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Ota R, Hirata A, Hata T, Nishihara M, Neo M, Katsumata T. Incidence of serious infections in the working-age Japanese adult population with rheumatoid arthritis treated with tumor necrosis factor-α inhibitors and interleukin-6 inhibitors: A nationwide retrospective cohort study. Pharmacotherapy 2024. [PMID: 38864468 DOI: 10.1002/phar.2946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 06/13/2024]
Abstract
AIM This retrospective cohort study aimed to compare the risk of serious infections in patients with rheumatoid arthritis (RA) treated with tumor necrosis factor-α inhibitors (TNFαi) and interleukin-6 inhibitors (IL-6i), with no prior use of biological disease-modifying antirheumatic drugs (bDMARDs). METHODS We employed the nationwide insurance claims database encompassing the years 2005 to 2018 in Japan. The inclusion criteria specified patients who were prescribed any type of bDMARDs, including TNFαi and IL-6i. The following exclusion criteria were applied: missing prescription dates, RA not diagnosed, below 16 years of age, bDMARDs prescribed within 6 months of registration, RA diagnosed post-bDMARDs prescription, and incidence of serious infections within 2 weeks before bDMARDs therapy. We applied stabilized inverse probability weights and utilized a Cox regression model to estimate the risk of serious infections associated with TNFαi and IL-6i. RESULTS The cohort of 2493 patients with RA was categorized into a TNFαi group and an IL-6i group of 2018 and 475 participants, respectively. The median follow-up duration (interquartile range) was 347 (147-820) days in the TNFαi group and 369 (149-838) days in the IL-6i group. In the inverse probability-weighted cohort, the incidence rates (95% confidence interval) of serious infections were 2.13 (1.65-2.71) and 3.25 (2.15-4.69) per 100 person-years for the TNFαi and IL-6i groups, respectively. The hazard ratio (95% confidence interval) comparing the TNFαi group to the IL-6i group was 0.66 (0.36-1.20, p = 0.168). DISCUSSION The results underscore the lack of evidence to preferentially favor either TNFαi or IL-6i as later-line therapy in the management of bDMARDs-naive RA to mitigate the risk of serious infections.
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Affiliation(s)
- Ryosuke Ota
- Department of Pharmacy, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Atsushi Hirata
- Department of Pharmacy, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Takeo Hata
- Department of Pharmacy, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Osaka, Japan
- Department of Hospital Quality and Safety Management, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Osaka, Japan
| | - Masami Nishihara
- Department of Pharmacy, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Osaka, Japan
- Department of Hospital Quality and Safety Management, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Osaka, Japan
| | - Masashi Neo
- Department of Pharmacy, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Osaka, Japan
- Department of Orthopedic Surgery, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Takahiro Katsumata
- Department of Pharmacy, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Osaka, Japan
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
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Ota R, Hata T, Hirata A, Hamada T, Nishihara M, Neo M, Katsumata T. Risk of infection from glucocorticoid and methotrexate interaction in patients with rheumatoid arthritis using biologics: A retrospective cohort study. Br J Clin Pharmacol 2023; 89:2168-2178. [PMID: 36755477 DOI: 10.1111/bcp.15687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
AIMS This retrospective cohort study aimed to evaluate the effect of the interaction between methotrexate and glucocorticoids on the risk of developing bacterial infections in patients with rheumatoid arthritis (RA) using biological disease-modifying antirheumatic drugs (bDMARDs). METHODS We used the 2005-2018 JMDC claims database, a nationwide claims database in Japan. From the database of 7 175 048 patients, study patients were obtained by applying the following exclusion criteria: no use of bDMARDs; without information on the date of prescription; without RA as a disease; other than the new users of bDMARDs; and age <18 years. The exposures were glucocorticoids and methotrexate, and the outcome was bacterial infection. The interaction effects were examined using multivariate Cox regression analysis. Bacterial infections were identified according to antibiotic prescription and International Statistical Classification of Diseases and Related Health Problems, 10th revision codes. RESULTS A total of 2837 RA patients were identified, with a median age of 50 years. The incidence of infection was 16.8% (95% confidence interval: 15.5-18.3). The interaction term for the doses of glucocorticoids and methotrexate was significant. Additionally, a higher dose of glucocorticoid was a significant risk factor for developing bacterial infections on the side of high doses of methotrexate. The incidence of bacterial infections tended to increase significantly with increasing methotrexate doses coprescribed with glucocorticoids ≥5 mg or glucocorticoid doses coprescribed with methotrexate ≥8 mg. CONCLUSION Our results indicate a potential association between methotrexate dose and bacterial infections during bDMARDs administration with glucocorticoids in patients with RA.
