Publications by authors named "Sandeep Patel"

237 Publications

Early versus delayed thromboprophylaxis with LMWH in pelvic-acetabular trauma- a prospective study.

Injury 2021 Oct 2. Epub 2021 Oct 2.

Professor, Department of Radiodiagnosis, PGIMER, Chandigarh, INDIA.

Background: Delayed presentation of pelvic-acetabular fractures is a common scenario in developing countries and there is usually a delay of more than 24 h in their presentation.

Objectives: We aim to comparatively analyse early(<24 h) versus delayed (>24 h) thromboprophylaxis with low molecular weight heparin (LMWH) in prevention of deep venous thrombosis (DVT) in Pelvic Acetabular fractures.

Methods: Patients of pelvic-acetabular fractures who presented during 1 year of study period were divided into 2 groups after exclusion of patients with contraindications for thromboprophylaxis. Group A included patients who received LMWH prophylaxis within 24 h of injury. Group B included patients who received LMWH prophylaxis after 24 h of injury. All patients underwent CT venography at day 14 and were followed up with doppler ultrasound on 4th and 8th week.

Results: 110 patients with pelvic-acetabular fractures were included after exclusion of 61 patients. 4 out of 29 patients in group A (13.8%) and 12 out of 81 patients (14.8%) in group B developed DVT. There was no significant difference in incidence of DVT between Group A and B (P value-0.893).

Conclusion: There was no difference between early and delayed thromboprophylaxis with LMWH in pelvic-acetabular trauma.
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http://dx.doi.org/10.1016/j.injury.2021.09.047DOI Listing
October 2021

Chain-walking reactions of transition metals for remote C-H bond functionalization of olefinic substrates.

Chem Commun (Camb) 2021 Oct 6. Epub 2021 Oct 6.

Department of Chemistry, Indian Institute of Technology Ropar, Nangal Road, Rupnagar, Punjab-140001, India.

Past several decades have witnessed the great evolution of inert C-H bond functionalization reactions as an emerging technique for synthesizing drug molecules, agrochemicals, and functional materials with intricate three-dimensional architectures. Although most activation of "unreactive" C-H bonds was accomplished by exploiting the power of transition metal catalysts, the distant and selective activation of unreactive C-H bonds in an undirected fashion remains one of the critical challenges to this rapidly growing field of organic chemistry. In this context, to meet all these concerns, much more attractive and challenging transition metal catalytic transformations have begun to blossom in recent years with the aid of the chain-walking process. The chain-walking strategy is one of the state-of-the-art techniques in organic synthesis to functionalize the unreactive C-H bonds by allowing the movement of a metal complex along the hydrocarbon chain of the substrate to recognize preferable bond-forming sites. The essential advantage of this strategy is that the bonds are formed only at the places where the catalyst selects for the specific C-H bonds to be cleaved, which not only avoids tedious synthetic procedures for prefunctionalization and the emission of undesirable wastes but also inspires chemists to plan novel synthetic strategies in a completely different manner. Consequently, various C-H bond functionalization reactions have been reported in recent years, employing the vast opportunity provided by this growing field mainly for the acyclic olefinic systems with flexible alkyl chains. Thus, chain-walking reactions allow the reactivity of the reaction centers within the substrates that cannot be realized the classical mode of reactivity of the substrates. Applying this approach, inexpensive feedstock materials and simple hydrocarbons as an isomeric mixture can be converted to a single isomeric product in a regioconvergent scenario. Simultaneously, the site-selectivity of these reactions can also be switched using a regiodivergent strategy appropriate tuning of ligands or a slight modification of reaction conditions. Herein, we have provided a comprehensive overview of the chain-walking reactions involving a variety of catalytic systems ranging from the first-row transition metal catalysts to the third-row transition metal catalysts for C-H activation in a concise fashion with the hope for further developments in this area through the appropriate application of the chain-walking reactions.
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http://dx.doi.org/10.1039/d1cc04370fDOI Listing
October 2021

Sepsis Among Medicare Beneficiaries: 4. Precoronavirus Disease 2019 Update January 2012-February 2020.

Crit Care Med 2021 Sep 27. Epub 2021 Sep 27.

United States Department of Health and Human Services, Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response, Washington, DC. Emory Critical Care Center, Emory University, Atlanta, GA. Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas, Kansas City, KS. Booz Allen Hamilton, McLean, VA. United States Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Washington, DC. Acumen, LLC, Burlingame, CA. United States Department of Health and Human Services, Center for Medicare and Medicaid Services, Baltimore, MD. Department of Economics, Stanford University, Stanford, CA. Hoover Institution, Stanford University, Stanford, CA. Stanford Institute for Economic Policy Research, Stanford University, Stanford, CA.

Objectives: To provide updated information on the burdens of sepsis during acute inpatient admissions for Medicare beneficiaries.

Design: Analysis of paid Medicare claims via the Centers for Medicare and Medicaid Services DataLink Project.

Setting: All U.S. acute-care hospitals, excluding federally operated hospitals (Veterans Administration and Defense Health Agency).

Patients: All Medicare beneficiaries, January 2012-February 2020, with an explicit sepsis diagnostic code assigned during an inpatient admission.

Interventions: None.

Measurements And Main Results: The count of Medicare Part A/B (fee-for-service) plus Medicare Advantage inpatient sepsis admissions rose from 981,027 (CY2012) to 1,700,433 (CY 2019). The proportion of total admissions with sepsis in the Medicare Advantage population rose from 21.43% to 35.39%, reflecting the increasing beneficiary proportion enrolled in Medicare Advantage. In CY2019, 6-month mortality rates in Medicare fee-for-service beneficiaries for sepsis continued to decline, but remained high: 59.9% for septic shock, 35.5% for severe sepsis, 30.8% for sepsis attributed to a specific organism, and 26.5% for unspecified sepsis. Total fee-for-service-only inpatient hospital costs rose from $17.79B (CY2012) to $22.98B (CY2019). We estimated that the aggregate cost of sepsis hospital care for the entire U.S. population was at least $57.47B in 2019. Inclusion of 14 months' (January 2019-February 2020) newer data exposed new trends: the cost per patient, number of admissions, and fraction of patients with sepsis labeled as present on admission inflected around November 2015, coincident with the change to International Classification of Diseases, 10th Edition, and introduction of the Severe Sepsis and Septic Shock Management Bundle (SEP-1) metric.

