Hand Trauma Virtual Clinics Prove Effective During the COVID-19 Pandemic

BACKGROUND

Due to the devastating and far-reaching impact of the novel COVID-19 pandemic, hospital resources have been redirected to protect patients and health care staff, thereby vastly reducing the capacity for outpatient follow-up within a busy Plastic Surgery and Hand Trauma center. Through the use of telephone and video technology, virtual clinics were rapidly introduced to reduce hospital footfall.

METHODS

This retrospective cohort study analyzed patient experiences in virtual and traditional face-to-face clinics through the month of April 2020, from the second week of the government-imposed lockdown. A 5-point Visit-Specific Satisfaction Questionnaire was used to subsequently collect patients' feedback regarding their appointments.

RESULTS

A total of 107 hand injury-related follow-up appointments were recorded during the 4-week period. Sixty (56.0%) appointments were performed as a virtual consultation, and 47 (43.9%) face-to-face consultations were carried out on site. It was possible to discharge 43.3% from the virtual clinic group and 57.4% from the face-to-face group. We identified no significant difference in patient satisfaction (P = .368, Mann-Whitney U test) between the 2 cohorts.

CONCLUSION

Virtual clinics appear to be safe and effective for the follow-up of patients with traumatic hand injuries during the COVID-19 pandemic. This approach may prove beneficial in terms of workforce organization, reducing waiting times, and providing an alternative for patients unable to attend physical appointments.

The COVID-19 Pandemic: The effect on open lower limb fractures in a London major trauma centre - a plastic surgery perspective

BACKGROUND

COVID-19 has created huge pressures on healthcare systems. The ongoing provision of major trauma services during this time has proved challenging. We report our experience of managing open lower limb fractures (oLLFs) during the pandemic in a London major trauma centre (MTC).

METHODS

This was a prospective study of all open lower limb fractures presenting to our unit over the initial 48 days of UK government lockdown - 24th March till 10th May 2020. Results were compared to the same time period in 2019 retrospectively. Epidemiological data, mechanism, Gustilo-Anderson (G-A) severity grading, time to initial debridement and definitive coverage were analysed.

RESULTS

There was a 64% reduction in emergency department (ED) attendances (25,264 vs 9042). There was an 18% reduction in oLLFs (22 vs 18). Approximately three-quarters of injuries were in males across both cohorts (77% vs 78%) and tended to occur in younger patients (median age, 37 vs 35). Road-traffic-accidents (RTAs) were the most common injury mechanism in both 2019 and lockdown, but a rise in jumpers from height was seen in the latter. A similar pattern of G-A severities were seen, however only 3 injuries during lockdown required major soft tissue reconstruction. There was no significant difference in times taken for initial debridement (p = 0.72786) or definitive wound coverage (p = 0.16152). A greater proportion of independent operating was seen during lockdown between orthopaedics and plastic surgery.

CONCLUSIONS

Despite government lockdown measures, oLLFs still placed significant burden on our MTC. Notwithstanding significant staffing alterations and theatre pressures, we have been able to ensure these lower limb emergencies remain a surgical priority and have managed to utilise resources appropriately.

Management of hand fractures

Hand fractures are the most common fractures of the upper extremity, with a reported incidence of 3.7 per 1000 per year for men and 1.3 per 1000 per year for women. Understanding the diagnosis and management of these injuries is vital for any clinician working in the emergency department, plastic or orthopaedic surgery or providing community care. This review identifies the most common presentations and outlines how to assess and manage such fractures appropriately, with an emphasis on clinical and radiographic examination. The majority of hand fractures are managed conservatively and operative management should be carefully considered on a case-by-case basis with analysis of patient and fracture-related factors, in order to achieve optimal hand function following treatment.

Management of amputated digits

Traumatic digit amputations account for 1% of all trauma admissions and are an important cause of morbidity in young, working people. It is essential that patients are worked up appropriately and referred promptly to a specialist unit for consideration of replantation. This review summarises the acute management of a patient presenting to the emergency department with an amputated digit. It discusses the assessment, initial management in the emergency department, how to make the decision to replant and operative steps.