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Affiliation(s)
- Ryosuke Ota
- Department of Pharmacy, Kindai University Nara Hospital, Nara, Japan
| | - Takeo Hata
- Department of Pharmacy, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
- Department of Hospital Quality and Safety Management, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Atsushi Hirata
- Department of Pharmacy, Kindai University Nara Hospital, Nara, Japan
| | - Takeshi Hamada
- Department of Pharmacy, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Masami Nishihara
- Department of Pharmacy, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
- Department of Hospital Quality and Safety Management, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Masashi Neo
- Department of Pharmacy, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
- Department of Orthopedic Surgery, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Takahiro Katsumata
- Department of Pharmacy, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
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Lenga P, Gülec G, Kiening K, Unterberg AW, Ishak B. Mortality, complication risks, and clinical outcomes after surgical treatment of spinal epidural abscess: a comparative analysis of patients aged 18-64 years, 65-79 years, and ≥ 80 years, with a 3-year follow-up. Neurosurg Rev 2023; 46:96. [PMID: 37099226 PMCID: PMC10133033 DOI: 10.1007/s10143-023-02003-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/30/2023] [Accepted: 04/16/2023] [Indexed: 04/27/2023]
Abstract
Spinal epidural abscess (SEA) with pyogenic vertebral osteomyelitis (PVO) is a rare illness with a steadily increasing incidence. However, comparative analyses of young and older patients with SEA are lacking. We aimed to compare the clinical course of patients aged 18-64 years, 65-79 years, and ≥ 80 years undergoing surgery for SEA. Clinical and imaging data were retrospectively collected from the institutional database between September 2005 and December 2021. Ninety-nine patients aged 18-64 years, 45 patients aged 65-79 years, and 32 patients ≥ 80 years were enrolled. Patients ≥ 80 years presented with a poorer baseline history (9.2 ± 2.4), as indicated by the CCI, than their younger counterparts (18-74 years: 4.8 ± 1.6;6.5 ± 2.5; p < 0.001). Patients aged 65-79 years and 80 years had a significantly longer length of stay. In-hospital mortality was significantly higher in those aged ≥ 80 years compared to their younger counterparts (≥ 80 years, n = 3, 9.4% vs. 18-64 years, n = 0, 0.0%; 65-79 years, n = 0, 0.0%; p < 0.001), while no differences in 90-day mortality or 30-day readmission were observed. After surgery, a significant decrease in C-reactive protein levels and leukocytes and amelioration of motor scores were observed in all the groups. Of note, older age (> 65 years), presence of comorbidities, and poor preoperative neurological condition were significant predictors of mortality. Surgical management led to significant improvements in laboratory and clinical parameters in all age groups. However, older patients are prone to multiple risks, requiring meticulous evaluation before surgery. Nevertheless, the risk profile of younger patients should not be underestimated. The study has the limitations of a retrospective design and small sample size. Larger randomized studies are warranted to establish the guidelines for the optimal management of patients from every age group and to identify the patients who can benefit from solely conservative management.
