Double Plating Fixation vs Distal Femoral Replacement in the Management of Distal Femoral Fractures in Geriatric Patients.

Background: Distal femur fractures are considered challenging to manage, particularly in geriatric patients. Double plating (DP) is a technique that helps with earlier rehabilitation and return to preinjury level of activity. Distal femoral replacement (DFR) is an alternative technique in the management of these fractures that may help to solve problems like associated knee osteoarthritis, osteoporosis, and severely comminuted condyles. The current study compares the functional and radiological outcomes of DFR and DP in the management of these fractures among geriatric patients. Methods: This randomized, comparative, interventional study was performed at a university hospital. A total of 30 patients who underwent DFR or DP after distal femur fractures (AO/OTA 33 A3, 33 C) were analyzed. The primary outcome was Knee Society Score (KSS), whereas secondary outcomes included postoperative complications rate, knee range of motion, reoperation rate, and operative time. Results: No significant difference was observed between DFR and DP except for the knee component of the KSS at a 12-month interval (P = .03) and knee range of motion at a 12-month interval (P = .001), both of which were in favor of DP. No significant difference in postoperative complications (P = .06), reoperation rate (P = 1.00), or operative time (P = .06) was noted. Conclusions: DFR and DP had comparable functional (KSS) and radiological outcomes with no significant difference in postoperative complications, reoperation rate, or operative time.

Adverse health events experienced by the recipients of COVID-19 vaccines and the associated factors in southwestern Saudi Arabia

Aims@#Studying the post-vaccination adverse health events is crucial to determine the confidence and acceptance of the public to the newly-developed COVID-19 vaccines. The present study aimed to investigate the prevalence rates of the adverse health events experienced by the recipients of COVID-19 vaccines in Saudi Arabia.@*Methodology and results@#A cross-sectional study was conducted in October 2021 using a google form of an online self-administered questionnaire sent via different social media platforms for recruiting participants from southwestern Saudi Arabia. The questionnaire was prepared by medical and public health professionals and then translated into Arabic, pilot-studied and validated. Among the 453 Saudi adults who participated in the study with at least one dose of the COVID-19 vaccine, about (77.9%) were males aged 25.5 ± 10.6 years. Most of the participants were college students living in the Makkah region. Nearly 68.3% reported post-vaccination adverse events, such as injection site pain/swelling (91.9%), fatigue (67.9%), bone and muscle pain (65.2%) and flu-like symptoms (58%). The type of vaccine was significantly associated with the development of adverse events p=0.002 (OR of Pfizer-BioNTech versus AstraZeneca: 0.33, 95% CI: 0.18-0.61). Additionally, ageing of more than the 3rd decade, male gender and being married were significantly associated with lower rates of reporting post-vaccination adverse events. @*Conclusion, significance and impact of study@#The development of COVID-19 vaccine-related adverse health events had no significant associations with residence, education, occupation, BMI, chronic diseases or smoking. However, age, gender, marital state and vaccine type may be considered significant predictors for developing post-vaccination adverse reactions.

Mechanical Thrombectomy for Acute Ischemic Stroke in Metastatic Cancer Patients: A Nationwide Cross-Sectional Analysis / 대한뇌졸중학회지

Background@#and Purpose Mechanical thrombectomy (MT) is the standard treatment for large vessel occlusion (LVO) acute ischemic stroke. Patients with active malignancy have an increased risk of stroke but were excluded from MT trials. @*Methods@#We searched the National Readmission Database for LVO patients treated with MT between 2016–2018 and compared the characteristics and outcomes of cancer-free patients to those with metastatic cancer (MC). Primary outcomes were all-cause in-hospital mortality and favorable outcome, defined as a routine discharge to home (regardless of whether home services were provided or not). Multivariate regression was used to adjust for confounders. @*Results@#Of 40,537 LVO patients treated with MT, 933 (2.3%) had MC diagnosis. Compared to cancer-free patients, MC patients were similar in age and stroke severity but had greater overall disease severity. Hospital complications that occurred more frequently in MC included pneumonia, sepsis, acute coronary syndrome, deep vein thrombosis, and pulmonary embolism (P<0.001). Patients with MC had similar rates of intracerebral hemorrhage (20% vs. 21%) but were less likely to receive tissue plasminogen activator (13% vs. 23%, P<0.001). In unadjusted analysis, MC patients as compared to cancer-free patients had a higher in-hospital mortality rate and were less likely to be discharged to home (36% vs. 42%, P=0.014). On multivariate regression adjusting for confounders, mortality was the only outcome that was significantly higher in the MC group than in the cancerfree group (P<0.001). @*Conclusion@#LVO patients with MC have higher mortality and more infectious and thrombotic complications than cancer-free patients. MT nonetheless can result in survival with good outcome in slightly over one-third of patients.

