COVID-19 among patients with orthopedic surgery: our experience from the Middle East.

BACKGROUND: We report our experiences with COVID-19 in one of the largest referral orthopedic centers in the Middle East and aimed to describe the epidemiology and clinical characteristics of these patients. METHODS: During February 20 and April 20, 2020, patients who underwent orthopedic surgery and healthcare staff who were in contact with these patients were screened for COVID-19. To identify patients who were in the incubation period of COVID-19 during their hospital stay, all patients were tested again for COVID-19 4 weeks after discharge. RESULTS: Overall, 1244 patients underwent orthopedic surgery (1123 emergency and 121 elective) during the study period. Overall, 17 patients were diagnosed with COVID-19 during hospital admission and seven after discharge. Among the total 24 patients with COVID-19, 15 were (62.5%) males with a mean (SD) age of 47.0±1.6 years old. Emergency surgeries were performed in 20 (83.3%) patients, and elective surgery was done in the remaining 4 patients which included one case of posterior spinal fusion, spondylolisthesis, acromioclavicular joint dislocation, and one case of leg necrosis. A considerable number of infections occurred in patients with intertrochanteric fractures (n=7, 29.2%), followed by pelvic fractures (n=2, 8.3%), humerus fractures (n=2, 8.3%), and tibial plateau fractures (n=2, 8.3%). Fever (n=11, 45.8%) and cough (n=10, 37.5%) were the most common symptoms among patients. Laboratory examinations showed leukopenia in 2 patients (8.3%) and lymphopenia in 4 (16.7%) patients. One patient with a history of cancer died 2 weeks after discharge due to myocardial infarction. Among hospital staff, 26 individuals contracted COVID-19 during the study period, which included 13 (50%) males. Physicians were the most commonly infected group (n = 11), followed by operation room technicians (n = 5), nurses (n = 4), and paramedics (n = 4). CONCLUSIONS: Patients who undergo surgical treatment for orthopedic problems, particularly lower limb fractures with limited ambulation, are at a higher risk of acquiring COVID-19 infections, although they may not be at higher risks for death compared to the general population. Orthopedic surgeons in particular and other hospital staff who are in close contact with these patients must be adequately trained and given appropriate personal protective equipment during the COVID-19 outbreak.

Long-term outcome of posterior spinal fusion for the correction of adolescent idiopathic scoliosis.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is the most common form of idiopathic scoliosis, and surgery is considered as one of the therapeutic options. However, it is associated with a variety of irreversible complications, in spite of the benefits it provides. Here, we evaluated the long-term outcome of posterior spinal fusion (PSF) of AIS to shed more light on the consequences of this surgery. METHODS: In a cross-sectional study, a total of 42 AIS patients who underwent PSF surgery were radiographically and clinically inspected for the potential post-operative complications. Radiographic assessments included the device failure, union status, and vertebral tilt below the site of fusion. Clinical outcomes were evaluated using the Oswestry disability index (ODI) and visual analogue scale (VAS). RESULTS: The mean age of the surgery was 14.4 ± 5.1 years. The mean follow-up of the patients was 5.6 ± 3.2 years. Complete union was observed in all patients, and no device failure was noticed. Pre- and post-operative vertebral tilt below the site of fusion were 11.12° ± 7.92° and 6.21° ± 5.73°, respectively (p < 0.001). The mean post-operative ODI was 16.7 ± 9.8. The mean post-operative VAS was 2.1 ± 0.7. ODI value was positively correlated with follow-up periods (p = 0.04, r = 0.471). New degenerative disc disease (DDD) was observed in 6 out of 37 (16%) patients. CONCLUSION: In spite of the efficacy and safety of PSF surgery of AIS, it might result in irreversible complications such as DDD. Moreover, the amount of post-operative disability might increase over the time and should be discussed with the patients.

"Adolescent metabolic phenotypes and early adult metabolic syndrome: Tehran lipid and glucose study".

OBJECTIVE: To investigate the predictive role of adolescent metabolic phenotypes in development of early adult metabolic syndrome (MetS). STUDY DESIGN: A group of 1446 adolescents (44.8% boys), participants of the Tehran Lipid and Glucose Study, with a mean (SD) of age 14.6 (2.2) years, followed for 10.4 years. Logistic regression models were developed to evaluate the predictive power of different metabolic phenotypes for adult MetS. Moreover, areas under the receiver operating characteristic (ROC) curve were estimated to compare the prediction power of metabolic phenotypes for adult MetS. RESULTS: The prevalence of MetS was 14.6% (29.7% and 2.4% for adult males and females, respectively) at the end of follow up. The most frequent metabolic phenotype in adolescent was high TGs/low HDL-C (23.7%), while the prevalence of high TGs/high WC was 10.4% and the other phenotypes were less than 10%. After adjustment for baseline BMI Z-Score and BMI change, high TGs/low HDL-C (OR: 1.70, 95%CI: 1.23-2.37), high WC/high BP (OR: 1.75., 95%CI: 1.08-2.84), high BP/low HDL-C (OR:1.68, 95%CI: 1.05-2.60) and high WC/low HDL-C (OR: 2.41, 95% CI: 1.37-4.23) phenotypes were associated with adult MetS. However, their AUCs were significantly lower than overweight or obesity. CONCLUSION: Some combinations of metabolic abnormalities in adolescence predict early adult MetS, independent of baseline BMI Z-Score and BMI change. However, the discriminative power of these phenotypes was weak, in comparison to adolescent overweight or obesity.

Changes in waist circumference and incidence of chronic kidney disease.

BACKGROUND: Many studies have evaluated the association of anthropometric indices with chronic kidney disease (CKD), but the association of waist circumference(WC) changes with CKD incidence is less clear. We evaluated the effect of WC changes on CKD incidence in participants of the Tehran Lipid and Glucose Study (TLGS). STUDY DESIGN: The risk of CKD incidence was evaluated in three serial phases with interval censoring. A group of 8,183 (46·5% men) participants, mean age 47·4 years, free of previous CKD, were followed. Waist changes were divided into four groups: (i)decrease in WC; (ii) reference group; (iii)mild to moderate increase in WC and (iv)severe increase in WC. Glomerular filtration rate(GFR) was estimated using the MDRD equation. RESULTS: In 8,183 participants, mean GFR was higher in men (77·1 vs. 74·4 mL/min/1·73 m2, P<0·001). During the 9 years of follow-up, 1477 new cases of CKD occurred(1026 in women). WC changes were not associated with the development of CKD in women. In men, decrease in WC was not related to lower risk of CKD (HR: 0·90, 95% CI 0·6-1·4), whereas a mild to moderate increase in WC was associated with a 70% (HR: 1·7, 95% CI 1·3-2·2) higher risk of CKD even after adjusting for covariates (HR: 1·6, 95% CI 1·2-2·2). Severe increase in WC was associated with a fourfold risk of CKD in comparison with reference group (HR: 3·7, 95% CI 2·7-5·1). CONCLUSION: Changes in WC are not independent risk factors for CKD development in women, whereas waist gain can adversely influence the development of CKD in men.