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Affiliation(s)
- Pavlina Lenga
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Gelo Gülec
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Karl Kiening
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Pathogenesis, Diagnostic Challenges, and Risk Factors of Pott's Disease. Clin Pract 2023; 13:155-165. [PMID: 36826156 PMCID: PMC9955044 DOI: 10.3390/clinpract13010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
Tuberculosis (TB) prevalence is increasing in developed nations and continuing to cause significant mortality in low- and middle-income countries. As a result of the uptick in cases, there also exists an increased prevalence of extrapulmonary TB. TB is caused by Mycobacterium tuberculosis (M. tb). When M. tb disseminates to the vertebral column, it is called Pott's disease or spinal TB. The frequency, symptoms, and severity of the disease range by the location of the spine and the region of the affected vertebrae. While the current literature shows that timely diagnosis is crucial to reduce the morbidity and mortality from Pott's disease, there is a lack of specific clinical diagnostic criteria for Pott's disease, and the symptoms may be very non-specific. Studies have shown that novel molecular diagnostic methods are effective and timely choices. Research has implicated the risk factors for the susceptibility and severity of Pott's disease, such as HIV and immunosuppression, poverty, and malnutrition. Based on the current literature available, our group aims to summarize the pathogenesis, clinical features, diagnostic challenges, as well as the known risk factors for Pott's disease within this literature review.
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Guran O, Ozmanevra R, Kuyumcu M, Cakmakci A, Aman T. The management of orthopedic trauma surgery during the COVID-19 pandemic in Turkey. Acta Orthop Belg 2022; 88:269-274. [DOI: 10.52628/88.2.7857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
COVID-19 has now alarmed the whole world, putting many countries’ health systems in trouble. We aimed to evaluate the affect of the new treatment strategy that shortens hospital stay in orthopedic trauma patients in pandemic.Trauma patients who underwent surgical treatment between March 15th-May 1st 2019 and 2020 were examined about time interval from admission to surgery, period from surgery to discharge and total hospital stay time. This cohort was compared to a retrospective cohort of patients admitted for the same reasons in the same period of the previous year. During COVID pandemia, 51 trauma patients operated with the mean period from admission to operation 1.45 days, faster than the previous year’s same period (3.76 days). From operation day to discharge time was 1.6 days in pandemic period and 4.3 days last year. The total hospitalization period (3,05 days) was significantly shorter in pandemic than the same period of the last year (8,06 days). (p<0.05). No complications and mortality were observed in any of our patients with faster trauma treatment strategy in pandemic. The operation of orthopedic trauma patients requiring surgery during a pandemic in a shorter time than normal time will not increase the complication and mortality, but will also help to use the bed more effectively by reducing the hospital stay.
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Kweh BTS, Lee HQ, Tan T, Rutges J, Marion T, Tew KS, Bhalla V, Menon S, Oner FC, Fisher C, Tee JW. The Role of Spinal Orthoses in Osteoporotic Vertebral Fractures of the Elderly Population (Age 60 Years or Older): Systematic Review. Global Spine J 2021; 11:975-987. [PMID: 32990034 PMCID: PMC8258809 DOI: 10.1177/2192568220948036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE Spinal orthoses have been generally used in the management of osteoporotic vertebral fractures in the elderly population with purported positive biomechanical and functional effects. To our knowledge, this is the first systematic review of the literature examining the role of spinal orthoses in osteoporotic elderly patients who sustain low energy trauma vertebral fractures. METHODS A systematic literature review adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Methodical searches utilizing MEDLINE, EMBASE, Google Scholar, and Cochrane Databases was performed. RESULTS Of the 2019 articles initially retrieved, 7 published articles (4 randomized controlled trials and 3 prospective cohort studies) satisfied the inclusion criteria. Five studies reported improvement in quantitative measurements of spinal column stability when either a rigid or semirigid orthosis was used, while 1 study was equivocal. The studies also showed the translation of biomechanical benefit into significant functional improvement as manifested by improved postural stability and reduced body sway. Subjective improvement in pain scores and quality of life was also noted with bracing. CONCLUSION The use of spinal orthoses in neurologically intact elderly patients aged 60 years and older with osteoporotic compression vertebral fractures results in improved biomechanical vertebral stability, reduced kyphotic deformity, enhanced postural stability, greater muscular strength and superior functional outcomes.