Conclusions: Sepsis among Medicare beneficiaries precoronavirus disease 2019 imposed immense burdens upon patients, their families, and the taxpayers.
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http://dx.doi.org/10.1097/CCM.0000000000005332DOI Listing
September 2021

Endoscopic Submucosal Dissection for Resolution of a Symptomatic Pancreatic Rest in a Pediatric Patient: A Case Report and Literature Review.

Case Rep Gastrointest Med 2021 13;2021:8853120. Epub 2021 Sep 13.

Department of Medicine, Division of Gastroenterology, University of Texas Health Science Center, San Antonio, TX, USA.

The pancreatic rest, aberrant, or heterotopic pancreas is a normal function pancreas found in the submucosal layer of the greater curvature of the gastric antrum and occasionally in the duodenum. Most of the patients are asymptomatic and the finding is usually incidental. We describe the case of a child with abdominal pain and history of recurrent ulcers that necessitated esophagogastroduodenoscopy and further evaluation with endoscopic ultrasound that confirmed a submucosal lesion consistent with a pancreatic rest. Endoscopic submucosal dissection was performed without complication, and complete symptom resolution was achieved after dissection of the pancreatic rest.
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http://dx.doi.org/10.1155/2021/8853120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8455212PMC
September 2021

The Increased Burden of SARS-CoV-2 Infection in Orthopaedic Trauma Patients: Comparison of Demographics of Both the Waves of the Pandemic-An Indian Tertiary Center Experience.

Indian J Orthop 2021 Sep 13:1-6. Epub 2021 Sep 13.

Department of Orthopedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: The second wave of SARS-CoV-2 pandemic has posed new challenges in the management of Orthopedic trauma patients due to the overburdened healthcare facilities and we aim to present the differences in demographics between the first wave and the initial part of the second wave.

Methodology: This study was a retrospective cross-sectional study of our trauma registry from June 19, 2020 to October 13, 2020 (1st study period) and from April 1, 2021 to the first week of May 2021 (2nd study period). We looked into differences in the following three parameters: (1) infection rate among Orthopaedic patients in the first and second study period of SARS-CoV-2 pandemic, (2) infection rate among the Health Care Workers and (3) hospital-acquired SARS-CoV-2 infections in admitted Orthopaedic trauma patients.

Results: 35 out of 852 patients (4.1%) were positive for SARS-CoV-2 infection in 1st study period as compared to 48 out of 262 patients (18.3%) in the 2nd study period ( < 0.001). 23 HCW's involved in management of Orthopaedic trauma patients tested positive in the second study period compared to none in the first study period. 17 patients had Hospital-acquired SARS-CoV-2 infection in 2nd study period compared to 7 in 1st study period. There were more asymptomatic patients for SARS-CoV-2 infection in the 2nd study period.

Conclusion: Significant increase in the number of SARS-CoV-2 infection in Orthopaedic trauma patients, and the increased number of HCW's affected with SARS-CoV-2 infection have been the challenges in 2nd study period.
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http://dx.doi.org/10.1007/s43465-021-00509-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436012PMC
September 2021

The Effect of High Temperature on Cardiovascular Autonomic Function Tests in Steel Plant Furnace Worker.

Indian J Occup Environ Med 2021 Apr-Jun;25(2):67-71. Epub 2021 Jul 9.

Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chattishgarh, India.

Background: The high temperature in the working environment could be one of the risk factors for cardiovascular diseases in steel plant workers. The excessive high temperature at the working place leads to altered autonomic activity and is related to more cardiovascular risk.

Aims And Objectives: The effect of high temperature on cardiovascular autonomic function tests in steel plant furnace worker.

Material And Method: This was a case-control study for which 50 steel plant furnace workers and 50 controls were selected. The cardiovascular sympathetic function status in worker and control were analyzed by three tests: (i) Blood pressure (BP) response to sustained isometric handgrip test, (ii) BP response to the cold pressor test, and (iii) BP response to standing from a supine position (orthostasis). Statistical analysis was done by using an independent -test.

Results: Diastolic BP (DBP) response to sustained isometric handgrip and systolic BP (SBP) and DBP response to the cold pressor test showed that the increase BP in workers were more than controls but the difference was not statistically significant ( > 0.05). SBP response to standing from the supine position showed statistically significant ( < 0.001) greater fall in steel plant workers.

Conclusion: The sympathetic autonomic dysfunction was seen in steel furnace workers in response to environmental stressor-excessive heat.
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http://dx.doi.org/10.4103/ijoem.IJOEM_193_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8341409PMC
July 2021

Innovating Maternal and Child Health: Incentive Prizes to Improve Early Childhood Development.

Matern Child Health J 2021 Oct 16;25(10):1508-1515. Epub 2021 Aug 16.

University of California, Berkeley, USA.

Purpose: Protecting and advancing maternal and child health is a critical goal to both society and to the economy, given that their health is a predictor of the next generation's health. Yet despite this recognition, many of the communities aiming to improve maternal and child health still problem-solve in silos: age silos, disease silos, organizational silos, disciplinary silos, data silos, and communication silos, often created or exacerbated by the disconnected approaches to research, funding, and reporting. These silos limit discovery and spread of new solutions to important maternal and child health problems.

Description: In this paper, we will discuss federal incentive prizes as a tool to break down silos and to engineer cognitive diversity and transdisciplinary collaboration.

