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POSTED MAY 21, 2021

ASSOCIATION OF SEX WITH ADOLESCENT SOCCER CONCUSSION INCIDENCE AND CHARACTERISTICS
This prospective, longitudinal cohort study assessed male and female soccer athletes from all high schools in the Michigan High School Athletic Association (MHSAA) during academic years 2016-2017 to 2018-2019. A total of 43 741 male and 39 637 female soccer athletes participated. In this study the risk of documented Sport Related Concussion (SRC) was 1.88 times higher among adolescent girls. Whereas boys most often sustained SRC from player contact (48.4%), documented SRCs in girls were most often from equipment contact (eg, ball or goalpost [41.9%]), and boys had 1.54 greater odds of immediate removal from play. Male athletes typically returned 2 days earlier than female athletes (median, 10 [IQR, 7-14] days vs 12 [IQR, 7-16] days; Peto test P < .001).
These findings suggest that concussion risk and outcome differences in adolescent soccer athletes might require sex-specific approaches to participation and concussion management in sport.
Full Article: JAMA

ASSOCIATION OF CANNABIS USE WITH SELF-HARM AND MORTALITY RISK AMONG YOUTHS WITH MOOD DISORDERS
On January 19th, 2021 a study describing the association of cannabis use with self-harm and death in adolescents and young adults with mood disorders was published in JAMA Pediatrics.  This population-based retrospective cohort study was performed using Ohio Medicaid claims data linked with death certificate data. The analysis included 204 780 youths (aged 10-24 years) with a diagnosis of mood disorders and the association of risk for self-harm and all-cause mortality. Urgent Care clinicians must recognize that this population are at significantly increased risk for self-harm, all-cause mortality, homicide, and death by unintentional overdose.
Full Article: JAMA

ANTIBODY COCKTAIL SEEMS TO PREVENT FAMILY SPREAD OF DISEASE IN COVID-19
A one-time injection of the monoclonal antibody cocktail casirivimab with imdevimab (REGEN-COV), taken within 96 hours of a household member's diagnosis with SARS-CoV-2, prevented 100% of COVID-19 illness, 100% of high SARS-CoV-2 viral loads, and cut length of asymptomatic infection to 1 week. The impressive results are based on a study with very few SARS-CoV-2 infections overall, meaning that the results did not reach statistical significance.
Full Access:
Medscape

CDC UPDATES GUIDANCE ON CHILDREN’S SUMMER, OVERNIGHT CAMPS
The CDC updated its guidance for children’s summer day and overnight camps, which includes recommendations about prevention, vaccination, physical distancing, and approaches to maintaining a healthy environment. This guidance is intended for all types of youth day camps with additional guidance provided for overnight camps. Consistent and layered use of multiple prevention strategies can help camps open safely for in-person activities; protect children, families, and staff; and slow the spread of the virus that causes COVID-19.
Guidance on physical distancing recommendations for day camps that align with current evidence, including at least 3 feet physical distance between campers in the same cohort, except when eating and drinking (at least 6 feet); at least 6 feet physical distance between campers and staff; and at least 6 feet between campers in different cohorts. This guidance outlines strategies that camp programs can use to maintain healthy environments and operations, lower the risk of COVID-19 spread in their programs, prepare for when someone is sick with COVID-19, and support coping and resilience.
Full Access: CDC

POSTED MAY 14, 2021

SPORT-RELATED CONCUSSION IN CHILDREN AND ADOLESCENTS
Concussion is a common chief complaint in Urgent Care. It is important for clinicians to understand the risks associated to this type of injury. Effective management can aid recovery and potentially reduce the risk of long-term symptoms and complications. The Journal of American Academy of Pediatrics discusses sport-related concussion in children and adolescents, including recommendations, diagnostic evaluation, and initial management strategies. Some of the recommendations include: “Neurocognitive testing after sport related concussion is only 1 tool that may be used in assessing an athlete for recovery and should not be used as a sole determining factor to determine when return to play is appropriate. Athletes with prolonged symptoms should be evaluated for coexisting problems that may be contributing to the lack of symptom resolution and may benefit from referral to an appropriate health care provider who can evaluate and treat these problems”
Full Article: Journal of American Academy of Pediatrics