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Affiliation(s)
- Barry Ting Sheen Kweh
- National Trauma Research Institute, Melbourne, Victoria, Australia,The Alfred Hospital, Melbourne, Victoria, Australia,Barry Ting Sheen Kweh, National Trauma Research Institute, 85-89 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Hui Qing Lee
- National Trauma Research Institute, Melbourne, Victoria, Australia,The Alfred Hospital, Melbourne, Victoria, Australia
| | - Terence Tan
- National Trauma Research Institute, Melbourne, Victoria, Australia,The Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Travis Marion
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | | | | | | | | | - Charles Fisher
- University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jin Wee Tee
- National Trauma Research Institute, Melbourne, Victoria, Australia,The Alfred Hospital, Melbourne, Victoria, Australia
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Bagherifard A, Arasteh P, Salehpour M, Zadeh HS, Mazhar FN, Ghandhari H, Bahaeddini MR, Tabrizian P, Askari A. COVID-19 among patients with orthopedic surgery: our experience from the Middle East. J Orthop Surg Res 2021; 16:336. [PMID: 34034785 PMCID: PMC8144277 DOI: 10.1186/s13018-021-02483-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
Background We report our experiences with COVID-19 in one of the largest referral orthopedic centers in the Middle East and aimed to describe the epidemiology and clinical characteristics of these patients. Methods During February 20 and April 20, 2020, patients who underwent orthopedic surgery and healthcare staff who were in contact with these patients were screened for COVID-19. To identify patients who were in the incubation period of COVID-19 during their hospital stay, all patients were tested again for COVID-19 4 weeks after discharge. Results Overall, 1244 patients underwent orthopedic surgery (1123 emergency and 121 elective) during the study period. Overall, 17 patients were diagnosed with COVID-19 during hospital admission and seven after discharge. Among the total 24 patients with COVID-19, 15 were (62.5%) males with a mean (SD) age of 47.0±1.6 years old. Emergency surgeries were performed in 20 (83.3%) patients, and elective surgery was done in the remaining 4 patients which included one case of posterior spinal fusion, spondylolisthesis, acromioclavicular joint dislocation, and one case of leg necrosis. A considerable number of infections occurred in patients with intertrochanteric fractures (n=7, 29.2%), followed by pelvic fractures (n=2, 8.3%), humerus fractures (n=2, 8.3%), and tibial plateau fractures (n=2, 8.3%). Fever (n=11, 45.8%) and cough (n=10, 37.5%) were the most common symptoms among patients. Laboratory examinations showed leukopenia in 2 patients (8.3%) and lymphopenia in 4 (16.7%) patients. One patient with a history of cancer died 2 weeks after discharge due to myocardial infarction. Among hospital staff, 26 individuals contracted COVID-19 during the study period, which included 13 (50%) males. Physicians were the most commonly infected group (n = 11), followed by operation room technicians (n = 5), nurses (n = 4), and paramedics (n = 4). Conclusions Patients who undergo surgical treatment for orthopedic problems, particularly lower limb fractures with limited ambulation, are at a higher risk of acquiring COVID-19 infections, although they may not be at higher risks for death compared to the general population. Orthopedic surgeons in particular and other hospital staff who are in close contact with these patients must be adequately trained and given appropriate personal protective equipment during the COVID-19 outbreak.
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Affiliation(s)
- Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mostafa Salehpour
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Hooman Shariat Zadeh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farid Najd Mazhar
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Ghandhari
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Bahaeddini
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Pouria Tabrizian
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Askari
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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Keskin A, Karslioglu B. Did Covid-19 pandemic narrow the spectrum of surgical indications? JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2021. [DOI: 10.25083/2559.5555/6.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction. The Covid-19 outbreak has changed orthopedic practices more than expected. We are going through a period in which conservative treatment will become prominent when deciding on fractures with indistinct surgical margins in guidelines. Considering global tendency for surgical interventions in the pre-pandemic period, we tried to find out the answer to the following question: will conservative treatment be the shining star in the post pandemic period? Materials and Methods. 262 patients who were with “gray zone fractures-injuries” like extraarticular distal radius fracture, proximal humerus fracture and Weber type B ankle fracture was treated conservatively during March and August, 2020. Open or pathological fracture, fractures with vascular or neurological injury and fractures involving the articular joint were excluded. Results. 59 patients with proximal humerus fracture followed with arm-sling. Mean ASES scores at 6th was 48.3 and 69.9 12th week. 91 patients with Weber B-type ankle fracture were followed up with below-knee plaster for 6 weeks. American Orthopedic Foot & Ankle Score was 48 in the 6th week and 75 in the 12th week. 90 patients with distal radius fracture were followed up with plaster. Malunion was detected at 5 patients. Mean Quick Dash score at 6th weeks was 52.3 and 29.5 at 12th weeks. Mean wrist flexion was 450, wrist extension was 350, forearm supination 600 and forearm pronation was 700 at final control. Conclusions. The conservative treatment experiences we have gained from pandemic periods probably will change our treatment algorithm.