Assessment: In 2018, the United States Health Resources and Services Administration, Maternal and Child Health Bureau (HRSA MCHB) launched the "Maternal and Child Health Bureau Grand Challenges," a suite of four prize competitions totaling $1.5 million addressing critical issues in maternal and child health. These included federal challenges designed to (1) prevent childhood obesity in low-income communities, (2) improve the remote monitoring of pregnancy, (3) improve care coordination and planning for children with special health care needs, and (4) prevent opioid misuse among pregnant women and new mothers.

Conclusion: The ability to incentivize innovation to address critical public health issues cannot rest in the private sector alone. Complementing other investments, the Challenge mechanism's power to catalyze the rapid development of innovative solutions can improve how we address barriers to achieve optimal maternal and child health for the families that we serve.
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http://dx.doi.org/10.1007/s10995-021-03219-yDOI Listing
October 2021

Crossed Screw Fixation Versus Dorsal Plating for First Metatarsophalangeal Joint Arthrodesis: A Retrospective Cohort Study.

J Foot Ankle Surg 2021 Jun 18. Epub 2021 Jun 18.

Attending Staff and Surgeon, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Podiatric Surgery, Kaiser Permanente Antioch Medical Center, Antioch, CA. Electronic address:

Multiple fixation techniques for first metatarsophalangeal joint arthrodesis have been described with an average fusion rate of 93.5%. This retrospective cohort study assesses the association between crossed screws (vs dorsal plating) and medical comorbidities and the outcome radiographic union. Bivariate tests of association and multivariable logistic regression were employed to assess differences across fixation type and outcomes. We identified 305 patients who underwent a first metatarsophalangeal joint arthrodesis during the study period. Crossed screw fixation was used in 158 (51.8%) patients while dorsal plating (tubular or anatomic locking plate) was used in 147 (48.2%) patients. Dorsal plating was utilized more often in patients with rheumatoid arthritis (p = .019) and history of smoking (p = .044). At 12 weeks post-operatively there were no significant differences in fusion rates between the two groups (crossed screw group = 95.3% vs dorsal plate group (referent) = 93.5%, Adjusted odds ratio (AOR) 1.39, 95% confidence interval [CI] 0.45-4.26). Not smoking was associated with a greater odds of fusion at 12 weeks (96.2% for nonsmokers vs 75.0% for smokers (referent), AOR 0.07, 95% CI 0.02-0.28). Lower body mass index was associated with a greater odds of fusion at 12 weeks (AOR 0.90, 95% CI 0.82-0.99). Surgeons allowed weightbearing earlier with dorsal plate fixation (2 weeks (interquartile range [IQR] 2.6) versus 5 weeks (IQR 2.6) for crossed screw fixation, p = .001). Patients with multiple medical comorbidities were more likely to require revision surgery than patients having 0-1 comorbidities (p < .05). Crossed screws can provide an inexpensive yet effective option for first metatarsophalangeal joint arthrodesis.
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http://dx.doi.org/10.1053/j.jfas.2021.06.002DOI Listing
June 2021

Outcomes of plate osteosynthesis for displaced 3-part and 4-part proximal humerus fractures with deltopectoral vs. deltoid split approach.

Eur J Trauma Emerg Surg 2021 Jul 31. Epub 2021 Jul 31.

Department of Orthopaedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Purpose: Three part and four-part fractures of the proximal humerus offer challenges in reduction and plate fixation, with considerable debate about use of Deltoid splitting (DS) and Delto-pectoral (DP) approaches, especially when they involving the greater tuberosity. We prospectively compared the results using DS approach and DP approach in these cases, with special focus on functional outcomes, complications, and ease of tuberosity reduction.

Materials And Methods: 84 patients with three- and four-part proximal humerus fracture were alternately allocated the DP approach or DS approach for proximal humerus locking plate fixation. The outcome analysis was done by evaluating relative Constant score and ease of surgical reduction of greater tuberosity; radiological malunion was evaluated using Beredjiklian classification and complications were noted.

Results: At mean follow-up of 23 months (19-48 months), the mean 'relative Constant score was 74.27 ± 8.19 in the DP group and 73.26 ± 8.02 in the DS group and the difference was statistically insignificant (p = 0.988). There was no significant difference with respect to shoulder ROM, abductor strength, radiological malunion or complications. However, the mean surgical time was significantly less (p value = 0.042) in DS group (65 ± 5 min) in comparison to DP group (92 ± 4.3 min); significantly less difficulties were documented by the surgeon in reducing the greater tuberosity in DS group(p value = 0.02).

Conclusion: Although surgical time was reduced and greater tuberosity reduction was easier in DS group, the other outcomes were similar; either surgical approach can be used based, and can be based on the experience and comfort level of the surgeon.
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http://dx.doi.org/10.1007/s00068-021-01761-6DOI Listing
July 2021

Methods to address metal artifacts in post-processed CT images - A guide for orthopedic surgeons.

J Clin Orthop Trauma 2021 Sep 1;20:101493. Epub 2021 Jul 1.

Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Computed tomography (CT) scans are often used for postoperative imaging in orthopedics. In the presence of metallic hardware, artifacts are generated, which can hamper visualization of the CT images, and also render the study ineffective for 3-D printing. Various solutions are available to minimize metal artifacts, and radiologists can employ these before or after processing the CT study. However, the orthopedic surgeon may be faced with situations where the metal artifacts were not addressed. To counter such problems, we present three (DIY) techniques that can be used to manage metal artifacts.
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http://dx.doi.org/10.1016/j.jcot.2021.101493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267498PMC
September 2021

Primary angiosarcoma of aorta: A systematic review.

Vascular 2021 Jul 8:17085381211026491. Epub 2021 Jul 8.

68993National and Kapodistrian University of Athens, Liako University Hospital, Athens, Greece.

Purpose: To elucidate the epidemiology, anatomical, presentation, classification, pathology, investigative modalities, management and prognosis of primary angiosarcoma of the aorta.

