽  
S. Ayres ◽  
A. Barrera ◽  
...  
Keyword(s):  
Mental Health ◽  
Young Adults ◽  
Young People ◽  
Case Series ◽  
Psychotic Episode ◽  
Published Data ◽  
Growing Up ◽  
Term Care ◽  
Perinatally Acquired

Abstract Background Increasing numbers of children with perinatally acquired HIV (PaHIV) are transitioning into adult care. People living with behaviourally acquired HIV are known to be at more risk of psychosis than uninfected peers. Young adults living with PaHIV face numerous risk factors; biological: lifelong exposure to a neurotrophic virus, antiretroviral medication and immune dysfunction during brain development, and environmental; social deprivation, ethnicity-related discrimination, and migration-related issues. To date, there is little published data on the prevalence of psychotic illness in young people growing up with PaHIV. Methods We conducted a retrospective case note review of all individuals with PaHIV aged over 18 years registered for follow up at a dedicated clinic in the UK (n = 184). Results In total, 12/184 (6.5%), median age 23 years (interquartile range 21–26), had experienced at least one psychotic episode. The presentation and course of the psychotic episodes experienced by our cohort varied from short-lived symptoms to long term illness and nine (75%) appear to have developed a severe and enduring mental illness requiring long term care. Conclusion The prevalence of psychosis in our cohort was clearly above the lifetime prevalence of psychosis in UK individuals aged 16–34 years, which has been reported to be 0.5–1.0%. This highlights the importance of clinical vigilance regarding the mental health of young people growing up with PaHIV and the need to integrate direct access to mental health services within the HIV centres providing medical care.

scholarly journals Long-term follow-up after colorectal endoscopic submucosal dissection in 182 cases

2021 ◽  
Vol 09 (02) ◽  
pp. E258-E262
Author(s):  
Christian Suchy ◽  
Moritz Berger ◽  
Ingo Steinbrück ◽  
Tsuneo Oyama ◽  
Naohisa Yahagi ◽  
...  
Keyword(s):  
Case Series ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Published Data ◽  
Low Grade ◽  
Recurrence Rates ◽  
En Bloc ◽  
Long Term Follow Up

Abstract Background and study aims We previously reported a case series of our first 182 colorectal endoscopic submucosal dissections (ESDs). In the initial series, 155 ESDs had been technically feasible, with 137 en bloc resections and 97 en bloc resections with free margins (R0). Here, we present long-term follow-up data, with particular emphasis on cases where either en bloc resection was not achieved or en bloc resection resulted in positive margins (R1). Patients and methods Between September 2012 and October 2015, we performed 182 consecutive ESD procedures in 178 patients (median size 41.0 ± 17.4 mm; localization rectum vs. proximal rectum 63 vs. 119). Data on follow-up were obtained from our endoscopy database and from referring physicians. Results Of the initial cohort, 11 patients underwent surgery; follow-up data were available for 141 of the remaining 171 cases (82,5 %) with a median follow-up of 2.43 years (range 0.15–6.53). Recurrent adenoma was observed in 8 patients (n = 2 after margin positive en bloc ESD; n = 6 after fragmented resection). Recurrence rates were lower after en bloc resection, irrespective of involved margins (1.8 vs. 18,2 %; P < 0.01). All recurrences were low-grade adenomas and could be managed endoscopically. Conclusions The rate of recurrence is low after en bloc ESD, in particular if a one-piece resection can be achieved. Recurrence after fragmented resection is comparable to published data on piecemeal mucosal resection.

A-14 Mechanisms and Neuropsychological Correlates of Sleep Disruption in Concussed College Athletes

2021 ◽  
Vol 36 (6) ◽  
pp. 1036-1036
Author(s):  
Kaitlin E Riegler ◽  
Erin T Guty ◽  
Garrett A Thomas ◽  
Megan Bradson ◽  
Peter A Arnett
Keyword(s):  
Memory Performance ◽  
Neuropsychological Testing ◽  
Cognitive Testing ◽  
Symptom Reporting ◽  
Sleep Disruption ◽  
Neuropsychological Battery ◽  
Symptom Scale ◽  
Concussion Management ◽  
Falling Asleep ◽  
Concussion History

Abstract Objective First, to explore demographic/injury characteristics associated with increased sleep disruption post-concussion. Second, to examine the association between sleep disruption post-concussion and symptom reporting and cognitive variability. Method 124 athletes (M = 103, F = 21) completed neuropsychological testing within 14 days of concussion. Athletes were categorized as sleep-disrupted (n = 52) or not sleep-disrupted (n = 72). Athletes in the sleep-disrupted group endorsed one or more of the following from the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) Post-Concussion Symptom Scale (PCSS): trouble falling asleep, sleeping more than usual, and sleeping less than usual. Loss of consciousness (LOC) and concussion history were explored. Two neurocognitive variability measures were derived from the neuropsychological battery: intraindividual standard deviation (ISD) and maximum discrepancy score (MDS). Variability in memory and attention/processing speed (APS) composites were explored. Total PCSS symptom score, without sleep items, was calculated. Results A significantly greater proportion of sleep-disrupted athletes experienced LOC (30%) compared to not sleep-disrupted athletes (13%), χ2(1,N = 118) = 4.99, p &lt; 0.03, φ = 0.21. Sleep-disrupted athletes reported more symptoms, t(122) = −5.42, p &lt; 0.001, d = 0.98, and demonstrated more memory variability (memory ISD, t(122) = −2.22, p = 0.03, d = 0.40, and memory MDS, t(122) = −2.29, p = 0.02, d = 0.41) than not sleep-disrupted athletes. Groups did not differ in APS variability or concussion history. Conclusions Given the higher rate of LOC in sleep-disrupted athletes, it is possible that LOC is a mechanism leading to post-concussion sleep difficulties. Furthermore, sleep disruption following concussion results in more variable memory performance and higher symptom reporting. Symptom reporting and/or return to baseline cognitive functioning are often decision-making tools in concussion management. The difficulties experienced by sleep-disrupted athletes may complicate recovery.

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