COVID-19 LINKED TO NEW-ONSET EPILEPTIC SEIZURES
In a retrospective study of more than 900 patients admitted to the hospital with COVID-19, those without a known history of epilepsy had three times greater odds of experiencing novel seizures than those with a known history of epilepsy. Researchers suggest that there are many neurological consequences that can happen with COVID-19 infections, and it is important for clinicians to be aware of these conditions.
Full Access:  MEDSCAPE

DRUG-RESISTANT MENINGITIS FOUND IN SEVERAL US PATIENTS
According to Health Alert Network advisory from the Centers for Disease Control and Prevention (CDC), 11 US patients have presented with drug-resistant meningitis. Neisseria meningitidis from a patient's demonstrated resistance to both penicillin and ciprofloxacin. Penicillin-resistant and ciprofloxacin-resistant meningococci are now present in the United States. Meningococcal disease is a sudden-onset, potentially fatal disease. Prompt empiric antibiotic treatment can reduce morbidity and mortality among patients, and antibiotic prophylaxis can prevent secondary disease in close contacts.
Full Article: MEDSCAPE

ASSOCIATION OF FACIAL PARALYSIS WITH MRNA COVID-19 VACCINES A DISPROPORTIONALITY ANALYSIS USING THE WORLD HEALTH ORGANIZATION PHARMACOVIGILANCE DATABASE
On April 27th, 2021 JAMA published an article discussing several cases of facial paralysis observed in the vaccine groups (7 of 35 654) compared with 1 case among people who received placebo (1 of 35 611) during the pivotal phase 3 clinical trials of mRNA COVID-19 vaccines.
Although a causal relationship could not be established from clinical trials, the US Food and Drug Administration recommended monitoring vaccine recipients for facial paralysis.
Among the 133 883 cases of adverse drug reactions reported with mRNA COVID-19 vaccines in the World Health Organization pharmacovigilance database, a total of 844 (0.6%) facial paralysis-related events, including 683 cases of facial paralysis, 168 cases of facial paresis, 25 cases of facial spasms, and 13 cases of facial nerve disorders (some adverse events were co-reported in the same case) were identified. A total of 749 cases were reported with the Pfizer-BioNTech vaccine, and 95 cases were reported with the Moderna vaccine.  Study did not detect any signal of disproportionality of facial paralysis vs other viral vaccines.
Full Access: JAMA

REGULAR COFFEE DRINKING TIED TO FUNCTIONAL BRAIN CHANGES
A recent imaging study showed that drinking coffee on a regular basis appears to enhance concentration and improve motor control and alertness by inducing functional and connectivity changes in the brain. Researchers found that connectivity in the somatosensory and limbic resting states was reduced in regular coffee drinkers, suggesting an association between coffee drinking and improved motor control and alertness. The take-home message for practicing clinicians is that the regular intake of coffee, by reducing the connectivity of particular brain networks at risk, may be of relevance for attention/alertness, with possible implications in learning and memory, and also for motor control.
Full Access: Medscape

POSTED MAY 7, 2021

ANTIBIOTIC STEWARDSHIP AND SINUSITIS: A QUALITY IMPROVEMENT PROJECT
Journal of Urgent Care Medicine recently published an article on the impact of clinician education and algorithmic clinical decision-support tool use to improve quality of care by decreasing unnecessary antibiotic prescription for acute sinusitis. Changes in antibiotic prescribing were evaluated for adults with acute sinusitis following provider education on current sinusitis guidelines and implementation of a clinical decision support tool at 14 affiliated urgent care centers. Antibiotic prescribing rates for acute sinusitis decreased by 20% in the month following intervention.
Full Article: JUCM

US CASE REPORTS OF CEREBRAL VENOUS SINUS THROMBOSIS WITH THROMBOCYTOPENIA AFTER AD26.COV2.S VACCINATION
On March 2 to April 21, 2021 JAMA published a case series of 12 patients with J&J rare side effects. By April 12, 2021, approximately 7 million Ad26.COV2.S vaccine doses had been given in the US, and 6 cases of CVST with thrombocytopenia had been identified among the recipients, resulting in a temporary national pause in vaccination with this product on April 13, 2021. Following the identification of the first 6 cases of CVST with thrombocytopenia, an additional 6 cases were identified. All cases were women, younger than 60 years, and had symptom onset ranging from 6 to 15 days after vaccination. In this study, 11 patients with heparin-platelet factor 4 enzyme-linked immunosorbent assay (ELISA) heparin-induced thrombocytopenia (HIT) antibody test results were positive.  A mechanism similar to autoimmune heparin-induced thrombocytopenia (HIT) has been proposed. These conditions are very rare.
Full Access: JAMA