Material And Methods: A systematic review of literature from the database inception to January 2021 in PubMed and Embase, CINAHL and Cochrane Library in accordance to PRISMA was conducted. Retrieval and extraction was performed by two independent reviewers. The hierarchy of the evidence was assessed through the National Institute for Health and Care Excellence Checklist. Data were subjected to pooled prevalence analysis, Kaplan-Meier survival and test of probability using log-rank analysis. This review is registered with International Prospective Register of Systematic Reviews: RD42021231314.

Results: 82 studies with = 123 cases met the inclusion criterion. Abdominal (45%) aorta was the commonest anatomical site with female predominance in ascending aorta (4:1) and aortic arch (2:1). The longest survival was in the ascending aorta and the shortest in the abdominal aorta [540 (interquartile range [IQR], 7-1560 days vs. 180 (IQR, 1-5730 days)], respectively. The overall median survival was 210 days (IQR, 1-5730 days) or 7 months. Lack of metastasis (47%) was a marker of longer survival ( < 0.03) irrespective of other attributes.

Conclusion: The pathophysiology appears to be a trend of increasing fatigue, fever and weight loss associated with segmental dysfunction of the aorta projecting occlusive or destructive phenotypes. Computed tomography angiography features of volume-occupying, bulky, polypoid (intraluminal), protrusive vegetation, hyper vascular without atherosclerotic lesions are extremely suggestive of PA of the aorta at 5th and 6th decades of life.
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http://dx.doi.org/10.1177/17085381211026491DOI Listing
July 2021

Current advances in the management of chronic pancreatitis.

Dis Mon 2021 Jun 24:101225. Epub 2021 Jun 24.

Department of Gastroenterology and Advanced endoscopy, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA. Electronic address:

Chronic pancreatitis is characterized by irreversible destruction of pancreatic parenchyma and its ductal system resulting from longstanding inflammation, leading to fibrosis and scarring due to genetic, environmental, and other risk factors. The diagnosis of chronic pancreatitis is made based on a combination of clinical features and characteristic findings on computed tomography or magnetic resonance imaging. Abdominal pain is the most common symptom of chronic pancreatitis. The main aim of treatment is to relieve symptoms, prevent disease progression, and manage complications related to chronic pancreatitis. Patients who do not respond to medical treatment or not a candidate for surgical treatment are usually managed with endoscopic therapies. Endoscopic therapies help with symptoms such as abdominal pain and jaundice by decompression of pancreatic and biliary ducts. This review summarizes the risk factors, pathophysiology, diagnostic evaluation, endoscopic treatment of chronic pancreatitis, and complications. We have also reviewed recent advances in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-guided therapies for pancreatic duct obstruction due to stones, strictures, pancreatic divisum, and biliary strictures.
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http://dx.doi.org/10.1016/j.disamonth.2021.101225DOI Listing
June 2021

Letter to the Editor on "Low Body Mass Index Is a Predictor for Mortality and Increased Length of Stay Following Total Joint Arthroplasty".

J Arthroplasty 2021 07;36(7):e63-e64

Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1016/j.arth.2021.03.014DOI Listing
July 2021

Comparative analysis of leucocyte poor vs leucocyte rich platelet-rich plasma in the management of lateral epicondylitis: Systematic review & meta-analysis of randomised controlled trials.

J Clin Orthop Trauma 2021 Aug 21;19:96-107. Epub 2021 May 21.

Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India.

Study Design: Systematic Review & Meta-analysis.

Objectives: We aim to comparatively analyse the efficacy and safety of using leucocyte-poor platelet rich plasma (LP-PRP) against leucocyte-rich platelet rich plasma (LR-PRP) in the management of lateral epicondylitis.

Materials And Methods: We conducted independent and duplicate electronic database searches including PubMed, Embase, Web of Science and Cochrane Library till September 2020 for randomised controlled trials analyzing the efficacy and safety of LP-PRP and LR-PRP in the management of lateral epicondylitis. Visual Analog Score(VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) Score, Patient Reported Tennis-Elbow Evaluation (PRETEE) Score, Mayo Elbow Performance Score(MEPS) and adverse events were the outcomes analyzed. Analysis was performed in R-platform using OpenMeta[Analyst] software.

Results: We performed a single arm meta-analysis of 26 studies involving 2034 patients. On analysis it was noted that significant improvement was noted in the VAS for pain (p < 0.001), DASH score (p < 0.001), PRETEE score (p < 0.001) and MEPS (p < 0.027) compared to their pre-operative state. No significant increase in adverse events were noted compared to the control group (p = 0.170). While stratifying the results based on the type of PRP used, no significant difference was noted between the use of LP-PRP or LR-PRP in any of the above-mentioned outcome measures.

Conclusion: PRP is a safe and effective treatment option for lateral epicondylitis with clinical improvements in pain and functional scores and both types of PRP (LR-PRP & LP-PRP) offer similar results.
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http://dx.doi.org/10.1016/j.jcot.2021.05.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144683PMC
August 2021

Does the use of intraoperative CT scan improve outcomes in Orthopaedic surgery? A systematic review and meta-analysis of 871 cases.

J Clin Orthop Trauma 2021 Jul 15;18:216-223. Epub 2021 May 15.

Department of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India.

Background: Intraoperative imaging is frequently made use of in Orthopaedic surgery. Historically, conventional 2-dimensional fluoroscopy has been extensively used for this purpose. However, 2D imaging falls short when it is required to visualise complex anatomical regions such as pelvis, spine, foot and ankle etc. Intraoperative 3D imaging was introduced to counter these limitations, and is increasingly being employed in various sub-specialities of Orthopaedic Surgery.

Objectives: This review aims to outline the clinical and radiological outcomes of surgeries done under the guidance of intraoperative 3D imaging and compare them to those done under conventional 2D fluoroscopy.