Impact of COVID-19 on ECT Practice in Qatar.

There is paucity of Electroconvulsive therapy (ECT) utilization surveys from the Arabian Gulf region and none available from Qatar. There is no literature available on impact of Coronavirus Disease 2019 (COVID-19) pandemic on ECT provision. ECT is a lifesaving treatment in psychiatric practice requiring anesthetic support and there were concerns that redeployment of anesthetists due to COVID-19 pandemic might have comparatively bigger impact on the provision of ECT. These concerns stem from the fact that psychiatric patients often get discriminated against in health care systems; largely due to stigma and the belief among healthcare providers that psychiatric illness is somehow not as serious as other types of medical or surgical illness. In this brief report we present pre-COVID ECT utilization from Qatar. We also report findings on ECT utilization during COVID-19 and compare changes with other elective and non-elective surgeries. ECT provision was down by 40% during March to August 2020 in our setting. The decline in ECT provision was comparable to other elective and non-elective surgeries.

Out-of-hospital Cardiac Arrest Before and During the COVID-19 Pandemic in the South Bronx

BackgroundOut-of-hospital cardiac arrest (OHCA) is a major health challenge; the impact of the COVID-19 pandemic on OHCA in the South Bronx is unknown. The aim of this study was to determine differences between return of spontaneous circulation(ROSC), witnessed arrest, bystander CPR and survival to discharge, prior to and during the COVID-19 pandemic to improve ROSC and survival. MethodsSingle-center retrospective study of non-traumatic OHCA adult patients admitted to Lincoln Medical Center between 8/2019 to 6/2021, 3/2020 being the first established date of the COVID-19 pandemic in New York City. International Classification of Diseases (ICD) coding was used to identify cardiac arrests and collect information. Statistical analysis was performed using IBM-SPSS. ResultsROSC time pre COVID-19 was 26 minutes, during the COVID-19 pandemic it was 25 minutes 54 seconds. A significant difference in witnessed arrests in the pre COVID-19 period compared to the COVID-19 period (86% vs 55% p = 0.03). Bystander CPR occurred 36% of the time in the pre COVID-19 period contrasting to 19% during. Prior to the COVID-19 pandemic the overall survival to discharge in OHCA ROSC cases was 28.5% comparing to 29% during the pandemic. ROSC was 18 minutes among survivors during the pandemic, compared to 21 minutes in survivors prior to COVID (p = 0.2). ConclusionThere was a non-significant difference in ROSC, bystander CPR and survival to discharge in non-traumatic OHCA prior to and during the COVID-19 pandemic in the South Bronx. There was a significant difference in witnessed vs unwitnessed OHCA prior to and during the COVID-19 pandemic.

Anti-N-methyl-D-aspartate receptor encephalitis in a young female with subclinical hypothyroidism associated with anti-thyroid peroxidase and anti-thyroglobulin antibodies: A case report.

Anti-N-methyl-D-aspartate receptor encephalitis is a life-threatening medical emergency that can be clinically misperceived as Hashimoto's encephalopathy. We present a case of anti-N-methyl-D-aspartate receptor encephalitis in an otherwise healthy young female with subclinical hypothyroidism without an associated ovarian teratoma. She was first misdiagnosed as Hashimoto's encephalopathy due to delirium and behavioral changes, seizures, psychosis, and increased amount of thyroid peroxidase and thyroglobulin antibodies in serum. Final diagnosis was established by third week following presentation with the detection of anti-N-methyl-D-aspartate receptor antibodies in her cerebrospinal fluid. After treatment with intravenous immunoglobulin, methylprednisolone, and amisulpride, she recovered significantly with minimal sequelae at 3-week follow-up.