Proangiogenic signature in advanced laryngeal carcinoma after microRNA expression profiling

The aim of this study is to evaluate which dysregulated angiomiRs compose the specific proangiogenic microRNA signature of advanced laryngeal cancer and review the literature. Thirty-six samples from twelve patients with advanced laryngeal carcinoma were collected. Total RNA was extracted and microRNA global profiling was performed using Agilent Technologies Microarray Kit. Fifty-nine microRNAs were found to have significantly different expression levels. Eleven microRNAs from the whole group were sorted as regulators of tumor angiogenesis (angiomiRs): seven were up-regulated-miR-1246, miR-181b 5p, miR-18a 5p, miR-21 3p, miR-210 3p, miR-503 5p, miR-93 5p and four were down-regulated-miR148a 5p, miR-145 5p, miR-204 5p, miR-125b 5p. For none of those microRNAs we found heterogeneity in tumor tissue. We are the first to report the specific proangiogenic microRNA signature in advanced laryngeal carcinoma and we confirm and amplify findings from previous studies that expand our perception of a specific "molecular state" of angiogenesis that is distinctive only for laryngeal cancer.

Comparison between myringotomy and tympanostomy tubes in combination with adenoidectomy in 3-7-year-old children with otitis media with effusion

The specific aim of this study was to compare, by means of a randomized clinical trial, the efficacy between the two surgical combinations - adenoidectomy with myringotomy and tympanostomy (A+T) and adenoidectomy with myringotomy (A+M) - in reducing middle ear disease in children with otitis media with effusion (OME). Seventy-eight 3-7-year-old patients (156 ears) with a history of bilateral middle ear effusion for at least 3 months were randomly assigned to either A+T or A+M. Hearing threshold levels, recurrence rate of the effusion and episodes of acute otitis media (AOM) and otorrhea were evaluated for a follow-up period of 1 year. Audiometry testing showed that there was no statistically significant difference in the hearing loss levels of both groups during the whole follow-up period. Free of AOM episodes were 72% of the patients in the A+T group and 75% of those in the A+M group. None of the patients with A+M had episodes with otorrhea which contrasted with the 40% occurrence rate in the A+T group. During the follow-up period we documented a 10% recurrence rate of OME in the A+T group and 14% recurrence rate in the A+M group. Overall our data suggests that the insertion of tympanostomy tubes in association with adenoidectomy provides no additional benefit to adenoidectomy in association with myringotomy alone in terms of hearing loss or AOM episode occurrences in patients with bilateral otitis media with effusion. Furthermore no relationship was found between the choice of operative intervention and the recurrence rate of OME despite the slightly greater relative risk in the A+M group.

[Antioxidant parameters in metabolic syndrome -- a dynamic evaluation during oral glucose tolerance test]

Patients with metabolic syndrome show augmented cardio-vascular risk, at least in part mediated through disequilibrium between mechanisms generating free radicals, and antioxidant defense. Carbohydrate and lipid disturbances in metabolic syndrome induce oxidative stress via several non fully understood mechanisms. Glucose overload in oral glucose tolerance test (OGTT) can also induce oxidative stress. The aim of our study was to evaluate changes in superoxide dismutase and glutathione peroxidase activity, as well as total antioxidant status in OGTT in patients with metabolic syndrome and in healthy subjects. OGTT was performed in 36 healthy volunteers and in patients with metabolic syndrome. Glucose, Insulin, and triglycerides were evaluated at 0th, 30th, 60th, 120th, and 180th min. Superoxide dismutase and glutathione peroxidase were measured at 0th, 60th, and 120th min. Total antioxidant status was measured at 0th, and 120th min. At 0th min total, HDL and LDL cholesterol were evaluated. A statistically significant decrease (p < 0.05) in superoxide dismutase activity at 120th as compared with 60th min were observed. Glutathione peroxidase activity decreased significantly (p < 0.05) even though at 60th as compared with 0th min and remained decreased at 120th min. Total antioxidant status was found to be increased (p < 0.05) at 120th as compared with 0th min. The observed dynamic in patients did not differed (p > 0.05) from control group. The study shows a decrease in antioxidant enzyme activity and a compensatory increase in total antioxidant status, indicating a surcharge of antioxidant homeostasis. In context of carbohydrate and lipid disturbances in metabolic syndrome, this is to suggest an existing of complementary pathogenic mechanisms, able to aggravate cardiovascular risk in these patients. Correction of metabolic disturbances may be an efficacious tool for influencing on prooxidant-antioxidant homeostasis too.