STUDY: COVID-19 CAN KILL MONTHS AFTER INFECTION
Researchers discuss the risk of death after COVID-19 infection in “Long-haulers” patients. These individuals face many health threats, including a higher chance of dying up to 6 months infection.  A second study, released by the CDC, also found lingering symptoms months later among COVID-19 patients who originally had mild symptoms. A Nature study examined more than 87,000 COVID-19 patients and nearly 5 million control patients in a federal database. Study found that COVID-19 patients had a 59% higher risk of death up to 6 months after infection. Long-haul COVID patients also had a much higher chance of getting sick, and not just in the respiratory system; high rate of stroke and other nervous system ailments; mental health problems such as depression; the onset of diabetesheart disease and other coronary problems; diarrhea and digestive disorderskidney diseaseblood clotsjoint painhair loss; and general fatigue.
Full Access: WEBMD

ASSOCIATION OF ORAL CORTICOSTEROID BURSTS WITH SEVERE ADVERSE EVENTS IN CHILDREN
A population-based cohort study of 1 064 587 children who received a single corticosteroid burst (< 14 days), found a 1.4- to 2.2-fold increased risk of gastrointestinal bleeding, sepsis, and pneumonia within the first month after corticosteroid initiation. The most common indications were acute respiratory tract infections and allergic diseases. Clinicians should be aware of potentially severe adverse events associated with corticosteroid bursts in children.  These rare events can be serious, particularly during the first month after corticosteroid initiation.
Full Article: JAMA

CDC Guidelines Coming on Long COVID
The CDC is finalizing new guidelines for doctors on long-haul COVID-19. National Institutes of Health estimated as many as 3 million people could be left with chronic health problems after even mild COVID infections. The CDC guidance on diagnosis and managing post-acute sequelae of covid 19 infection, which were developed in collaboration with newly established long-haul COVID-19 clinics and with patient advocacy groups.
Full Access: Medscape

 

POSTED APRIL 23, 2021

CORONAVIRUS DISEASE 2019 AND THE ATHLETIC HEART EMERGING PERSPECTIVES ON PATHOLOGY, RISKS, AND RETURN TO PLAY
This report published on October 2020, addresses common questions regarding COVID-19 and cardiac pathology in athletes in competitive sports, including the extension of return-to-play considerations. Reports of presumptive myocarditis among several athletes have magnified concerns about COVID-19 CV sequelae in athletes. Some of the recommendations include: • Isolated ECG screening after COVID-19 infection is of limited value because of the limited sensitivity for the detection of myocarditis (47%). • Troponin testing to screen for COVID-19 cardiac injury must be performed at least 24 to 48 hours after exercise and should be repeated after a similar period of rest following an isolated abnormality. • Persistently elevated troponin levels should prompt detailed characterization of the myocardium with cardiac magnetic resonance imaging. • Clinical presentations of systemic and/or CV symptoms indicate a higher pretest probability of clinically relevant myocarditis, thus favoring exercise restrictions for at least 3 months. • Before returning to sports, athletes diagnosed with a clinical syndrome consistent with myocarditis should undergo a resting echocardiogram, 24-h Holter monitoring, and an exercise 12-lead electrocardiogram no less than 3 to 6 months after the illness.

Full access: JAMA

ASSOCIATION OF POTENT AND VERY POTENT TOPICAL CORTICOSTEROIDS AND THE RISK OF OSTEOPOROSIS AND MAJOR OSTEOPOROTIC FRACTURES

Systemic and inhaled corticosteroids negatively affect bone remodeling and cause osteoporosis and bone fracture when given continuously or in high doses. JAMA describes a retrospective cohort study that included adults treated with potent or very potent topical corticosteroids and the association with increased risk of osteoporosis and major osteoporotic fracture with a dose-response association for cumulative use. A total of 723 251 adults treated with the equivalent of at least 200 g of mometasone were included in the analysis. Dose-response associations were found between increased use of potent or very potent topical corticosteroids and the risk of osteoporosis and Major Osteoporotic Fracture. The overall population-attributable risk was 4.3% (95% CI, 2.7%-5.8%) for osteoporosis and 2.7% (95% CI, 1.7%-3.8%) for Major Osteoporotic Fracture. Clinicians may need to consider other corticosteroid-sparing therapeutic options for people requiring potent anti-inflammatory treatment on large body surfaces for prolonged periods to limit the risk of osteoporosis.
Full Article: JAMA 