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Rizkallah M, Melhem E, Sadeqi M, Meyblum J, Jouffroy P, Riouallon G. Letter to the editor on the outcomes in fracture patients infected with COVID-19. Injury 2020; 51:2333-2334. [PMID: 32605785 PMCID: PMC7315939 DOI: 10.1016/j.injury.2020.06.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/24/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Maroun Rizkallah
- Orthopedic Surgery Department, Groupe Hospitalier Paris Saint Joseph, Paris, France.,Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon,Corresponding author at: Saint Joseph University, Faculty of medicine, Beirut, LEBANON, Department of Orthopedic surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France, 185, Rue Raymond Losserand, Paris, 75014, France
| | - Elias Melhem
- Orthopedic Surgery Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Mansour Sadeqi
- Orthopedic Surgery Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Jean Meyblum
- Orthopedic Surgery Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Pomme Jouffroy
- Orthopedic Surgery Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Guillaume Riouallon
- Orthopedic Surgery Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
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Jerome JTJ, Mercier F, Mudgal CS, Arenas-Prat J, Vinagre G, Goorens CK, Rivera-Chavarría IJ, Sechachalam S, Mofikoya B, Thoma A, Medina C, Rivera-Chavarría IJ, Henry M, Afshar A, Dailiana ZH, Prasetyono TOH, Artiaco S, Madhusudhan TR, Ukaj S, Reigstad O, Hamada Y, Bedi R, Poggetti A, Al-Qattan MM, Siala M, Viswanathan A, Romero-Reveron R, Hong JP, Khalid KA, Bhaskaran S, Venkatadass K, Leechavengvongs S, Goorens CK, Nazim S, Georgescu AV, Tremp M, Nakarmi KK, Ellabban MA, Chan P, Aristov A, Patel S, Moreno-Serrano CL, Rai S, Kanna RM, Malshikare VA, Tanabe K, Thomas S, Gokkus K, Baek SH, Brandt J, Rith Y, Olazabal A, Saaiq M, Patil V, Jithendran N, Parekh H, Minamikawa Y, Atagawi AA, Hadi JA, Berezowsky CA, Moya-Angeler J, Altamirano-Cruz MA, Galvis R LA, Antezana A, Paczesny L, Fernandes CH, Asadullah M, Yuan-Shun L, Makelov B, Dodakundi C, Regmi R, Pereira GU, Zhang S, Sayoojianadhan B, Callupe I, Rakha MI, Papes D, Ganesan RP, Mohan M, Jeyaraman A, Prabhakar P, Rajniashokan A, Geethan I, Chandrasekar S, Löw S, Thangavelu K, Giudici LD, Palanisamy Y, Vaidyanathan S, Boretto J, Ramirez MA, Goundar TS, Kuppusamy T, Kanniyan K, Srivastava A, Chiu YC, Bhat AK, Gopinath NR, Vasudevan VP, Abraham V. Perspectives and Consensus among International Orthopaedic Surgeons during Initial and Mid-lockdown Phases of Coronavirus Disease. J Hand Microsurg 2020; 12:135-162. [PMID: 33408440 DOI: 10.1055/s-0040-1713964] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
With a lot of uncertainty, unclear, and frequently changing management protocols, COVID-19 has significantly impacted the orthopaedic surgical practice during this pandemic crisis. Surgeons around the world needed closed introspection, contemplation, and prospective consensual recommendations for safe surgical practice and prevention of viral contamination. One hundred orthopaedic surgeons from 50 countries were sent a Google online form with a questionnaire explicating protocols for admission, surgeries, discharge, follow-up, relevant information affecting their surgical