Flexural strength of small connector designs of zirconia-based partial fixed dental prostheses.

STATEMENT OF PROBLEM: Partial fixed dental prostheses with a small connector size are required for optimal esthetics and limited interarch space; however, final strength is endangered. PURPOSE: The purpose of this in vitro study was to evaluate the effect of different connector designs on the flexural strength of simulated 3-unit partial fixed dental prostheses made of yttria-stabilized tetragonal zirconia polycrystalline using computer-aided design and computer-aided manufacturing technology. MATERIAL AND METHODS: To simulate a 3-unit partial fixed dental prosthesis, 20 rectangular bar-shaped specimens were fabricated with dimensions of 4 ± 0.05 mm (H) × 4 ± 0.05 mm (W) × 30 0.5 mm (L). Each bar specimen had 2 constricted parts on both sides, representing the connector and defining a central pontic of 10 ± 0.10 mm in length. The specimens were divided into 4 groups according to the connector diameter and design, as follows: SR: 2 mm (H) × 3 mm (W) round 0.6 mm radius of curvature; SS: 2 mm (H) × 3 mm (W) sharp 0.1 mm radius of curvature; CR: 3 mm (H) × 3 mm (W) round 0.6 mm radius of curvature; and CS: 3 mm (H) × 3 mm (W) sharp 0.1 mm radius of curvature. An additional 5 specimens were fabricated with no constriction and served as the control group. The specimens were subjected to a 3-point flexural strength test in a universal testing machine with a crosshead speed of 0.5 mm/min until failure. Scanning electron microscopic and photomicrograph images were used to examine the fracture surfaces. Two-way ANOVA and the Tukey-Kramer post hoc test were used to analyze the data (α = .05). RESULTS: The mean flexural strength for SR 2 mm (H) × 3 mm (W) round 0.6 mm radius of curvature (583.6 ± 49.7 MPa) was significantly higher than that of SS, which was 2 mm (H)× 3 mm (W) sharp 0.1 mm radius of curvature (502.8 ± 23.3 MPa). Similarly, the mean flexural strength for CR was 3 mm (H) × 3 mm (W) round 0.6 mm radius of curvature (682.9 ± 36.8), which was significantly higher than that of CC, 3 mm (H) × 3 mm (W) sharp 0.1 mm radius of curvature (486.7 ± 35.6 MPa). CONCLUSIONS: The flexural strength of the yttria-stabilized tetragonal zirconia polycrystalline-based ceramics was affected by the connector dimension and design. The 2-round connector design was more able to withstand occlusal forces than the sharp design. The 3-connector design with a minimum cross section of 2 × 3 mm is recommended for anterior fixed dental prostheses, provided it has a round curvature.

Accuracy of ceramic restorations made with two CAD/CAM systems.

STATEMENT OF PROBLEM: Different types of CAD/CAM systems are currently available, but information regarding which system produces the best marginal fit is lacking. PURPOSE: The purpose of this study was to evaluate the effect of 2 different CAD/CAM systems (Cerec inLab, Kavo Everest) on the marginal fit of 2 types of zirconia-based and lithium disilicate crowns. MATERIAL AND METHODS: Forty zirconia-based and lithium disilicate crowns, 20 each, were fabricated with the Cerec inLab and Everest CAD/CAM systems on a specially designed stainless steel die to ensure the standardization of specimen shape and dimensions. The vertical marginal fit for all tested crowns was evaluated by using a digital microscope at ×100 magnification, and the data were tabulated and statistically analyzed with 2-way ANOVA, followed by the Tukey honestly significant difference (HSD) test with a confidence level of .05 to determine the mean differences. RESULTS: The results showed that the CAD/CAM technique, ceramic type, and their interaction had a statistically significant effect on the mean marginal fit of both ceramic types tested. CONCLUSIONS: Better marginal fit values were exhibited by the Everest CAD/CAM technique for both ceramic types tested.