A Case Report: Co-presenting COVID-19 Infection and Acute Drug Intoxication
BACKGROUND:Coronavirus disease 2019 (COVID-19) has spread throughout the world since late 2019. Symptoms appear after a two-week incubation period and commonly include fever, cough, myalgia or fatigue, and shortness of breath. CASE REPORT/METHODS:A 32-year-old male with a history of opiate abuse presented to the emergency department with altered mental status. The patient was lethargic and hypoxic with improvement from naloxone. Official chest radiograph was read as normal; however, the treating clinicians noted bilateral interstitial opacities, raising concern for underlying infectious etiology. Opiates and cocaine were positive on drug screen, and an arterial blood gas on room air showed hypoxemia with respiratory acidosis. The patient was intubated during the treatment course due to persistent hypoxemia and for airway protection after resuscitation. The COVID-19 test was positive on admission, and later computed tomography showed ground-glass opacities. The patient was extubated and discharged after one week on the ventilator. CONCLUSION/CONCLUSIONS:When screening patients at and during evaluation, physicans should consider a broad differential as patients with atypical presentations may be overlooked as candidates for COVID-19 testing. As screening and evaluation protocols evolve, we emphasize maintaining a high index of suspicion for COVID-19 in patients with atypical symptoms or presenting with other chief complaints in order to avoid spreading the disease.
The Association of Sport Specialization and Training Volume With Injury History in Youth Athletes
BACKGROUND:Recommendations exist to encourage safe youth participation in sport. These recommendations include not specializing in 1 sport, limiting participation to less than 8 months per year, and limiting participation to fewer hours per week than a child's age. However, limited evidence exists to support or refute these recommendations. HYPOTHESIS/OBJECTIVE:High levels of specialization will be associated with a history of injuries and especially overuse injuries, independent of age, sex, or weekly sport training hours. Athletes who exceed current sport volume recommendations will be more likely to have a history of injuries and overuse injuries. STUDY DESIGN/METHODS:Case-control study; Level of evidence, 3. METHODS:Youth athletes (n = 2011; 989 female and 1022 male; 12-18 years of age) completed a questionnaire regarding their specialization status, yearly and weekly sport participation volume, and injury history. Specialization was classified as low, moderate, or high using a previously utilized 3-point scale. Athletes were classified into groups based on either meeting or exceeding current volume recommendations (months per year and hours per week). Odds ratios (ORs) and 95% CIs were calculated to investigate associations of specialization and volume of participation with a history of sport-related injuries in the past year ( P ≤ .05). RESULTS:Highly specialized athletes were more likely to report a previous injury of any kind ( P < .001; OR, 1.59; 95% CI, 1.26-2.02) or an overuse injury ( P = .011; OR, 1.45; 95% CI, 1.07-1.99) in the previous year compared with athletes in the low specialization group. Athletes who played their primary sport more than 8 months of the year were more likely to report an upper extremity overuse injury ( P = .04; OR, 1.68; 95% CI, 1.06-2.80) or a lower extremity overuse injury ( P = .001; OR, 1.66; 95% CI, 1.22-2.30). Athletes who participated in their primary sport for more hours per week than their age (ie, a 16-year-old athlete who participated in his or her primary sport for more than 16 h/wk) were more likely to report an injury of any type ( P = .001; OR, 1.34; 95% CI, 1.12-1.61) in the previous year. CONCLUSION/CONCLUSIONS:High levels of specialization were associated with a history of injuries, independent of age, sex, and weekly organized sport volume. Athletes who exceeded volume recommendations were more likely to have a history of overuse injuries. CLINICAL RELEVANCE/CONCLUSIONS:Parents and youth athletes should be aware of the risks of specialization and excessive sport volume to maximize safe sport participation.