practices, difficulties faced, and many more important issues that happened during and after the lockdown. Ten surgeons critically construed and interpreted the data to form rationale guidelines and recommendations. Of the total, hand and microsurgery surgeons (52%), trauma surgeons (32%), joint replacement surgeons (20%), and arthroscopy surgeons (14%) actively participated in the survey. Surgeons from national public health care/government college hospitals (44%) and private/semiprivate practitioners (54%) were involved in the study. Countries had lockdown started as early as January 3, 2020 with the implementation of partial or complete lifting of lockdown in few countries while writing this article. Surgeons (58%) did not stop their surgical practice or clinics but preferred only emergency cases during the lockdown. Most of the surgeons (49%) had three-fourths reduction in their total patients turn-up and the remaining cases were managed by conservative (54%) methods. There was a 50 to 75% reduction in the number of surgeries. Surgeons did perform emergency procedures without COVID-19 tests but preferred reverse transcription polymerase chain reaction (RT-PCR; 77%) and computed tomography (CT) scan chest (12%) tests for all elective surgical cases. Open fracture and emergency procedures (60%) and distal radius (55%) fractures were the most commonly performed surgeries. Surgeons preferred full personal protection equipment kits (69%) with a respirator (N95/FFP3), but in the case of unavailability, they used surgical masks and normal gowns. Regional/local anesthesia (70%) remained their choice for surgery to prevent the aerosolized risk of contaminations. Essential surgical follow-up with limited persons and visits was encouraged by 70% of the surgeons, whereas teleconsultation and telerehabilitation by 30% of the surgeons. Despite the protective equipment, one-third of the surgeons were afraid of getting infected and 56% feared of infecting their near and dear ones. Orthopaedic surgeons in private practice did face 50 to 75% financial loss and have to furlough 25% staff and 50% paramedical persons. Orthopaedics meetings were cancelled, and virtual meetings have become the preferred mode of sharing the knowledge and experiences avoiding human contacts. Staying at home, reading, and writing manuscripts became more interesting and an interesting lifestyle change is seen among the surgeons. Unanimously and without any doubt all accepted the fact that COVID-19 pandemic has reached an unprecedented level where personal hygiene, hand washing, social distancing, and safe surgical practices are the viable antidotes, and they have all slowly integrated these practices into their lives. Strict adherence to local authority recommendations and guidelines, uniform and standardized norms for admission, inpatient, and discharge, mandatory RT-PCR tests before surgery and in selective cases with CT scan chest, optimizing and regularizing the surgeries, avoiding and delaying nonemergency surgeries and follow-up protocols, use of teleconsultations cautiously, and working in close association with the World Health Organization and national health care systems will provide a conducive and safe working environment for orthopaedic surgeons and their fraternity and also will prevent the resurgence of COVID-19.
