Cranial neuropathy in COVID-19: a case series and review of literature.

Neurological presentation of COVID-19 is increasingly being recognised. Cranial neuropathy in COVID-19 is an uncommon and under-diagnosed entity. We report a case series of 4 patients who presented with trigeminal neuropathy (two cases) and facial nerve palsy (two cases) which recovered with conservative treatment along with the review of the literature.

Virtual risk assessment pathway for deep venous thrombosis: a preliminary model.

BACKGROUND: COVID-19 has necessitated the reduction in conventional face-to-face patient consultation to reduce the risk of novel coronavirus SARS-CoV-2 transmission. Traditional pathways to risk assess for deep venous thrombosis (DVT) would involve face-to-face assessment to formulate an appropriate management plan following an initial presentation usually in secondary care or in-hospital settings. Appropriate antithrombotic measures can prevent complication of DVT such as pulmonary embolism with prompt early diagnosis and treatment. METHODS: This observational, pilot study evaluates the possibility of combining telemedicine technology and a virtual examination pathway for remote triage and assessment of patients with suspected DVT. RESULTS: Piloting and development of a virtual risk assessment pathway for DVT involves various challenges and multidisciplinary co-ordination. CONCLUSION: Advances in telecommunication technology can enable clinicians, specialist nurses and hospital departments to develop a virtual examination pathway for remote triage and assessment of patients with suspected DVT. This pathway is not a replacement for conventional 'face-to-face' evaluation, but we believe the template can be explored and refined to act as a blueprint for future applications even when the pandemic has stabilised.

Bibliometric analysis of COVID-19 related publications in Indian orthopaedic journals.

BACKGROUND: The COVID-19 pandemic has resulted in an infodemic about the novel coronavirus SARS-CoV-2 outbreak to build knowledge and develop mitigation strategies. In addition, scientific journals across the world have studied the impact of COVID-19 on trauma and orthopaedics. METHODS: A cross-sectional, bibliometric analysis of the literature was undertaken on COVID-19 related articles from three Pubmed and Scopus indexed orthopaedic journals from India, namely, Indian Journal of Orthopaedics(IJO),Journal of Clinical Orthopaedics and Trauma(JCOT), and Journal of Orthopaedics (JOO), in May 2021. All the article types and study designs were included for this review. The authors, institutions, countries, keywords, and co-authorship mapping were studied. RESULTS: A total of 112 COVID-19 related documents were retrieved. Period of these publications was from 2nd April 2020 to 31st May 2021. Vaishya R. (n = 16) was the most cited author, and Indraprastha Apollo Hospitals (n = 16) was the most cited research Institution. India led the list of countries in academic publication output. On keyword mapping, telemedicine was the most prominent Medical Subject Headings (MeSH) search word. CONCLUSION: The Indian orthopedic journals have addressed the impact of COVID-19 on orthopaedic practice in India and aborad whilst continuing to publish knowledge about basic science and clinical orthopaedic research studies. The JCOT has outperformed and become the most leading orthopaedic journal from India during the pandemic. COVID -19 articles have been fast tracked, open accessed and attracted more citations in reduced duration of time compared to non-COVID-19 papers.

Characteristics and clinical outcomes of hip fracture patients during the first lockdown of COVID-19, lessons learnt: A retrospective cohort analysis.

BACKGROUND: The management of hip fracture patients has been challenging across the UK in the wake of emergency coronavirus disease 2019 guidelines. AIMS: This retrospective, observational cohort study analyses the impact of the first lockdown during the early part of the coronavirus disease 2019 pandemic on the management of hip fracture patients at a district general hospital in the UK. METHODS: Comparative analysis to assess hip fracture patients treated at this Trust between 1 April to 31 May 2019 and 1 April to 31 May 2020 was undertaken. The primary outcome measures appraised were 30 and 60-day mortality and the secondary outcome measure included time to surgery. RESULTS: There was a higher 30 and 60-day mortality rate in the first lockdown period at 8.1% and 13.5%, respectively, compared to 1.96% and 5.88% in 2019. A significantly lower proportion of hip fracture patients at 59.46% were operated within the 36h target time frame during the first lockdown. CONCLUSION: In our Trust, hip fractures were treated as obligatory injuries. However, the mortality was higher in the 2020 cohort with a significant reduction in patients achieving the recommended '36 hours' time to surgery target and accruement of Best Practice Tariff. Enhanced infection control strategies have prepared us for the future.

Multisystem inflammatory syndrome in an adult following the SARS-CoV-2 vaccine (MIS-V).

SARS-CoV-2 vaccine roll-out has been successful in the UK and other parts of the world; however, there are increasing concerns about adverse events. A 44-year-old woman presented to a UK hospital with left upper arm pain at the vaccine site a couple of days after receiving the Pfizer-BioNTech mRNA vaccine, which progressed to fever, diarrhoea and abdominal pain over the next few days. She had an erythematous rash on the chest with subcutaneous oedema. Her C reactive protein was 539 mg/L, white cell count of 17×109/L (1.8-7.5), troponin-T of 1013 ng/L and creatine kinase of 572 u/L. She developed an unprovoked pulmonary embolism with acute kidney injury. After administration of intravenous methylprednisolone, the muscle oedema, skin rashes and acute kidney injury resolved. Although multisystem inflammatory syndrome (MIS) is described in children (MIS-C) and adults (MIS-A) following SARS-CoV-2 infection, we highlight the first reported MIS-V case after the SARS-CoV-2 vaccine.

Is performing joint arthroplasty surgery during the COVID-19 pandemic safe?: A retrospective, cohort analysis from a tertiary centre in NCR, Delhi, India.

