Epidemiological characteristics of COVID-19 cases among Indians residing in Kuwait.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has rapidly spread to most countries around the world. Disproportionate spread of COVID-19 among the Indian community in Kuwait prompted heightened surveillance in this community. AIMS: To study the epidemiological characteristics of COVID-19 patients and their contacts among the Indian community in Kuwait. METHODS: Data collection was done as a part of contact tracing efforts undertaken by the Kuwaiti Ministry of Health. RESULTS: We analysed contact-tracing data for the initial 1348 laboratory-confirmed Indian patients and 6357 contacts (5681 close and 676 casual). The mean (standard deviation) age of the patients was 39.43 (10.5) years and 76.5% of the cases were asymptomatic or had only mild symptoms. Asymptomatic patients were significantly older [40.05 (10.42) years] than patients with severe symptoms [37.54 (10.54) years] (P = 0.024). About 70% of the patients were living in shared accommodation. Most of the close contacts were living in the same household, as compared with casual contacts, who were primarily workplace contacts (P < 0.001). Among the different occupations, healthcare workers had the highest proportion of cases (18.4%). Among the 216 pairs of cases with a clear relationship between the index and secondary cases, the mean serial interval was estimated to be 3.89 (3.69) days, with a median of 3 and interquartile range of 1-5 days. CONCLUSION: An early increase in the number of COVID-19 cases among the Indian community could be primarily attributed to crowded living conditions and the high proportion of healthcare workers in this community.

"Repair and Flap technique": A Retrospective Analysis of Single Stage Reconstruction Method for Treatment of Chronic Open Achilles Tendon Defect with Proximal Turndown Flap and Reverse Sural Flap.

BACKGROUND: Management of complex wounds of the lower extremity with concomitant Achilles tendon injury is a challenging situation for orthopaedic surgeons and plastic surgeons. The objective of the current study was to evaluate the clinical outcome of chronic open defects of the Achilles tendon with composite tissue loss. We have performed single stage reconstruction using the central segment of the proximal part of the Achilles tendon as turn-down flap and was covered immediately with reverse sural flap. MATERIALS AND METHODS: Between March 2017 and February 2020, five cases of chronic open composite Achilles tendon defects which were treated by a single stage reconstruction method of "Repair and Flap technique" were included in this study. The patient with the defect for more than 4 weeks duration and had substance loss of Achilles tendon together with loss of overlying skin and soft tissue was included the current study. RESULTS: All the flaps survived and healed well, providing stable coverage of the wound. The mean operative duration, including flap elevation, definitive flap inset and donor-site coverage was 98 min (range 90-120 min). Focal areas of skin graft loss were seen in two patients which healed with conservative management. The functional results evaluation was performed with The Achilles Tendon Total Rupture Score (ATRS). The mean Achilles Tendon Total Rupture Score (ATRS) was 70 (range 65-76). CONCLUSION: To conclude, use of proximal turned down flap and coverage with reverse sural flap can be opted as a first option for the management of chronic open wounds with composite defects of the Achilles tendon. "Repair and Flap technique" will be a useful method of reconstruction in centres with limited resources for microsurgical flap. However, a multicenter study with more number of patients are required to further analyse this method.

Use of Free Anterolateral Thigh Flap in Reconstruction of Soft Tissue Defects in Orthopedic Oncology: What are the Outcomes?

INTRODUCTION: Soft tissue defects due to trauma with crush injuries and post-tumor excision are large in size. Free anterolateral flap provides a stable and durable coverage of soft tissue defects and leads to good functional outcomes. MATERIALS AND METHODS: Between January 2017 and January 2019, eight males and six female patients with soft tissue defects were operated upon using a free anterolateral thigh flaps. The defects in ten patients were due to post-tumor extirpation and in four patients due to wound breakdown following post-tumor extirpation. RESULTS: The average flap dimension was 14 cm × 12 cm. The mean follow-up was 11 months (4-28 months). All the flaps survived well except in one patient who with an upper limb defect, had flap necrosis owing to which patient needed to undergo abdominal flap coverage. Two patients with sarcoma developed local recurrence and had to undergo above­knee amputation. CONCLUSION: The method of reconstruction depends on the size of defect and area to be covered and need of post-surgery mobilization and need for radiotherapy. The free anterolateral thigh flap has varied uses in orthopedics with very good extent of coverage and provides very potent coverage of neurovascular structures, bones, tendons, and implants.

Coverage of chest wall defect in a case of electric burns by pedicled omental flap.