[Optimization of nutritional intake in malnourished patients on periodic hemodialysis therapy--pharmacoeconomic aspects]

Protein-energy malnutrition (PEM) is an often exhibited complication in patients on periodical hemodialysis treatment (PHDT). Oral intake of nutritional supplements broadens the possibilities to treat PEM. A group of 24 patients with signs of malnutrition on hemodialysis, was investigated. In order the protein intake to be increased to the prescribed norm of 1.2 g/kg B.W./day, the nutritional supplement "Nutridial" was added to the usual daily ration of the patients. With a prize of 12 BGL per kilogram "Nutridial" the average cost of the treatment per patient/month is approximately 10,20 BGL (10,16), which is significantly cheaper compared to same treatment with foreign analogues.

Captopril in treatment of hypertensive diabetic patients. Preliminary study

This investigation was performed in 15 adult patients: 6 with type I and 9 with type II diabetes mellitus, all with arterial hypertension. Captopril (12.5 to 100 mg daily, mean 34 mg) was administered for a month and was effective as monotherapy in all patients. The supine arterial pressure changed from: 177 +/- 19 mm Hg to 141.7 +/- 7.7 mm Hg systolic and 106 +/- 7.6 mm Hg to 87.3 +/- 5.3 mm Hg diastolic; and upright: from 162.7 +/- 16 mm Hg to 139 +/- 11.4 mm Hg systolic and from 101.7 +/- 11.6 mm Hg to 87.3 +/- 6.5 mm Hg diastolic. The differences were statistically significant (p less than 0.001). The mean blood glucose was changed significantly at the end of the study (from 11.1 +/- 3.4 mmol.l-1 to 8.1 +/- 1.0 mumol.l-1, p less than 0.001), while the daily insulin dose (respectively glybenclamide) remained unchanged. No alterations in serum creatinine, HbA1 (glycohemoglobin), urinary excretion rate of albumin, beta 2-microglobulin, glomerular filtration rate were observed during follow-up. No important change in plasma aldosterone was found, while plasma renin activity was significantly increased (p less than 0.05) as expected. No side effects were reported during the therapy. Captopril appears to be an effective and safe drug for lowering blood pressure in diabetic patients without affecting renal function.

[Late complications in patients having undergone a gastric resection]

A total of 37 patients who had undergone partial gastrectomy for duodenal or gastric ulcers, were investigated. The postoperative periods ranged from 5 to 28 years. All the patients were subjected to comprehensive clinical and neurologic examinations. The content of vitamin B12 and folic acid in the blood serum was studied by radioimmunoassay in 29 gastrectomized patients, hematological parameters (hemoglobin, serum iron, red blood cell morphology, proteinogram) were estimated in 19 patients. The mean content of vitamin B12 in the blood serum of patients was lower than in normal subjects. The mean level of folic acid in the blood of patients was also lower than in the control, however, this difference was insignificant. Nine patients had subnormal content of vitamin B12, eight of them showed manifest neurologic complications, such as myelopathy and polyneuropathy. Only 3 patients had subnormal content of folic acid in the blood serum. Weakly pronounced anemic syndrome was detected only in 2 out of 19 patients. The role of vitamin B12 deficiency in the development of neurologic symptoms has been considered.