Methods: Three electronic databases (PubMed, Embase and Scopus) were searched for relevant studies that directly compared intraoperative 3D imaging with conventional fluoroscopy. Case series on intraoperative 3D imaging were also included for qualitative synthesis. The outcomes evaluated included accuracy of implant placement, mean surgical duration and rate of revision surgery due to faulty implants.

Results: A total of 31 studies from sub-specialities of spine surgery, pelvi-acetabular surgery, foot and ankle surgery and trauma surgery, having data on a total of 658 patients were analysed. The study groups which had access to intraoperative 3D imaging was found to have significantly increased accuracy of implant positioning (Odds Ratio 0.35 [0.20, 0.62], p = 0.0002) without statistically significant difference in mean surgical time (p = 0.57). Analysis of the studies that included clinical follow up showed that the use of intraoperative 3D imaging led to a significant decrease in the need for revision surgeries due to faulty implant placement.

Conclusion: There is sufficient evidence that the application of intraoperative 3D imaging leads to precise implant positioning and improves the radiological outcome. Further research in the form of prospective studies with long term follow up is required to determine whether this superior radiological outcome translates to better clinical results in the long run.
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http://dx.doi.org/10.1016/j.jcot.2021.04.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138210PMC
July 2021

Endoscopic management of benign recalcitrant esophageal strictures.

Ann Gastroenterol 2021 27;34(3):287-299. Epub 2021 Jan 27.

Division of Gastroenterology, University of Texas Health, San Antonio, TX (Sandeep Patel, Juan Echavarria, Hari Sayana, Shreyas Saligram), USA.

Benign esophageal strictures are one of the common clinical conditions managed by endoscopists. Nearly 90% of the benign esophageal strictures respond to endoscopic dilation. However, a small percentage of patients progress to recalcitrant strictures. The benign recalcitrant esophageal strictures are difficult to manage both medically and endoscopically as they do not respond to conventional treatment with proton pump inhibitors and esophageal dilations. Patients with benign recalcitrant esophageal strictures are at a high risk of developing debilitating malnutrition and morbidity due to severe dysphagia. This condition is associated with psychological trauma to patients as treatments are usually prolonged with poor outcomes. Also, this can be a financial burden on the healthcare industry due to several sessions of treatment. In this article, we discuss the classification of benign esophageal strictures, evidence-based treatment strategies, endoscopic procedural techniques, and complications of endoscopic interventions. We aim to guide providers in managing benign esophageal strictures with a focus on endoscopic management of benign recalcitrant esophageal strictures.
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http://dx.doi.org/10.20524/aog.2021.0585DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8079876PMC
January 2021

Bioaerosols in orthopedic surgical procedures and implications for clinical practice in the times of COVID-19: A systematic review and meta-analysis.

J Clin Orthop Trauma 2021 Jun 28;17:239-253. Epub 2021 Mar 28.

Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

Introduction: Orthopedic surgical procedures (OSPs) are known to generate bioaerosols, which could result in transmission of infectious diseases. Hence, this review was undertaken to analyse the available evidence on bioaerosols in OSPs, and their significance in COVID-19 transmission.

Methods: A systematic review was conducted by searching the PubMed, EMBASE, Scopus, Cochrane Library, medRxiv, bioRxiv and Lancet preprint databases for studies on bioaerosols in OSPs. Random-effects metanalysis was conducted to determine pooled estimates of key bioaerosol characteristics. Risk of bias was assessed by the RoB-SPEO tool; overall strength of evidence was assessed by the GRADE approach.

Results: 17 studies were included in the systematic review, and 6 in different sets of meta-analyses. The pooled estimate of particle density was 390.74 μg/m, Total Particle Count, 6.08 × 10/m, and Microbial Air Contamination, 8.08 CFU/m. Small sized particles (
Conclusion: Whereas there is evidence to suggest that OSPs generate large amounts of bioaerosols, their potential to transmit infectious diseases like COVID-19 is questionable. High-quality research, as well as consensus minimum reporting guidelines for bioaerosol research in OSPs is the need of the hour.
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http://dx.doi.org/10.1016/j.jcot.2021.03.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005256PMC
June 2021

Management of Non-Variceal Upper GI Bleeding in the Geriatric Population: An Update.

Curr Gastroenterol Rep 2021 Mar 25;23(4). Epub 2021 Mar 25.

Department of Medicine, Division of Gastroenterology & Nutrition, Long School of Medicine, UT Health San Antonio, San Antonio, TX, 78229-3900, USA.

Purpose Of Review: Upper gastrointestinal (GI) bleeding is a significant cause of morbidity and mortality in the geriatric (age > 65 years) population and presents a unique management challenge in the context of multiple medical comorbidities, polypharmacy, and increased risk of adverse outcomes and is confounded by an increased prevalence of obscure GI bleeds. A review of relevant guidelines, literature, and personal observations will enhance management strategies in the elderly.

Recent Findings: Non-variceal bleeding represents a significant proportion of upper GI bleeding (UGIB) in geriatric patients. Peptic ulcer disease (PUD) remains the most common cause in geriatric patients hospitalized for UGIB, but its incidence is decreasing. Esophagogastroduodenoscopy (EGD) is the gold standard for treating UGIB in geriatrics with a therapeutic yield of approximately 75%. Scoring systems such as Glasgow-Blatchford (GBS) and AIMS-65 may be useful for risk stratification but are not validated in trials. Obscure bleeds account for up to 30% of hospitalizations and must be considered during triage and management. Video capsule endoscopy (VCE) technology is efficacious for detecting obscure jejunal bleeding after failed EGD and may enhance the yield of balloon-assisted enteroscopy (BAE). The most significant factor for the increased morbidity and mortality in the geriatric population is the presence of multiple medical comorbidities and polypharmacy. An EGD should be done within 24 h of hospital presentation. If non-diagnostic, VCE may be a viable option for diagnosing an obscure small-bowel bleed, representing up to 30% of GI bleeds in this population.
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http://dx.doi.org/10.1007/s11894-021-00805-6DOI Listing
March 2021

Pre and Postoperative Analysis of Flatfoot Reconstruction Sparing the Talonavicular Joint.

