Of the many bizarre complications of administration of the COVID 19 vaccine, adhesive capsulitis is almost unheard of, although shoulder injury related to vaccine administration, which by definition has symptom onset within 48 hrs and is caused by faulty injection technique, has been rarely reported. Nine cases of adhesive capsulitis, five males and four females with a mean age of 48.7 ± 12.7 yrs, presenting within 1 mo of intramuscular Covishield vaccine on the ipsilateral deltoid and fulfilling the standard UK FROST Multicenter Study diagnostic criteria are reported. The mean time interval from vaccination until symptom onset was 12.3 ± 3.1 days, and mean symptom duration was 9.4 ± 2.4 wks. Conventional treatment with nonsteroidal anti-inflammatory drugs, followed by intra-articular steroid injection coupled with suprascapular nerve steroid block, improved the pain score and range of movement in 8 wks. The exact pathogenesis remains an enigma, although mechanisms such as local spread via deltoid muscle microvasculature, nerves, or shoulder injury related to vaccine administration causing secondary adhesive capsulitis have been hypothesized. While adhesive capsulitis is a very common diagnosis in the physiatric outpatient setting, the possible association with Covishield vaccination, the Indian version of the Oxford AstraZeneca recombinant ChAdOx1 nCoV-19 vaccine, is almost absent in existing literature and hence likely to be missed by clinicians, which necessitates this report.
Coronavirus disease 2019 (COVID-19) infection in some patients has been documented to cause acute central nervous system (CNS) affection, or CNS depression, even in the absence of demonstrable hypoxia. These observations indicate that there may be some direct effect of the virus on CNS. In this case series of cured post-COVID-19 cases, mood changes like elation, depression, and emotionally labile state have been reported in three previously healthy individuals. The mood changes are waning very slowly in them with the passage of time. All of them also sustained fall sometime following acute COVID-19. Fall is considered to be an event indicating frailty and old age, and there is no mood change associated with fall in that population. Here, the three cases are being reported because neither fall nor mood changes during post-COVID-19 phase have been reported as yet to the best of our knowledge. The case series is worth reporting to generate awareness about the matter in the scientific community and also to indicate that further research in this field is required either to accept or to reject any correlation between COVID-19 infection and fall or mood change in otherwise healthy individuals, which can even be due to some direct effect of the virus on CNS.
Objectives: To evaluate changes in Pulmonary Function Test (PFT) parameters in individuals with paraplegia following Partial Body Weight Supported Treadmill Training (PBWSTT). Design: Randomized controlled trial Setting: Inpatient rehabilitation facility Participants: Adults with chronic SCI (n = 42). Intervention: Patients were randomly allocated in CR group (N= 20) receiving Conventional Rehabilitation or in PBWSTT group (N=22) receiving both Conventional Rehabilitation and PBWSTT for 4 weeks. Main outcome measure(s): Changes in % predicted PFT parameter for the subject’s age, sex and BMI. Results: With PBWSTT, significant PFT changes were VC (P =.009), PEF (p = .001) and ERV (p = .032). In complete SCI, PEF (p = .026) improved, while in incomplete SCI VC (p = .005), ERV (p = .029), PEF( p = .001) improved with PBWSTT. In upper neurological level of injury (NLI) (T6-T11), PBWSTT improved PEF (p = .004) alone while in lower NLI (T12-L2), with PBWSTT both ERV (p = .016) and PEF (p = .035) improved. Conclusions: With added PBWSTT most parameters including Vital Capacity, the global measure of PFT, improved significantly, especially in Lower NLI and incomplete SCI. The positive role of this noninvasive exercise based intervention in improving lung functions comes as an added benefit to the usual benefit of locomotion. This may encourage researchers to design future larger studies to validate it aiming the inclusion of PBWSTT in routine SCI rehabilitation protocols.
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