COVID-19-Induced Seizures: A Meta-Analysis of Case Series and Retrospective Cohorts.

The adverse events and complications of coronavirus disease 2019 (COVID-19) continue to challenge the medical profession despite the worldwide vaccination against the severe acute respiratory coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. Other than typical respiratory manifestations, COVID-19 also presents a wide range of neurological manifestations. This article underlines the pooled incidence of COVID-19-induced seizures in patients with epilepsy and without epilepsy. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocols, we conducted a bibliographical search, and an initial search revealed 1,375 articles. In total, 21 articles were included in the final analysis by following the inclusion criteria. A total of 11,526 patients from 21 published articles that met the predetermined search criteria were included. The median age of the patients was 61.9 years, of whom 51.5% were males. A total of 255 patients presented with seizures as the first manifestation of COVID-19 with a prevalence of 2.2% (95% confidence interval = 0.05-0.24, p < 0.01) (I 2 = 97%), of which 71 patients had previously been diagnosed with epilepsy. Among patients with epilepsy, 49 patients had seizures as an initial presentation of SARA-CoV-2 with an incidence of 72% (0.54-0.85, p = 0.1) (I 2 = 34). Although the incidence of COVID-19-induced seizures is not high compared to other neurological manifestations, seizure incidence in epileptic patients with COVID-19 is remarkably high. New-onset seizures in any patient should be considered a presentation of COVID-19 in the absence of other causative factors.

Clopidogrel-Associated Interstitial Lung Disease: A Case Report and Literature Review.

Clopidogrel is an antithrombotic agent widely used for the secondary prevention of cerebrovascular and cardiovascular complications. Clopidogrel can cause serious adverse events, including gastrointestinal bleeding. Pulmonary complications caused by clopidogrel are not widely described, and clopidogrel-induced interstitial lung disease (ILD) is rare. Here, we report a case of drug-induced ILD in a patient who presented with dyspnea, chest pain, and mild fever. The patient underwent percutaneous coronary intervention two months ago and was commenced on clopidogrel. He was diagnosed with clopidogrel-induced ILD based on clinical and imaging findings, history of drug exposure without any change, exclusion of other respiratory disorders, and clinical improvement after discontinuation of clopidogrel and steroid use.

Osteoporosis treatment rate following hip fracture in a community hospital.

Treatment rates for osteoporosis after a major osteoporotic fracture are unacceptably low. We evaluate the effectiveness of an ortho-geriatric team (OGT) in initiating pharmacologic therapy for osteoporosis post-hip fracture. The OGT was able to achieve a higher treatment rate for patients post-hip fracture in comparison to usual care provided by the primary care hospitalist. Potential reasons for delaying or not proceeding with drug therapy include patient concern regarding potential rare side effects of antiresorptive therapy including osteonecrosis of the jaw and atypical femoral fracture. These events however are rare, and in this study, only 3% of hip fractures were atypical femoral fractures. INTRODUCTION: Currently, a significant care gap for osteoporosis therapy exists post-hip fracture despite advances in pharmacologic therapy. We evaluate the effectiveness of the OGT at the Oakville Trafalgar Memorial Hospital (OTMH), Ontario, Canada, in reducing the care gap and initiating pharmacologic therapy in hip fracture patients prior to hospital discharge. We also evaluated the incidence of atypical femoral fracture (AFF) separately. METHODS: A retrospective chart review of patients 59 years and older with a hip fracture admitted to OTMH from January 1, 2016, to February 1, 2017, was conducted. The primary outcome was the proportion of hip fracture patients discharged from the hospital with appropriate treatment for their underlying osteoporosis. A sub-analysis was completed reporting the incidence of AFF among older adults. RESULTS: A total of 197 patients with a hip fracture were identified, 134/197 (68%) patients were seen by the OGT, 98/134 (73%) of these patients were started on pharmacologic therapy prior to discharge, and 120/134 (89%) of patients seen by the OGT were on treatment within 3 months of discharge following assessment in the complex osteoporosis clinic. Sixty-three patients of the 197 (63/197) (32%) of the hip fracture patients were seen by a hospitalist, and treatment rates prior to discharge were 5%. Only 6/197 patients had experienced an AFF during the study period, and all patients with an atypical femoral fracture had been on long-term bisphosphonate therapy. All of the patients with an AFF had thigh or groin pain for several weeks to months prior to the development of the atypical femoral fracture, providing an opportunity to stop therapy and possibly prevent the development of a complete AFF. CONCLUSION: The OGT was able to initiate anti-osteoporosis therapy in significantly more patients in comparison to usual care, and higher treatment rates are possible with an OGT.

Flexor tendon injuries of hand: experience at Pakistan Institute of Medical Sciences, Islamabad, Pakistan.