J Foot Ankle Surg 2021 Jul-Aug;60(4):650-654. Epub 2021 Mar 17.

Surgeon, Kaiser Permanente Antioch Medical Center, Antioch, CA.

Surgical correction of a flatfoot deformity is controversial. The purpose of our study was to evaluate the structural radiographic changes of the flatfoot deformity while maintaining the mobile adapter of the foot. We conducted a retrospective analysis of 56 patients that underwent this procedure comparing their pre- to postoperative angular changes during a follow-up period. The mean age of our study cohort was 53.6 (range, 20-77) years and mean follow-up period was 23 (range, 4-73) months. Radiographic union was achieved in 48 patients (86%). Forty-six patients (82%) had all required radiographs completed through final follow-up visit. We illustrated statistically significant changes to the talonavicular, Meary, talocalcaneal, calcaneal inclination, and talar declination angles, and navicular height at 3 months and final follow-up. This study suggests surgical correction of the flatfoot deformity that fused the subtalar but spared the talonavicular joint appears to achieve and maintain radiographic angular changes and achieve union.
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http://dx.doi.org/10.1053/j.jfas.2020.04.002DOI Listing
July 2021

Hand Surgery in New Zealand.

J Hand Microsurg 2021 Jan 31;13(1):4-9. Epub 2020 Dec 31.

University of Otago, Dunedin, New Zealand.

Hand surgery in New Zealand has steadily grown from its origins in plastic surgery and orthopaedic surgery into its own discipline. There has been much progress and innovation in hand surgery that has originated from New Zealand and this review acknowledges the historical figures and events that have led to our present position. The current and future directions of hand surgery in our country are also discussed. As a small and remote country, we are very fortunate to have close relationships with other international hand societies. Through these relationships and the efforts of committed regional hand surgeons, the art and science of hand surgery in New Zealand continues to progress.
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http://dx.doi.org/10.1055/s-0040-1721568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937443PMC
January 2021

INFIX-safe and effective surgical option for complex fracture patterns of the anterior pelvic ring: A prospective single center study.

J Orthop 2021 Jan-Feb;23:142-149. Epub 2021 Jan 16.

Department of Radiodiagnosis, Pgimer, Chandigarh, India.

Background: Complex fracture patterns of anterior pelvic ring are a challenge and usually needs extensive surgeries. The purpose of this study was to evaluate INFIX as a minimally invasive procedure for such injuries in terms of feasibility, outcomes and complications in the Indian population.

Methods: Patients with complex fracture patterns of anterior pelvic ring were selected for anterior INFIX application along with standard posterior stabilization. Outcomes were assessed radiographically by Matta's criteria and amount of displacement. Post-operative CT scan for relation of implant to vital structures and Doppler at varying hip flexion for possible vascular occlusion was used. Functional outcomes included both disease specific scores (Majeed score, IOWA pelvic score) and quality of life scores (SMFA, SF-12). Complications were also noted.

Results: 12 cases out of 112 patients had complex fracture pattern of the anterior ring. Most common injury pattern were LC-3 and VS (n = 6 and 3) Young and Burgess type. The average follow up was 6 months. Fracture reduction as per Matta's criteria was excellent in 10 (83.3%) cases and good in 2 (16.6%) cases with functional outcomes excellent in 11 cases, and a mean Majeed score of 92.67 ± 5.8. The average SMFA score was 51 ± 4.39 and mean SF-12 scores for physical and mental health were 48.493 ± 6.74 and 56.370 ± 4.04 respectively. Complications noted were lateral femoral cutaneous nerve palsy (1/24 nerves), skin dehiscence (n = 2), infection (n = 2) and sacral nonunion (n = 1).

Conclusion: INFIX is a safe and effective minimally invasive technique for addressing complexfracture patterns involving the anterior half of pelvic ring with excellent fracture reduction, radiological and functional outcomes and predictable fracture healing.
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http://dx.doi.org/10.1016/j.jor.2021.01.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829118PMC
January 2021

A new WATCHMAN sizing algorithm utilizing cardiac CTA.

Cardiovasc Revasc Med 2021 Jan 12. Epub 2021 Jan 12.

Tampa General Hospital, University of South Florida, United States of America. Electronic address:

Background: The WATCHMAN left atrial appendage (LAA) occlusion device has emerged as an alternative for anticoagulation in patients with non-valvular atrial fibrillation who cannot tolerate oral anticoagulation therapy. Cardiac computed tomography (CTA) is increasingly being utilized to guide WATCHMAN device sizing, however no consensus algorithm exists. We present our experience with a new cardiac CTA LAA ostium area based sizing algorithm.

Methods: This is a single center, prospective study analyzing consecutive patients who underwent cardiac CTA and WATCHMAN device implantation between March 2017 and October 2019 at University Hospitals Cleveland Medical Center. Patients baseline characteristics, procedural data, and clinical outcomes were collected and analyzed.

Results: 115 patients were included in our study. The mean age of our population was 76.5 years ±8.3 years. 70.4% of our patients had preserved ejection fraction. The predominant indication for device implantation was gastrointestinal bleeding in 57.4% of patients. The mean CHADSVASC score was 4.68 ± 1.4. The procedure success rate was 99.1% and the mean number of device used per case of 1.15 ± 0.4 devices. Our CTA LAA ostium area based sizing algorithm accurately predicted the final deployed WATCHMAN device size in 95.6% of cases.

