Case: A 65-year-old male presented with multiple nodules with central ulceration and necrosis located on the left lateral neck, ear, and arm. The patient recently traveled to Mexico where he developed a “persistent bug bite” with the development of new lesions. Biopsy revealed leishmaniasis infection. The patient did not respond to initial treatments with microwave therapy or topical ketoconazole with oral Bactrim and Keflex. Lesions located on the left superior anterior neck, left superior posterior ear, and right ventral proximal forearm were treated with freeze-thaw cycles with liquid nitrogen. During each visit, the areas were assessed, and liquid nitrogen was applied depending on the level of visible improvement. Postoperative care between visits involved daily cleansing and mupirocin ointment.
of cryotherapy, the lesions were almost clear. One lesion on the left posterior ear required two additional treatments. Six months after treatment initiation, the lesions were resolved and required no further treatment. No adverse events were noted throughout treatment. The patient was counseled and instructed to return for a follow-up visit in three months. The patient remains disease free. Discussion: Weekly to bi-weekly intervals of 1-4 cryotherapy sessions cured lesions caused by leishmaniasis infection. Cryotherapy with liquid nitrogen is a safe, effective, cost-efficient, and accessible treatment modality for cutaneous leishmaniasis unlike other first-line therapies. For these reasons, cryotherapy should be researched further and adopted as a first-line treatment in developing countries where leishmaniasis is endemic.
After one month, the lesions improved and were treated with liquid nitrogen. After four rounds
TJA PATIENT DEMOGRAPHICS BEFORE AND AFTER COVID-19 ELECTIVE SURGERY RESTRICTIONS Morgan McCoy, Natalie Touchet, Anna Cohen-Rosenblum, Andrew Chapple; LSUHSC School of Medicine, New Orleans, LA.
Introduction: In 2020, the COVID-19 pandemic caused an abrupt cessation of non-emergency Total Joint Arthroplasty operations, with most states implementing a ban on elective surgeries between mid-March and April of 2020. The purpose of this study is to analyze the effects of the COVID-19 restrictions on TJA patients and look for any disparities in access to care when compared to the previous year. Methods/Results: A private healthcare system database was used to examine the demographics of patients undergoing primary TJA in a single state from May to December 2019 (Pre-COVID-19) and May to December 2020 (Post-COVID-19). Patients with a diagnosis of infection or femoral neck fracture were excluded from the analysis. Categorical covariates were summarized by reporting counts and percentages. Continuous covariates were summarized by reporting means and standard deviations. Categorical covariates were compared between COVID-19 groups using Fisher exact tests, while two-sample t-tests were used for continuous covariates. There was a significant increase in the relative percentage of THAs vs. TKAs performed in 2020 compared to 2019 (26.9% vs 18.8%, p<.001), and an increase in patients with Medicaid insurance
with a concurrent decrease in private insurance (p-value=.043). The average length of stay was also shorter in 2020 (p<.001). There were no statistically significant differences in patient sex, race, BMI, smoking status, or age between the 2 periods. Discussion: After elective surgery restrictions were put in place due to COVID-19, the following changes occurred when compared to the same time in 2019: 1) Increase relative percentage of THA procedures. 2) Increase in proportion of TJA patients with Medicaid insurance and decrease in private insurance. 3) Decreased length of stay. These trends may reflect pandemic-related changes in insurance status due to job loss, as well as the growing shift to same-day discharge TJA.
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