BACKGROUND: Flexor tendon injury is one of the most common hand injuries. This initial treatment is of the utmost importance because it often determines the final outcome; inadequate primary treatment is likely to give poor long tem results. Various suture techniques have been devised for tendon repair but the modified Kessler's technique is the most commonly used. This study was conducted in order to know the cause, mechanism and the effects of early controlled mobilization after flexor tendon repair and to assess the range of active motion after flexor tendon repair in hand. METHODS: This study was conducted at the department of Plastic Surgery, Pakistan Institute of Medical Sciences, Islamabad from 1st March 2002 to 31st August 2003. Only adult patients of either sex with an acute injury were included in whom primary or delayed primary tendon repair was undertaken. In all the patients, modified Kessler's technique was used for the repair using non-absorbable monofilament (Prolene 4-0). The wound was closed with interrupted non-absorbable, polyfilament (Silk 4-0) suture. A dorsal splint extending beyond the finger tip to proximal forearm was used with wrist in 20-30 degrees palmer flexion, metacarpophalangeal (MP) joint flexed at 60 degrees. Passive movements of fingers were started from the first post operative day, and for controlled, active movements, a dynamic splint was applied. RESULTS: During this study, 33 patients with 39 digits were studies. 94% of the patients had right dominated hand involvement. 51% had the complete flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) injuries. Middle and ring fingers were most commonly involved. Thumb was involved in 9% of the patients. Zone III(46%) was the commonest to be involved followed by zone II (28%). Laceration with sharp object was the most frequent cause of injury. Finger tip to distal palmer crease distance (TPD) was < 2.0 cm in 71% cases (average 2.4cm) at the end of 2nd postoperative week. Total number of patients was 34 at the end of 6th week. TPD was < 2.0 cm in 55% patients and < 1.0 cm in 38% cases (average 1.5cm) at the end of 6th week. Total 9 patients were lost to the follow up at the end of 8th week. TPD was < 1.0 cm in 67% (average 0.9 cm) at the end of 8th postoperative week. No case of disruption of repair was noted during the study. CONCLUSION: Early active mobilization programme is essential after tendon repair. Majority of the patients (92%) had fair to good results at the end of 2nd week which increased to 97% at the end of 8th week to good to excellent.

Management of phalangeal fractures of hand.

BACKGROUND: Phalangeal fractures are approximately 10% of all the fractures of skeletal system. Most fractures are functionally stable. Surgical treatment is necessary when fracture is displaced and reduction is not possible. This study was conducted in order to study the aetiology, features and management of the phalangeal fractures of hand. METHODS: This descriptive study was conducted in the department of Plastic Surgery, Pakistan Institute of medical Sciences, Islamabad from June 1st 2002 to July 31st 2003. Adult patients of either sex with acute injury presenting in the out-patient department and emergency department were included whereas patients below the age of 13 years and patients with amputated digits were excluded. The site and side of fracture were noted. All patients were X-rayed pre-operatively. These patients were divided into two groups. Group A comprised of those patients in whom only closed reduction was done. Group B comprised of patients in whom operative procedure was carried out. Various modalities used were percutaneous Kirschner wire fixation, open reduction and internal fixation with K-wires, screws, microplates and dental wires/ after operation, immobilization of fracture site was done for 3 4 weeks. Chi square test was used for statistical analysis of complications in both the groups. RESULTS: 51 fractures were seen in 43 men and 8 fractures in 8 females. Mean age of the patients of group A was 35.6 years as compared to 29.5 years of group B. 31% fractures were associated with soft tissue injury. Ring finger was the commonest to be involved in 36% patients. Left hand (64%) was commonly involved. Left proximal phalanx (31%) was the most frequently injured part. Intraarticular fractures were seen in 10% cases. 15 fractures were treated conservatively and some kind of operative modality was used in 44 fractures. Crush injury remained the commonest cause. In 36% patients fractures were fixed with K-wire using open reduction and internal fixation technique. In 22% patients, only percutaneous K-wire was used. In two patients, dynamic traction device was used. One case of post operative infection was noticed in group B. Whereas only one case of malunion and one case of limited joint movement and stiffness was noted in group A. CONCLUSIONS: Results of both the closed reduction and open reduction and internal fixation were equally good (p < 0.05). If there is any soft tissue injury, it is advisable to use open reduction and internal fixation technique.

Maxillofacial trauma: current practice in management at Pakistan Institute of Medical Sciences.

BACKGROUND: This study was carried out to determine the aetiology, pattern and management of maxillofacial injuries at PIMS, Islamabad. METHODS: This descriptive study was conducted at Plastic Surgery Department, PIMS Islamabad from 1st February 1998 to 30th April 2002. All the adult patients presenting with maxillofacial injures were included where as patients less than 12 years of age and only facial lacerations were excluded. Similarly isolated nasal bone fractures were also excluded because these patients were routinely managed by ENT department. Age, sex, presentation, aetiology, associated injuries and treatment modalities undertaken in these patients were recorded. RESULTS: In 164 patients 254 fractures were noted. Most were male (86%), ranging in age from 13-71 years with a male to female ratio of 6:1 respectively. The most frequent (48%) cause noticed was road traffic accidents followed by assault. Mandible was the commonest to be involved in such injuries followed by maxilla. Most of the patients (32%) had associated facial injuries. Various treatment modalities were practiced. CONCLUSION: Maxillofacial fractures should be managed by open reduction and internal fixation as early as possible.