Patients' perception of personal protective equipment during the SARS-Cov-2 pandemic

BACKGROUND

Since the outbreak of the coronavirus (SARS-Cov-2), wearing personal protective equipment (PPE) has become necessary. Patients' ability to recognize staff is disrupted impacting on the relationship between healthcare worker and patient.

OBJECTIVE

Assess the patients' perspective of healthcare workers wearing PPE and its effect on communication.

METHODS

Admitted Orthopaedic patients during the first wave of SARS-Cov-2 were surveyed about the experience with staff wearing PPE. In response to feedback, individual badges with large pictures and names were introduced to wear over PPE. Patient views and response to the badges was collected from surveying admitted patients.

RESULTS

Patients encountered staff wearing face masks and felt this was appropriate in the context of the pandemic. 44% responded that they would prefer staff wearing badges with names, roles and pictures more visible. Following the introduction of badges, patients were better able to recognize staff roles and remember names. Hospital staff felt this was a positive change to help improve rapport while wearing PPE.

CONCLUSION

Wearing PPE affects patients' ability to recognize individuals in a fast-paced environment such as an acute hospital. Introducing badges was an intervention based on patient feedback and an important adaptation to sustained PPE use to improve the patient's experience.

Inheritance patterns, challenges, and outcomes of fracture management in osteopetrosis patients. CASE series and review of pertinent literature

Background

Osteopetrosis (OP) is a group of rare inheritable genetic disorders which show increased bone radiodensity on radiography. As no cure exists, careful symptomatic treatment is the mainstay in management due to brittle bone and frequent complications. We would like to present a case series of OP patients, their management, a review of literature about this rare disease and its genetic and inheritance patterns.

Materials and methods

Retrospective case series of 6 patients with OP seen at our institution from 2010 to January 2018. We searched PubMed and Google Scholar for articles using the following keywords: Osteopetrosis, Radiology, Fracture and Management to review literature.

Cases presentation

We present 6 cases of OP each showing diverse history of frequent fractures and describe the challenges faced during management and the long-term follow-up results.

Results

Abnormal osteoclast activity in OP results in defective bone resorption with patients having varied clinical presentations. Bones are brittle, increasing risk of fractures. Osteosynthesis is the recommended first-choice treatment for osteopetrotic fractures despite the risk of failure. Good preoperative planning is critical. Genetic studies showed multiple genes to be involved and varied patterns of inheritance in different types of OP. Conservative management could including varied therapies has also been proposed.

Conclusion

With all-inclusive preoperative planning and careful postoperative care surgical treatment of fractures in OP is effective. The cases presented showed that plate osteosynthesis and intramedullary nailing are suitable options. Genetic factors and inheritance pattern should be discussed with patients.

Bone graft donor site infection with a rare organism, Aeromonas Hydrophila. A typical location, presentation and organism with 2 years follow-up. Case report

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A. Hydrophila found in immunocompromised patients, burns or aquatic trauma patients.

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Aeromonas produce β-lactamase making it resistant to usual prophylactic antibiotics.

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Early surgical and antibiotic treatment is essential.

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Following a multidisciplinary approach, these patients avoid catastrophic results.

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Combined case report with detailed review of A. Hydrophila from recent literature.

Introduction

Aeromonas are Gram-negative bacilli often causing necrotizing fasciitis or sepsis in immunocompromised patients. Aeromonas Hydrophila is most often found in immunocompromised patients or those with burns or aquatic trauma. When patients present with a discharge and infection on bone graft donor site and progressive sepsis, an Aeromonas hydrophila infection should be considered in the differential diagnosis.

Presentation of case

We report here a rare case of Aeromonas hydrophila with surgical site sepsis/infection in an immunocompromised 69 years old female, with several comorbids. Here we are reporting infection on donor surgical graft site, sparing major surgical site with the implant. After getting culture report of exudates from the wound that grew A. hydrophila, immediate wound debridement and antibiotic beads insertion was performed with appropriate antimicrobial therapy and regular wound dressing. She was followed for around 2 years.

Discussion

This is the first report to our knowledge of A. Hydrophila infection in bone graft donor site. Aeromonas most often cause gastrointestinal and soft tissue infections, and bacteremia in immunocompromised patients. Early surgical intervention is essential to reducing mortality in deep soft tissue infections caused by this organism. Aeromonas have shown resistance to penicillin but are sensitive to other broad-spectrum antibiotics.

Conclusion

Early suspicion, diagnosis, and treatment with potent antibiotics are needed to prevent any further complications resulting from infection by this emerging aggressive pathogen.

Role of multifunctional Chemerin in obesity and preclinical diabetes

BACKGROUND

"Chemerin" is a multifuntional peptide involved in lipid and glucose metabolism. Elevated levels of this peptide have been associated with insulin resistance and systemic inflammation. This study aims to identify whether Chemerin along with other inflammatory markers (TNFα and hsCRP) can discriminate subjects with subclinical diabetes.

METHODOLOGY/FINDINGS

Fifty-two asymptomatic healthy volunteers and 22 chronic diabetics (T2DM) were enrolled in a cross sectional study design. They were subjected to a 75 g oral glucose tolerance test [OGTT (2-h glucose>200 mg/dL)] and were then classified as either newly diagnosed diabetics (NDM) (n=23) or healthy controls (n=29). Our results showed a higher Chemerin level in NDM (p<0.01; MWU) compared to controls and previously diagnosed DM. Using ROC analysis, Chemerin level in NDM and T2DM had AUC of 0.963 and 0.764 respectively, compared to healthy controls. We suggest that the cut off of 13.7 ng/ml of Chemerin can discriminate 73% of NDM subjects with impaired glucose level with 91% and 96% of sensitivity and specificity respectively. Elevated serum Chemerin in NDM group is a surrogate of impairment in glucose metabolism in obese individual.