PURPOSE: Resuming joint replacement arthroplasty amidst the COVID-19 pandemic and lockdown has come with various challenges that had to be dealt with utmost caution. Patients with severe arthritis experiencing a state of intolerable pain, could not be left unaddressed. Guidelines published by surgical associations, collaborative surgical author groups including public health organisations had to be modified to suit the Indian scenario and obtain optimal functional outcomes in these patients. METHODS: A retrospective cohort analysis of 147 patients who underwent arthroplasty during the pandemic (March 2020 to April 2021), for either primary or secondary arthritis, was performed. We assess the efficacy and safety of the newly established Institutional surgical peri-operative protocol at our tertiary care centre in the National Capital Region, India in response to COVID-19 guidelines. The primary outcome measures appraised was 30-day mortality and the secondary outcome measures included length of stay, peri-operative complications and COVID-19 infection. RESULT: The most common indication for arthroplasty during the pandemic was neglected trauma. One patient died, due to myocardial infarction during the follow-up period. About 67% of patients were discharged to their usual residence within 7 days of admission. Two patients tested positive for COVID-19 postoperatively, but none required Intensive Care Unit admission. CONCLUSION: Joint replacement arthroplasty can be undertaken safely with diligent patient selection, application of a stringent COVID appropriate behaviour and a 'ring-fenced' peri-operative pathway.

Elucidating causes of COVID-19 infection and related deaths after vaccination.

BACKGROUND AND AIMS: Symptomatic or asymptomatic COVID-19 infection has been reported in vaccination. In the current article, we try to elucidate various causes behind COVID-19 infection and mortality following COVID-19 vaccination and suggest possible strategies to counteract this threat. METHODS: We carried out a comprehensive review of the literature using suitable keywords such as 'COVID-19', 'Pandemics', 'Vaccines', 'Mortality', 'deaths', 'infections', and 'India' on the search engines of PubMed, SCOPUS, Google Scholar, and ResearchGate in from January to May 2021. Epidemiology, risk factors, Adverse Events Following Immunization (AEFI) and mortality after COVID-19 vaccination were assessed. RESULTS: A number of factors have been associated with symptomatic or asymptomatic COVID-19 infection reported after vaccination. A high viral load, comorbidities, mutant strains, Variants of Concern (VOC) leading to Vaccine escape and casual attitude towards COVID Appropriate Behaviors appear to be the most important factors for infection and deaths after COVID-19 vaccination. CONCLUSIONS: COVID-19 Infection and mortality after COVID-19 vaccination are of great concern. Application of COVID Appropriate Behaviour (CAB) before and after vaccination is essential for the population. Effective Vaccines against mutant strains and enhanced vaccination drive are key strategies to avoid this quintessential threat. Early medical intervention in high-risk groups can prevent overall mortality.

COVID-19 Pandemic and Debates on the Design of Operating Theatre Ventilation Systems in Healthcare Facilities

COVID-19 pandemic had a significant impact on providing Trauma and Orthopedic surgery around the world. The orthopedic community had to reconfigure emergency and urgent trauma services safely but also support strategies to prevent person-to-person coronavirus transmission. Various organizations including British Orthopedic Association (BOA), American Academy of Orthopedic Surgeons (AAOS) and Public Health England (PHE) have provided guidelines for conducting safe essential surgery in operating theatres. One of the areas that have not been debated enough is the type of ventilation systems that should be used in operating theatres during this global pandemic. We review the current evidence in the literature particularly in the challenges faced by health care professionals in current COVID-19 pandemic in deciding and implementing an effective operating theatre ventilation system protecting both our patients and operating room personnel.

Bioengineering Technology in Context of COVID-19 Pandemic: Potential Roles and Applications

Bioengineering (BE) technology has significant influence on the healthcare environment. This has grown steadily particularly since the medical practice has become more technology based. We have tried to assess the impact of bioengineering in tackling the COVID-19 pandemic. The use of bioengineering principles in healthcare has been evaluated. The practical implications of these technologies in fighting the current global health pandemic have been presented. There has been a shared drive worldwide to harness the advancements of bioengineering to combat COVID-19. These efforts have ranged from small groups of volunteers to large scale research and mass production. Together the engineering and medical fields have worked to address areas of critical need including the production and delivery of personal protective equipment, ventilators as well as the creation of a viable vaccine. The fight against COVID-19 has helped highlight the work and contributions of so many professionals in the bioengineering fields who are working tirelessly to help our health services cope. Their innovation and ingenuity are paving the way to successfully beat this virus. We must continue to support these fields as we evolve our health systems to deal with the challenges of healthcare in the future.

Significant Role of Modern Technologies for COVID-19 Pandemic

Modern technologies are now available to provide appropriate information and improved services in healthcare delivery. During the COVID-19 pandemic, these technologies have played a vital role in providing advanced and digital solutions. The main objective of this paper is to explore various modern technologies. This study further describes the significant applications of these technologies for the COVID-19 pandemic. In this paper, we have identified research papers on modern technologies applications for COVID-19 from the databases of Scopus, Google Scholar, Science direct, and Research Gate. In this paper, we have provided the significant challenges faced during the ongoing COVID-19 pandemic and the role of various modern technologies that can be used to take the challenges of the COVID-19 pandemic. The substantial benefits and limitations of these technologies are briefly discussed. Finally, the paper would provide essential details of these technologies and their significant role during the COVID-19 pandemic. These technological innovations are increasing rapidly to save human beings’ lives by providing innovative solutions that can convert doctors’ and researchers’ ideas into reality. Various software and digital applications are now available to manage these technologies to provide better healthcare services digitally.