Conclusion: Our study demonstrates that cardiac CTA LAA ostium area based sizing algorithm is highly accurate at predicting WATCHMAN device size and demonstrates excellent clinical outcomes with lower device utilization per case than what is reported in literature.
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http://dx.doi.org/10.1016/j.carrev.2021.01.009DOI Listing
January 2021

When Harry Met Sally: Single-Session INARI FlowTriever and Impella RP.

J Cardiol Cases 2021 Feb 22;23(2):57-60. Epub 2020 Oct 22.

Structural Heart and Intervention Center, St. Rita's Medical Center, Lima, OH, USA.

Percutaneous mechanical thrombectomy devices have revolutionized the treatment of massive pulmonary embolism (PE) by providing a rapid, non-thrombolytic based method to re-establish right-sided circulation while reducing bleeding complications. However, with massive PE, the acute increase in right ventricular afterload results in a compounded hemodynamic compromise, which may necessitate the need for advanced cardiac support. This case exemplifies the need for a comprehensive and synergistic approach to the management of massive PE. To our knowledge, this is the first report of combination therapy using large bore mechanical suction thrombectomy (FlowTriever, INARI Medical, Irvine, CA, USA) in conjunction with the implantation of right ventricular mechanical support (Impella RP, ABIOMED, Danvers, MA, USA) in an effort to reverse the right ventricular "shock spiral." < To understand the importance of timely intervention in massive pulmonary embolism (PE) and the role of percutaneous mechanical thrombectomy devices in such situations where thrombolysis fails or is contraindicated. To incorporate the simultaneous use of mechanical circulatory support in the setting of massive PE.>.
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http://dx.doi.org/10.1016/j.jccase.2020.10.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817901PMC
February 2021

Single-Session Treatment of Upper Extremity Deep Venous Thrombosis and Central Venous Catheter Malfunction Using the ClotTriever System.

Cureus 2020 Dec 14;12(12):e12071. Epub 2020 Dec 14.

Interventional Cardiology, Mercy Health St. Rita's Medical Center, Lima, USA.

Intravenous catheters account for the majority of cases of upper extremity deep vein thrombosis (UEDVT), with a higher incidence in patients suffering from malignancy. Sequelae of UEDVT are similar to that of lower extremity DVT, comprising post-thrombotic syndrome and pulmonary embolism. While there are several treatment options for UEDVT including systemic anticoagulation, catheter-directed thrombolysis, and percutaneous mechanical thrombectomy, due to the absence of consistent guidelines regarding its management, treatment is often individualized based on patient characteristics, clinical factors, and technical considerations. We present a case of a 49-year-old female suffering from breast cancer with a central venous catheter (CVC) who came to the clinic with UEDVT and CVC malfunction and was successfully treated with mechanical thrombectomy using the ClotTriever System (Inari Medical, Irvine, CA). To our knowledge, this is the first report of the ClotTriever System being used to treat UEDVT and simultaneously salvage the CVC in a single session.
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http://dx.doi.org/10.7759/cureus.12071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805419PMC
December 2020

Platelet-Rich Plasma Is More Than Placebo-Rich Plasma for Early Osteoarthritis Knee.

Cartilage 2021 Jan 19:1947603521989485. Epub 2021 Jan 19.

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http://dx.doi.org/10.1177/1947603521989485DOI Listing
January 2021

A study of oxidative stress in cervical cancer- an institutional study.

Biochem Biophys Rep 2021 Mar 29;25:100881. Epub 2020 Dec 29.

Biochemistry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.

Cervical cancer is the second most common cause of cancer-related death among women worldwide, especially in developing countries. Oxidative stress has been associated with cervical cancer. Many studies demonstrated that the low level of antioxidants induces the production of free radicals that cause lipid peroxidation, DNA, and protein damage leading to mutations that favors malignant transformation. This is a case-control institutional study conducted to evaluate the level of oxidative stress in cervical cancer patients and the age-matched healthy controls. We measured level of TBARS expressed as MDA, activity of SOD and GSH level by the spectrophotometric method, and level of 8-OHdG was estimated using a competitive sandwich ELISA assay. Our results showed a significant increase in the level of lipid peroxidation in group IV when compared to the control, group II and group III (p < 0.001). The activity of SOD was also significantly higher in group IV when compared to the control group (p < 0.001), group II (p < 0.001), and group III (p < 0.001). The level of GSH was also significantly lower in group IV when compared to the control group (p < 0.01), group II (p < 0.01), and group III (p < 0.01). The level of 8-OHdG was significantly higher in group IV than in the other groups (p < 0.01). The results suggest that oxidative stress is involved in the pathogenesis of cervical cancer, which is demonstrated by an increased level of lipid peroxidation and higher levels of 8-OHdG and an altered antioxidant defense system.
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http://dx.doi.org/10.1016/j.bbrep.2020.100881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786028PMC
March 2021

Outcomes and complications of the INFIX technique for unstable pelvic ring injuries with high-velocity trauma: a systematic review and meta-analysis.

Arch Orthop Trauma Surg 2021 Jan 11. Epub 2021 Jan 11.

Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Background: The pelvic INFIX technique has been proposed as a useful alternative to symphyseal plating for management of unstable pelvic ring injuries. The minimally invasive nature of the procedure, shorter operative time and less perioperative blood loss have been purported as potential advantages.

Questions/purposes: This systematic review and meta-analysis were conducted to determine the outcomes and complications of the INFIX technique for unstable pelvic ring injuries.

Methods: A systematic review of literature was performed on the PubMed, EMBASE and Scopus databases. Prospective and retrospective studies in all languages, whether comparative or non-comparative, pertaining to the use of INFIX in pelvic fractures were included. Studies which did not evaluate INFIX, case reports, conference abstracts and those with less than 10 cases were excluded. Cadaveric studies, technique papers and studies that did not describe the prespecified outcome measures were also excluded. Meta-analysis consisted of two different arms: a comparative arm, to compare INFIX to symphyseal plating, and a non-comparative meta-analysis arm, to determine pooled rates of outcomes and complications. Risk of bias was determined by the Methodological Index for Non-Randomised Studies (MINORS) tool.