MOST ANTIBODY DRUGS INEFFECTIVE AGAINST BRAZIL VARIANT
According to a peer reviewed report available on bioRxiv and provisionally accepted by the journal Cell Host & Microbe, the coronavirus variant first identified in Brazil is resistant to three of the four antibody therapies with emergency use authorization in the United States. Researchers found that only imdevimab retained any potency. The neutralizing ability of the other three were markedly or completely abolished. Full Access: Medscape

COVID-RELATED INFLAMMATORY SYNDROME TIED TO NEUROLOGIC SYMPTOMS IN KIDS
About half of children with pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) have new-onset neurologic symptoms, involving the central and peripheral nervous systems. Researchers retrospectively examined data for children and adolescents younger than 18 years who had the disorder and presented to a single center between April 4, 2020, and September 1, 2020. A total of 46 patients (median age, 10.2 years) were included in the analysis. Twenty-four (52.2%) patients had new-onset neurologic symptoms, which included headache (n = 24), encephalopathy (n = 14 patients), dysarthria/dysphonia (n = 6), hallucinations (n = 6), ataxia (n = 4), peripheral nerve involvement (n = 3), and seizures (n=1). Four of 7 patients who underwent nerve conduction studies and electromyography had myopathic and neuropathic changes. It is important that clinicians be aware that children with PIMS-TS can present with neurologic symptoms, even in the absence of respiratory involvement.
Full Access: Medscape

 

POSTED APRIL 23, 2021

NONPHARMACOLOGIC AND PHARMACOLOGIC MANAGEMENT OF ACUTE PAIN FROM NON-LOW BACK, MUSCULOSKELETAL INJURIES IN ADULTS: A CLINICAL GUIDELINE FROM THE AMERICAN COLLEGE OF PHYSICIANS AND AMERICAN ACADEMY OF FAMILY PHYSICIANS.
The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) developed a guideline on nonpharmacologic and pharmacologic management of acute pain from non-low back, musculoskeletal injuries in adults in the outpatient setting. The recommendation is that clinicians treat patients with acute pain from non-low back, musculoskeletal injuries with topical nonsteroidal anti-inflammatory drugs with or without menthol gel as first-line therapy to reduce or relieve symptoms, including pain; improve physical function; and improve the patient's treatment satisfaction. This guideline was based on a systematic evidence review of comparative efficacy and safety of nonpharmacologic and pharmacologic management. This was graded as “strong recommendation; moderate-certainty evidence”.
Full Article: Pubmed

COVID-19 CAN CAUSE ATYPICAL THYROID INFLAMMATION
New research suggests that individuals who experience inflammation of the thyroid gland during acute COVID-19 illness may still have subacute thyroiditis months later even if thyroid function has normalized. In an assessment of 51 patients 3 months after hospitalization for moderate-to-severe COVID-19, both inflammatory markers and thyroid function had normalized, yet on imaging, a third of patients still exhibited focal hypoechoic areas suggestive of thyroiditis. The thyroid dysfunction induced by COVID-19 seems not mediated by autoimmunity. It is important to continue to follow these patients since they might develop thyroid dysfunction during the following months. Full article: Medscape
Full article: Medscape

URGENT CARE DIAGNOSIS AND MANAGEMENT OF TICK-BORNE DISEASES
As the incidence of tick bites increases, it is imperative for urgent care clinicians to be able to recognize various species of ticks and the symptoms of tick-borne illnesses. Thus, it is prudent for providers to have a firm understanding of Lyme disease and an appropriate treatment plan. As public awareness of Lyme disease and incidental situational exposure to ticks increases, urgent care physicians must know what time-sensitive questions to ask, what are the manifestations of infection, when to order diagnostic tests and select appropriate treatment.
Full Article: JUCM

PFIZER, MODERNA SAY BOOSTER SHOTS PROBABLY NEEDED
On April 16th, Medscape describes the possible need of Covid-19 vaccine boosters. People who've received both doses of the Pfizer-BioNTech or Moderna coronavirus vaccines will probably need a booster shot this year. Pfizer announced that people who've gotten both doses would likely need a third shot within 12 months and might need an annual shot thereafter. Earlier this month, Pfizer said studies show its vaccine is 93.1% effective 6 months after the second dose. Moderna said studies show 90% effectiveness in its vaccine after 6 months.
Full Article: Medscape

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