CONCLUSIONS

Chemerin along with other inflammatory biomarkers suggest an ongoing inflammatory process in a high risk obese group that indicates a pre-diabetic state.

Is redo percutaneous mitral balloon valvuloplasty (PMV) indicated in patients with post-PMV mitral restenosis?

OBJECTIVES

The purpose of this study was to assess the immediate and long-term outcome of repeat percutaneous mitral balloon valvuloplasty (PMV) for post-PMV mitral restenosis.

BACKGROUND

Symptomatic mitral restenosis develop in 7% to 21% of patients after PMV. Currently, most of these patients are referred for mitral valve replacement. However, it is unknown if these patients may benefit from repeat PMV.

METHODS

We report the immediate outcome and long-term clinical follow-up results of 36 patients (mean age 58+/-13 years, 75% women) with symptomatic mitral restenosis after prior PMV, who were treated with a repeat PMV at 34.6+/-28 months after the initial PMV. The mean follow-up period was 30+/-33 months with a maximal follow-up of 10 years.

RESULTS

An immediate procedural success was obtained in 75% patients. The overall survival rate was 74%, 72% and 71% at one, two, and three years respectively. The event-free survival rate was 61%, 54% and 47% at one, two, and three years respectively. In the presence of comorbid diseases (cardiac and noncardiac) the two-year event-free survival was reduced to 29% as compared with 86% in patients without comorbid diseases. Cox regression analysis identified the echocardiographic score (p = 0.03), post-PMV mitral valve area (p = 0.003), post-PMV mitral regurgitation grade (p = 0.02) and post-PMV pulmonary artery pressure (p = 0.0001) as independent predictors of event-free survival after repeat PMV.

CONCLUSIONS

Repeat PMV for post-PMV mitral restenosis results in good immediate and long-term outcome in patients with low echocardiographic scores and absence of comorbid diseases. Although the results are less favorable in patients with suboptimal characteristics, repeat PMV has a palliative role if the patients are not surgical candidates.

Comparison of immediate and long-term results of mitral balloon valvotomy with the double-balloon versus Inoue techniques

There is controversy as to whether the double-balloon or Inoue technique of percutaneous mitral balloon valvotomy (PMBV) provides superior immediate and long-term results. This study compares the immediate procedural and long-term outcomes of patients undergoing PMBV using the double-balloon versus the Inoue techniques. Seven hundred thirty-four consecutive patients who underwent PMBV using the double-balloon (n = 621) or Inoue technique (n = 113) were studied. There were no statistically significant differences in baseline clinical and morphologic characteristics between the double-balloon and Inoue patients. The double-balloon technique resulted in superior immediate outcome, as reflected in a larger post-PMBV mitral valve area (1.9 +/- 0.7 vs 1.7 +/- 0.6 cm2; p = 0.005) and a lower incidence of 3+ mitral regurgitation after PMBV (5.4% vs 10.6%; p = 0.05). This superior immediate outcome of the double-balloon technique was observed only in the group of patients with echocardiographic score < or = 8 (post-PMBV mitral valve areas 2.1 +/- 0.7 vs 1.8 +/- 0.6; p = 0.004). Despite the difference in immediate outcome, there were no significant differences in event-free survival at long-term follow-up between the 2 techniques. Our study demonstrates that compared with the Inoue technique, the double-balloon technique results in a larger mitral valve area and less degree of severe mitral regurgitation after PMBV. Despite the difference in immediate outcome between both techniques, there were no significant differences in event-free survival at long-term follow-up.

Directional coronary atherectomy for the treatment of Palmaz-Schatz in-stent restenosis

Management of in-stent restenosis has become a significant challenge in interventional cardiology. The results of balloon angioplasty have been disappointing due to the high recurrence of restenosis at follow-up. Debulking of the restenotic tissue within the stents using directional coronary atherectomy (DCA) may offer a therapeutic advantage. We report the immediate clinical and angiographic outcomes and long-term clinical follow-up results of 45 patients (46 lesions), mean age 63+/-12 years, 73% men, with a mean reference diameter of 2.9+/-0.6 mm, treated with DCA for symptomatic Palmaz-Schatz in-stent restenosis. DCA was performed successfully in all 46 lesions and resulted in a postprocedural minimal luminal diameter of 2.7+/-0.7 mm and a residual diameter stenosis of 17+/-10%. There were no in-hospital deaths, Q-wave myocardial infarctions, or emergency coronary artery bypass surgeries. Four patients (9%) suffered a non-Q-wave myocardial infarction. Target lesion revascularization was 28.3% at a mean follow-up of 10+/-4.6 months. Kaplan-Meier event-free survival (freedom from death, myocardial infarction, and repeat target lesion revascularization) was 71.2% and 64.7% at 6 and 12 months after DCA, respectively. Thus, DCA is safe and efficacious for the treatment of Palmaz-Schatz in-stent restenosis. It results in a large postprocedural minimal luminal diameter and a low rate of both target lesion revascularization and combined major clinical events at follow-up.