Results: A total of 22 studies were included in the systematic review, of which 7 were comparative and 15 were non-comparative. 746 patients were included for qualitative analysis and pooled analysis done for 589 patients. The average follow-up of these studies ranged from a minimum of 5.4 months to a maximum of 54 months. Comparative meta-analysis (n = 3 studies) of plating and INFIX showed significantly lesser blood loss (mean difference = 176.46 mL; 95% CI - 207.54 to - 145.38) and shorter operative time (mean difference = 26.43 min, 95% CI - 31.79 to - 21.07) with INFIX, but no significant difference in the overall complication rates (OR 1.59, 95% CI 0.83-3.05) and functional outcome scores (mean difference = - 2.51, 95% CI - 5.73 to 0.71). Pooled analysis showed overall good radiological (mean percentage of excellent to good reduction = 91.4%, 95% CI 0.860-0.969) and functional outcomes (mean Majeed score = 86.48, 95% CI 83.34-89.61) with INFIX. The most common complications were lateral femoral cutaneous nerve (LFCN) injury (overall rate 28%, 95% CI 15.1-41%) and heterotopic ossification (HO) (overall rate 9.4%, 95% CI 5.5-13.3%); rates of other complications were low. Significant heterogeneity was noted in the pooled analysis of blood loss, operative time, functional outcome, HO and LFCN injury. The overall strength of evidence was found to be weak.

Conclusion: The INFIX technique can be considered as a viable alternative to symphyseal plating for unstable pelvic ring injuries. It has the advantages of shorter operative times and less blood loss, along with comparable functional outcomes, when compared to plating. Overall, good functional outcomes can be expected. However, well-designed, multi-center randomized controlled trials are needed to conclusively prove the benefit of this technique.
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http://dx.doi.org/10.1007/s00402-020-03742-7DOI Listing
January 2021

Perspectives and Consensus among International Orthopaedic Surgeons during Initial and Mid-lockdown Phases of Coronavirus Disease.

J Hand Microsurg 2020 Dec 6;12(3):135-162. Epub 2020 Jul 6.

Department of Orthopedics, IIUM Medical Centre, Jalan Sultan Ahmad Shah, Kuantan, Pahang, Malaysia.

With a lot of uncertainty, unclear, and frequently changing management protocols, COVID-19 has significantly impacted the orthopaedic surgical practice during this pandemic crisis. Surgeons around the world needed closed introspection, contemplation, and prospective consensual recommendations for safe surgical practice and prevention of viral contamination. One hundred orthopaedic surgeons from 50 countries were sent a Google online form with a questionnaire explicating protocols for admission, surgeries, discharge, follow-up, relevant information affecting their surgical practices, difficulties faced, and many more important issues that happened during and after the lockdown. Ten surgeons critically construed and interpreted the data to form rationale guidelines and recommendations. Of the total, hand and microsurgery surgeons (52%), trauma surgeons (32%), joint replacement surgeons (20%), and arthroscopy surgeons (14%) actively participated in the survey. Surgeons from national public health care/government college hospitals (44%) and private/semiprivate practitioners (54%) were involved in the study. Countries had lockdown started as early as January 3, 2020 with the implementation of partial or complete lifting of lockdown in few countries while writing this article. Surgeons (58%) did not stop their surgical practice or clinics but preferred only emergency cases during the lockdown. Most of the surgeons (49%) had three-fourths reduction in their total patients turn-up and the remaining cases were managed by conservative (54%) methods. There was a 50 to 75% reduction in the number of surgeries. Surgeons did perform emergency procedures without COVID-19 tests but preferred reverse transcription polymerase chain reaction (RT-PCR; 77%) and computed tomography (CT) scan chest (12%) tests for all elective surgical cases. Open fracture and emergency procedures (60%) and distal radius (55%) fractures were the most commonly performed surgeries. Surgeons preferred full personal protection equipment kits (69%) with a respirator (N95/FFP3), but in the case of unavailability, they used surgical masks and normal gowns. Regional/local anesthesia (70%) remained their choice for surgery to prevent the aerosolized risk of contaminations. Essential surgical follow-up with limited persons and visits was encouraged by 70% of the surgeons, whereas teleconsultation and telerehabilitation by 30% of the surgeons. Despite the protective equipment, one-third of the surgeons were afraid of getting infected and 56% feared of infecting their near and dear ones. Orthopaedic surgeons in private practice did face 50 to 75% financial loss and have to furlough 25% staff and 50% paramedical persons. Orthopaedics meetings were cancelled, and virtual meetings have become the preferred mode of sharing the knowledge and experiences avoiding human contacts. Staying at home, reading, and writing manuscripts became more interesting and an interesting lifestyle change is seen among the surgeons. Unanimously and without any doubt all accepted the fact that COVID-19 pandemic has reached an unprecedented level where personal hygiene, hand washing, social distancing, and safe surgical practices are the viable antidotes, and they have all slowly integrated these practices into their lives. Strict adherence to local authority recommendations and guidelines, uniform and standardized norms for admission, inpatient, and discharge, mandatory RT-PCR tests before surgery and in selective cases with CT scan chest, optimizing and regularizing the surgeries, avoiding and delaying nonemergency surgeries and follow-up protocols, use of teleconsultations cautiously, and working in close association with the World Health Organization and national health care systems will provide a conducive and safe working environment for orthopaedic surgeons and their fraternity and also will prevent the resurgence of COVID-19.
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http://dx.doi.org/10.1055/s-0040-1713964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773504PMC
December 2020

Classical Cutaneous Lichen Planus Exhibiting Locus Minoris Resistentiae.

Indian Dermatol Online J 2020 Nov-Dec;11(6):1019-1021. Epub 2020 Sep 19.

Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.4103/idoj.IDOJ_197_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7734977PMC
September 2020
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