Low Mortality of Orthopedic Trauma Patients With Asymptomatic COVID-19: A Level I Trauma Center Pandemic Experience.

Background: Early (2020) reports on mortality in patients with coronavirus disease 2019 (COVID-19) who underwent orthopedic surgery ranged from 20.5% to 56%, but these studies included elderly patients with multiple comorbidities. The mortality rate for younger and asymptomatic COVID-19-positive patients undergoing orthopedic surgery after high-energy trauma is underreported. The purpose of this study was to compare the 30-day mortality of asymptomatic COVID-19-positive patients and COVID-19-negative patients surgically treated for orthopedic trauma at a Level I trauma center during the coronavirus pandemic. A secondary objective was to compare the patients' postoperative hospital course and length of stay. Methods: This study is a single-center retrospective review of all patients who underwent an orthopedic surgical procedure at a Level I trauma center during a 3-month period early in the COVID-19 pandemic. All patients received a preoperative nasopharyngeal swab to determine COVID-19 infection status. Preoperative demographic variables, perioperative and postoperative mortality within 30 days, length of stay, and intensive care unit days were compared between COVID-19-positive and COVID-19-negative patients. Results: Of the 471 total patients, 13 were COVID-19-positive and 458 were COVID-19-negative prior to surgery. The average age of all patients was 40.5 ± 19.8 years. The mortality rate in the COVID-19-positive group was 0% vs 0.7% in the COVID-19-negative group, with no significant difference between groups (P=0.77). The COVID-19-positive group vs the COVID-19-negative group had no significant difference in hospital length of stay (7.4 days vs 4.4 days, respectively, P=0.12). Conclusion: Asymptomatic COVID-19-positive orthopedic trauma patients treated with surgery at a Level I trauma center in a 3-month period during the COVID-19 pandemic had a 0% mortality rate, and we found no differences between COVID-19-positive and COVID-19-negative patients with respect to mortality and hospital length of stay.

A New Antiviral Regimen Against SARS-CoV-2 Based on Nanoviricide’s Biopolymer (NV-CoV-2)

NV-CoV-2, a nanoviricide composed of covalently attached polyethylene glycol and alkyl pendants that are designed to bind free virion particles of multiple strains of coronaviruses in a broad-spectrum manner at multiple points. The binding interaction is like a nano-velcro-tape and may cause a lipid–lipid fusion between nanoviricide micelle and the lipid envelope of the virus. A nanoviricide can encapsulate the virus and dismantle it without any involvement of the host immune system, ultimately disabling the infectibility of the host cells. Thus, it may be expected to count a stronger and synergistic antiviral effect by combining NV-CoV-2 with other anti-coronavirus regimens like remdesivir. Furthermore, some ligands similar to the SARS-CoV S-protein are designed by molecular modeling and attached to the nanoviricide at the same site as where the cognate cellular receptor, ACE2, binds. As a result, a competitive binding inhibition may occur. A nanoviricide can encapsulate other antiviral compounds and protect them from serum-mediated degradation in vivo. This makes the antiviral compounds available for a longer period of time to interact with RNA polymerase and inhibit it. Altogether, a multipoint antiviral efficacy can be achieved with our nanoviricide, NV-CoV-2. Copyright © 2022 Chakraborty, Diwan, Barton, Arora, Thakur, Chiniga, Tatake, Pandey, Holkar, Holkar and Pond.

Multisystem inflammatory syndrome in children presenting as acute acalculous cholecystitis

Case Report Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare, hyperinflammatory complication of SARSCoV-2 infection. The diagnostic criteria established by the CDC require fever, laboratory evidence of inflammation, clinically severe illness requiring hospitalization with multisystem organ involvement, and evidence of current or recent SARSCoV-2 infection. Case Description A previously healthy eight-year-old male without clinical history of SARS-CoV-2 infection presented to the pediatric emergency department with a three-day history of fever and abdominal pain and was found to have acute acalculous cholecystitis. He quickly developed hyperinflammatory shock and had positive SARS-CoV-2 serology. Following treatment with intravenous immunoglobulin (IVIG) and high dose corticosteroids, his fever and shock quickly resolved. Acalculous cholecystitis resolved within two weeks of IVIG. Discussion Presentations of MIS-C vary significantly and some documented cases more closely resemble severe COVID-19 or Kawasaki Disease vasculitis. This case is clinically and phenotypically distinct and represents the newly recognized hyperinflammatory physiology unique to MIS-C. It is important for pediatric clinicians who encounter any inflammatory disease process, including acalculous cholecystitis, to include MIS-C in the differential diagnosis.

Adapting Orthopaedic Surgery Training Programs During the COVID-19 Pandemic and Future Directions.

The COVID-19 pandemic swept across the world, altering the structure and existence of graduate medical education programs across all disciplines. Orthopaedic residency programs can adapt during these unprecedented times to continue providing meaningful education to trainees and to continue providing high-quality patient care, all while keeping both residents and patients safe from disease. The purpose of this review was to evaluate the literature and describe evidence-based changes that can be made in an orthopaedic residency program to ensure patient and resident safety while sustaining the principles of graduate medical education during the COVID-19 pandemic. We describe measures that can be enacted now or during future pandemics, including workforce and occupational modifications, personal protective equipment, telemedicine, online didactic education, resident wellness, return to elective surgery, and factors affecting medical students and fellows. After a review of these strategies, programs can make changes for sustainable improvements and adapt to be ready for second-wave events or future pandemics. LEVEL OF EVIDENCE: Level V.

Orthopaedic Surgical Selection and Inpatient Paradigms During the Coronavirus (COVID-19) Pandemic.

The novel coronavirus pandemic, also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has placed an immense strain on healthcare systems across the entire world. Consequently, multiple federal and state governments have placed restrictions on hospitals such as limiting "elective surgery" and recommending social or physical distancing. We review the literature on several areas that have been affected including surgical selection, inpatient care, and physician well-being. These areas affecting inpatient paradigms include surgical priority, physical or social distancing, file sharing for online clinical communications, and physician wellness. During this crisis, it is important that orthopaedic departments place an emphasis on personnel safety and slowing the spread of the virus so that the department can still maintain vital functions. Physical distancing and emerging technologies such as inpatient telemedicine and online file sharing applications can enable orthopaedic programs to still function while attempting to protect medical staff and patients from the novel coronavirus spread. This literature review sought to provide evidence-based guidance to orthopaedic departments during an unprecedented time. Orthopaedic surgeons should follow the Centers for Disease Control and Prevention guidelines, wear personal protective equipment (PPE) when appropriate, have teams created using physical distancing, understand the department's policy on elective surgery, and engage in routines which enhance physician wellness.