Electrical burns can be devastating and result in dreaded outcomes. Electrical burn is a common problem in our society and needs special attention because of its various modes of presentations, the numbers of organ systems involved, and the mortality associated in spite of the small percent of burns. The authors present a case of electrical burns with a posterolateral chest wall defect associated with blunt abdominal trauma that was successfully managed by debridement and pedicled omental flap over a synthetic prolene mesh.

Life threatening deep scald burns in a neonate: A rare case report.

Domestic burns in neonate are rare in literature. Neonates are high risk for burns because of their thin and fragile skin, fluid overload or dehydration as the fluid balance range is small and immature immune system leading to septicaemia. Neonates are not small adults, owing to their different physiological response makes the management of neonates challenging as the clinical signs are different from the adults and the resuscitation protocols or end points are also different. We present a case of 11 days old neonate, who sustained 51% scald burns when the hot water bag being used by her mother accidentally burst, the youngest reported case of domestic scald burns with such high percentage. The baby was managed by fluid resuscitation, antibiotics, dressings, ventilatory support for septicaemia and subsequently homograft application. The neonate was discharged with completely healed areas after 35 days of burns and is on regular follow up and no complications have been observed.

Outcomes of 1,090 consecutive, elective, nonselected percutaneous coronary interventions at a community hospital without onsite cardiac surgery.

We evaluated the efficacy and safety of elective percutaneous coronary intervention (PCI) at a hospital without onsite cardiac surgery. A growing number of hospitals without onsite cardiac surgery perform elective PCI. Few hospitals have reported outcomes, despite controversy surrounding this practice. From August 2003 to December 2005, 1,090 elective PCI were performed at Saint Luke's South Hospital (SLS), a hospital without onsite cardiac surgery, for which the referral center is the Mid America Heart Institute (MAHI). The elective PCI program used experienced interventionalists, technicians, and nurses; a tested helicopter transport protocol; a well-equipped catheterization laboratory; and a quality assurance process. Baseline characteristics, procedural success, and adverse clinical outcomes were compared. Observed frequencies of in-hospital death, a combined end point of Q-wave myocardial infarction (MI)/emergency coronary artery bypass grafting (CABG) surgery, and vascular complications were compared with prediction models. SLS, with lower risk characteristics than MAHI, had unadjusted frequencies of procedural success (93% vs 94%, p = NS), Q-wave MI (0.3% vs 0.3%, p = NS), emergency CABG surgery (0.2% vs 0.03%, p = 0.09), vascular complications (0.6% vs 0.6%, p = NS), and in-hospital death (0.1% vs 0.8%, p = 0.002) that compared favorably with MAHI. Two patients transferred from SLS to MAHI for emergency CABG surgery without adverse effects. Fewer in-hospital deaths and vascular complications were observed at SLS than predicted by models. In conclusion, favorable clinical outcomes were achieved for elective PCI at a hospital without onsite cardiac surgery that used strict program requirements.

Varied low density lipoprotein binding property of proteoglycans synthesized by vascular smooth muscle cells cultured on extracellular matrix.

Earlier we showed that the extracellular matrix (ECM) secreted by vascular cells modulated proteoglycan synthesis by vascular smooth muscle cells in culture and altered the proteoglycan characteristics. In this study, we tested the hypothesis that these ECM-mediated alterations increased the affinity of the proteoglycans for plasma low density lipoprotein (LDL). Newly synthesized proteoglycans were isolated from smooth muscle cells cultured on the ECMs secreted by vascular endothelial cells, smooth muscle cells, or THP-1 macrophages and their binding affinity for LDL determined. Proteoglycans from all cultures contained sub-fractions that bound LDL with low and high affinity. However, compared with the cells plated on the endothelial cell ECM, the cells plated on the smooth muscle cell ECM and macrophage ECM synthesized significantly more high affinity proteoglycans. Removal of collagen, elastin, and chondroitin sulfates from the smooth muscle cell ECM and chondroitin sulfates from the macrophage ECM increased the production of high affinity proteoglycans by 15-22%. However, neutralization of fibronectin from both ECMs decreased the high affinity proteoglycans by 20%. Removal of matrix-bound growth factors had no effect on the synthesis of high affinity proteoglycans. Compared with the low affinity proteoglycans, the high affinity proteoglycans were larger, more sulfated and contained higher proportions of chondritin sulfate, dermatan sulfate, and N-sulfated heparan sulfate chains. These results suggest that the ECM-mediated alterations in vascular smooth muscle cell proteoglycans may lead to increased deposition of LDL in the arterial wall.