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Affiliation(s)
- J Terrence Jose Jerome
- Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital and Research Centre, Tamil Nadu, India
| | | | - Chaitanya S Mudgal
- Harvard Medical School, Massachusetts, United States; Hand Surgery Services, Massachusetts General Hospital, Boston, Massachusetts, United States.,Hand Surgery Service, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Joan Arenas-Prat
- Department of Orthopaedics, ServeisMedics Penedes, Barcelona, Catalonia, Spain
| | - Gustavo Vinagre
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Chul Ki Goorens
- Department of Orthopaedics, Regional Hospital Tienen, Tienen, Belgium
| | | | | | - Bolaji Mofikoya
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | | | - Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Theddeus O H Prasetyono
- Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | | | | | - Ole Reigstad
- Hand Surgery Unit, Oslo University Hospital, Oslo, Norway
| | - Yoshitaka Hamada
- Hand Surgery Unit, Kansai Medical University Medical Center, Moriguchi City, Osaka, Japan
| | | | - Andrea Poggetti
- Hand and Reconstructive Microsurgery Unit, AOU Careggi, Florence, Italy
| | | | - Mahdi Siala
- Service d'Orthopedie, chu de purpan, Toulouse, France
| | | | - Rafael Romero-Reveron
- Trauma and Orthopaedic Departamento, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - Joon Pio Hong
- Hand and Reconstructive Microsurgery Unit, Asan Medical Center, Songpagu Seoul, Korea
| | - Kamarul Ariffin Khalid
- Department of Orthopedics, IIUM Medical Centre, Jalan Sultan Ahmad Shah, Kuantan, Pahang, Malaysia
| | | | | | | | - Chul Ki Goorens
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Sifi Nazim
- Department of Orthopaedics, Algiers Faculty of Medicine, Algiers, Algeria
| | | | - Mathias Tremp
- Department of Orthopaedics, Dorfplatz 1, Cham, Switzerland
| | | | - Mohamed A Ellabban
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine, Suez Canal University, Egypt
| | - Pingtak Chan
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | | | | | | | | | | | | | - Katsuhisa Tanabe
- Department of Orthopaedics, Nishinomiya Municipal Central Hospital, Hayashidacho, Nishinomiya, Japan
| | - Simon Thomas
- Department of Ort hopaedics, Rohini, Delhi, India
| | - Kemal Gokkus
- Alanya Research and Practice Center, Baskent University School of Medicine, Saray Mah, Antalya, Turkey
| | - Seung-Hoon Baek
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | | | - Yin Rith
- Department of Orthopaedics, Cambodia
| | | | - Muhammad Saaiq
- Department of Hand Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
| | - Vijay Patil
- Orthopedics, Hand and Microsurgery Unit, Basildon Unive rsity Hospital, Basildon, Essex, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | - Lukasz Paczesny
- Orvit Clinic, Citomed Healthcare Center, Sklodowskiej, Torun, Poland
| | | | - Md Asadullah
- Orthopedics and Hand surgery Unit, Eman Medical College Hospital, Savar, Dhaka, Bangladesh
| | | | | | | | - Rabindra Regmi
- Department of Orthopedics and Reconstructive Microsurgery, National Trauma Centre, Kathmandu, Nepal
| | | | - Shuwei Zhang
- Department of Spine and Bone Tumor Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Binoy Sayoojianadhan
- Hand and Reconstructive Microsurgery Unit, Department of Orthopedic Surgery, St James Hospital, Chalakudy, Kerala, India
| | | | - Mohamed I Rakha
- Orthopedic Department, Suez Canal university hospital, Ismailia, Egypt
| | - Dino Papes
- Department of surgery (Ped and Vasc), University Hospital Center Zagreb, Zagreb, Croatia
| | - Ramesh Prabu Ganesan
- Department of Orthopedics, KAP Viswanatham Government Medical College, Trichy, India
| | | | | | - Ponnaian Prabhakar
- Orthopaedics and Joint Replacement Care Hospitals, Nampally Hyderabad, India
| | | | | | | | - Steffen Löw
- Clinic for Trauma and Hand Surgery, Bad Mergentheim, Germany
| | | | - Luca Dei Giudici
- Ortopedia e Traumatologia, Chirurgiaarticolare di Spalla e Ginocchio, Albodei Medici e Chirurghi di Latina, Cagliari, Italy
| | | | | | | | | | | | - Thirumavalavan Kuppusamy
- Department of Orthopedics, Trauma and Joint Replacement, Shri Bharani Hospital, Villupuram, Tamil Nadu, India
| | | | | | - Yung-Cheng Chiu
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Anil K Bhat
- Department of Orthopaedics, KMC, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | | | - Vineet Abraham
- Department of Orthopaedics, Mahatma Gandhi Medical College, Pondicherry, India
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Abdelnasser MK, Morsy M, Osman AE, AbdelKawi AF, Ibrahim MF, Eisa A, Fadle AA, Hatem A, Anter Abdelhameed M, Hassan AAA, Shawky Abdelgawaad A. COVID-19. An update for orthopedic surgeons. SICOT J 2020; 6:24. [PMID: 32609085 PMCID: PMC7328530 DOI: 10.1051/sicotj/2020022] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/13/2020] [Indexed: 12/19/2022] Open
Abstract
The COVID-19 pandemic has affected our world in a short period of time, and the orthopedic surgery practice was not an exclusion. Elective care was deferred in most health care facilities and emergency care was continued with strict precautions. With rapid progression of the pandemic, the response of the medical community is also rapidly changing in all aspects of delivering care. This led to a large number of publications with reports, guidelines, measures, ways to react to the crisis, and post-pandemic predictions and speculations. In this review we aimed at summarizing all the relevant information to the orthopedic surgery community. To do this, a comprehensive search was performed with all related terms on two scientific search engines, PubMed and SCOPUS, and the results were filtered by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The result was 72 articles that were further reduced to 33 articles after full text reading. The resultant information was organized under 5 main headings; the impact of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, peri-operative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. This review represents the most up to date information published in the literature that is a must-know to every orthopedic surgeon.
