Sixteen Fractures in a Seven-Month-Old Child Caused by Nonaccidental Trauma

Definition of physical child abuse is used to refer to a casualty injured by the caregiver. Health-care professionals providing medical care are responsible for detecting and reporting child abuse. A 7-month-old pediatric patient was referred to us from an outer center with the diagnosis of multiple fractures (14 different bones in 16 different anatomical regions). Skeletal pathologies were evaluated after exclusion of head and abdomen injuries in the emergency department. This child with fractures in 16 different anatomical regions of 14 different bones in her body is alive and does not have an intracranial injury. The number of fractures was too high to be explained even by major trauma. If child abuse is suspected, relevant authorities should be notified immediately. Medical records must be meticulously done as they can contribute to the possible court process. Our case, which contains almost all of the history and physical examination and risk factors of typical child abuse, is instructive enough to guide any health-care professional who may encounter this issue. The threshold in deciding on reporting of child abuse should be low. Every suspicious case should be reported in order to prevent repetitive abuse.

Suspicious Case of a Body packer “Mule” in a Low Resource Country: A Case Report

Body packing is the process of smuggling illicit drugs in the form of packages concealed within the gastrointestinal tract via ingestion or inserting into body orifices. These individuals are described as “body packers”, “stuffers”, “mules” or “swallowers” and resort to carrying drugs like heroin, cocaine and cannabis. They present to the hospital following the development of complications or brought dead due to the rupture of packets or directly from detention for further investigations. This case illustrates a suspected case detained from the airport who was found to be carrying 93 pellets of an illicit drug, heroin, weighing 900 grams, one of the highest quantity carried by any body packer in the country till date. This case further sheds light on the fact that a meticulous history, detailed clinical examination and radiographic investigations like abdominal radiograph and imaging are the keys to diagnose body packers in a resource limited setting.

Use of an online questionnaire as a follow-up tool for a cohort of health personnel and patients attending a chemoradiotherapy unit in Mexico.

e13518 Background: COVID-19 detection in a timely manner in patients (pts) undergoing anticancer treatment is essential. RT-PCR test for SARS-CoV2 is the diagnostic gold standard, however it is a potentially limited resource in our setting. As an alternative, clinicians have developed symptom-based questionnaires as a screening tool for the detection of COVID-19 to optimize resources. The predictive efficacy of these tools in pts with cancer and healthcare personnel (HCP) who treat them has not been evaluated. Our objective was to describe the findings of the follow-up through an online clinical tool in our cohort, and determine its predictive performance compared against the gold standard. Methods: Data was obtained from a follow-up cohort of HCP and pts attending the chemoradiotherapy unit of a tertiary hospital designated as a COVID-19 priority facility in Mexico City . The follow-up period was from June 12 to September 30, 2020, and consisted of a 10-item clinical questionnaire (CQ) on respiratory symptoms and contact with patients diagnosed with COVID-19, collected daily electronically or by telephone . In addition, RT-PCR for SARS-CoV2 was performed every two weeks. The CQ was considered as a positive screening test if in the period between the biweekly RT-PCRs the participants had reported symptoms or contact. Results: We included 130 asymptomatic participants. 44.6% (n = 58) were HCP and 55.3 % (n = 72) were pts. Within a median follow-up of 85 days (IQR 48-103) a total of 8970 CQ were completed, 48.3% (n = 4335) were answered by HCP and 51.6% (n = 4635) by pts. 4.03% (n = 175) of CQ returned positive in HCP and 0.77% (n = 36) in pts. 634 nasopharyngeal swabs for SARS-CoV-2 RT-PCR were performed, 13.5% (n = 18) of the participants tested positive for SARS-CoV2 infection. When we evaluate within the biweekly period, the CQ for symptoms or contact was found to be a positive screening test in 12% (n = 78). If we applied the standardized definition of COVID-19 suspicious case used at our center, the CQ was found to be positive just in 3.9% (n = 25). The CQ as a general screening tool gave a sensitivity (SN) of 33.3%, specificity (SP) of 88.3%, a positive predictive value (PPV) of 7.6% and a negative predictive value (NPV) of 97.8%. Using the standardized definition, CQ gave a SN of 38.8% and a SP of 97.07%, a PPV of 28% and a NPV of 98.1%. Conclusions: Screening based on self-reporting of symptoms and contact through a questionnaire demonstrated low sensivity but high specificity in our cohort. When we applied a standardized definition of COVID-19 suspicious case, the clinical performance improved. RT-PCR testing remains as the gold standard to detect COVID-19 and should be preferred in patients undergoing anticancer treatment. Nevertheless, clinical questionnaires are an accessible tool for follow-up.

Protocol of sterile personal protective equipment for surgical personnel against SARS-CoV-2 during the COVID-19 pandemic

Background: COVID-19 represents the major pandemic seen the last years generating morbidity and mortality around the world. It is well known the propagation of the virus occurs by air mostly, so it is needed a barrier when the medic personal is treating suspect or confirm patients. Personal protective equipment represents a barrier between the health personnel and the patient during the COVID-19 pandemic. The surgical team during a COVID-19 confirmed o suspicious case procedure requires using PPE to be protected and keep the sterility for the patient safety.Methods: A team of surgeons from a 100% COVID-19 hospital of the Mexican institute of social security developed an inner protocol of safe use PPE maintaining sterility for the surgery.Conclusions: The protocol described provides safety to surgical team and the patient minimizing risk of surgical infections.

A rare presentation of eyelid tuberculosis

Mycobacterium tuberculosis is transmitted through aerosolization, hence commonly infects the lungs. The occurrence of extrapulmonary tuberculosis is rare. We report a case of eyelid tuberculosis in a 45-year-old gentleman with a history of treated testicular tuberculosis three years ago. He had insidious onset of painless swelling in the right upper eyelid associated with erythema for one month. He did not have other constitutional symptoms. Initially, he was treated as chalazion and given topical antibiotics. However, the swelling worsened despite medication. His best corrected visual acuity was 6/9 in both eyes. Examination showed an elevated ulcerative growth with broad base which bled easily upon touch. The clinical presentation varies from an eyelid infection as an eyelid tumour can be a diagnostic challenge. A slow response to oral and topical antibiotic warrants an excision biopsy. The results showed chronic granulomatous infection in acid-fast bacilli. An antituberculosis (anti-TB) therapy was started and the patient showed a positive clinical response. Althrough rare, tuberculosis of eyelid should be considered as differential diagnosis of chalazion. Any suspicious case should be confirmed by biopsy followed by anti-TB if indicated.