Objectives To determine if the initial COVID-19 societal restrictions, introduced in Ireland in March 2020, impacted on the number and nature of psychiatry presentations to the emergency department (ED) of a large academic teaching hospital. Methods We examined anonymised clinical data of psychiatry presentations to the ED during the initial 8-week period of COVID-19 restrictions. Data from corresponding 8-week periods in 2018 and 2019 were also extracted for comparison. Results Psychiatry presentations to ED reduced by 21% during the COVID-19 restrictions, from 24/week to 19/week when compared with corresponding periods in 2018/2019 (1-way 2-sample Poisson Rate Test estimate of difference -5.2/week, 95% CI 1.3-9.1, p = 0.012). Numbers attending for out of hours assessment remained unchanged (81 vs 80), but numbers seeking assessment during normal hours decreased (71 vs 114). We observed increased presentations from the <18 age group, but decreased presentations from the 18-29 age group (Pearson Chi-Square 20.363, DF = 6, p = 0.002). We recorded an increase in anxiety disorders during the initial COVID-19 restrictions (31 vs 23), and a reduction in alcohol disorders (28 vs 52). The proportion of presentations with suicidal ideation or self-harm as factors remained unchanged. Conclusions Rates of emergency presentation with mental illness reduced during the initial COVID-19 restrictions. This may represent an unmet burden of mental health need. Younger people may be experiencing greater distress and mental illness during the current crisis. More people sought help for anxiety disorders during the COVID-19 restrictions compared with corresponding data from 2018/2019.

Though a relatively recent development, bioactive glass used in concurrence with antibiotic therapy has significant potential in the treatment of chronic osteomyelitis.

A 14-year-old boy presented to the emergency department with pain and swelling over the lumbar area after blunt trauma of his lower back 2 h previously (after falling from a horse).On examination, there was a voluminous swelling (20315 cm) over the lumbar area, overlying segments L2eS4; the swelling was soft, elastic, immobile, painful to palpate, with moderate bruising (figure 1); there was generalised decreased range of movement of the lumbar spine and neurology was normal.X-rays showed spondylolisthesis of L5 on S1 and diffuse soft tissue thickening over the posterior and lateral aspects of the lumbar vertebral column (figure 2). The MRI scan confirmed a large solid haematoma and a long-standing stable spondylolisthesis ( figure 3).Morel-Lavallée lesion (haematoma or seroma) occurs after close blunt trauma, direct or tangential, with a degloving mechanism that separates the hypodermis from the fascia beneath, causing a shearing injury. 1 Post-traumatic lesions are often encountered in the region of the hip, thigh and pelvis and very rarely over the lumbar area. This lesion can also appear after plastic, reconstructive or orthopaedic surgery.The treatment varies from conservative compression methods to surgical drainage or continuous aspiration. For our patient, an open drainage was performed with uneventful postoperative evolution.

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