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Affiliation(s)
| | - Mohamed Morsy
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
| | - Ahmed E. Osman
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
| | | | | | - Amr Eisa
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
| | - Amr A. Fadle
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
| | - Amr Hatem
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
| | | | | | - Ahmed Shawky Abdelgawaad
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
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Spine center, Helios Klinikum Erfurt Nordhaeuser street 74 88089 Erfurt Germany
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12
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Mi B, Chen L, Xiong Y, Xue H, Zhou W, Liu G. Characteristics and Early Prognosis of COVID-19 Infection in Fracture Patients. J Bone Joint Surg Am 2020; 102:750-758. [PMID: 32379114 PMCID: PMC7219849 DOI: 10.2106/jbjs.20.00390] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Studies of the novel coronavirus-induced disease COVID-19 in Wuhan, China, have elucidated the epidemiological and clinical characteristics of this disease in the general population. The present investigation summarizes the clinical characteristics and early prognosis of COVID-19 infection in a cohort of patients with fractures. METHODS Data on 10 patients with a fracture and COVID-19 were collected from 8 different hospitals located in the Hubei province from January 1, 2020, to February 27, 2020. Analyses of early prognosis were based on clinical outcomes and trends in laboratory results during treatment. RESULTS All 10 patients presented with limited activity related to the fracture. The most common signs were fever, cough, and fatigue at the time of presentation (7 patients each). Other, less common signs included sore throat (4 patients), dyspnea (5 patients), chest pain (1 patient), nasal congestion (1 patient), headache (1 patient), dizziness (3 patients), abdominal pain (1 patient), and vomiting (1 patient). Lymphopenia (<1.0 × 10 cells/L) was identified in 6 of 10 patients, 9 of 9 patients had a high serum level of D-dimer, and 9 of 9 patients had a high level of C-reactive protein. Three patients underwent surgery, whereas the others were managed nonoperatively because of their compromised status. Four patients died on day 8 (3 patients) or day 14 (1 patient) after admission. The clinical outcomes for the surviving patients are not yet determined. CONCLUSIONS The clinical characteristics and early prognosis of COVID-19 in patients with fracture tended to be more severe than those reported for adult patients with COVID-19 without fracture. This finding may be related to the duration between the development of symptoms and presentation. Surgical treatment should be carried out cautiously or nonoperative care should be chosen for patients with fracture in COVID-19-affected areas, especially older individuals with intertrochanteric fractures. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Lang Chen
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Yuan Xiong
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Hang Xue
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Wu Zhou
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
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13
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Ogihara S, Yamazaki T, Shiibashi M, Maruyama T, Chikuda H, Miyoshi K, Inanami H, Oshima Y, Azuma S, Kawamura N, Yamakawa K, Hara N, Morii J, Okazaki R, Takeshita Y, Sato K, Tanaka S, Saita K. Risk Factor Analysis of Deep Surgical Site Infection After Posterior Instrumented Fusion Surgery for Spinal Trauma: A Multicenter Observational Study. World Neurosurg 2020; 134:e524-e529. [DOI: 10.1016/j.wneu.2019.10.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 11/25/2022]
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