Clinics in Surgery 1Remedy Publications LLC., | http://clinicsinsurgery.com/ 2021 | Volume 6 | Article 3380 The Effect of Spinal Steroid Injections on COVID-19 Infection and Its Severity

Aim: This paper is to determine the incidence of COVID-19 infection and severe symptoms following spinal steroid injections for pain control. Methodology: This a retrospective observational study based in the department of neurosurgery, Salford Royal Foundation Trust. Study period is from March 23rd, 2020 till December 31st, 2020. 222 patients had these injections during the time period. Data was collected by telephonic interview and online questionnaire. Data was analyzed to find out how many of the people who received steroid injection got COVID infection and how many had severe infection. It was then compared with local infection rates. Results: Out of 222 patients found, 130 patients opted to take part in the survey. Six patients among them had tested positive after the injection and two more patients had symptoms of COVID who have been considered to be positive. Overall, 6.15% of patients who received steroid injections had positive COVID-19 results. 3.85% patients had the infection within 3 months of injection. One patient (0.77%) needed hospital admission due to COVID. The incidence of COVID during this time period in Salford was 6.17% and rate of hospital admission due to COVID was 0.77%. Conclusion: The rate of COVID-19 infection after steroid injection are lower than the local incidence of COVID in Salford during that time period and equivalent to the rate of hospital admission due to COVID. This suggests that a steroid injection in the spine for pain management does not increase the incidence of COVID or cause severe infections.

Median Nerve Neuritis after Infection by the SARS-CoV-2 Virus

Background: The spectrum of neurological complications from SARS-CoV-2 infection is under constant investigation. According to numerous publications, occurrence of neurological complications can be about 36.4%. There are no reports to date of the occurrence of bilateral median nerve neuritis in the wrist after SARS-CoV-2 infection. Case: A previously healthy 24 years old female was observed in March 2021 due to dysesthesias in both hands, associated with nocturnal discomfort and decreased grip strength. The symptoms started a month earlier with acroparesthesias. SARS-CoV-2 virus infection was in January 2021 and evolved favorably, with progressive remission in about 10 days. Prior to the infection she didn’t have any of the hand symptoms; denied diabetes or metabolic diseases. Negative tests for SARS-CoV-2 infection since February. April 2021, the patient returned with persistent dysesthesias in her hands. Normal EMG, however with Sensitive Conduction Speed (SCS) of 50 m/sec on the right wrist; on the left SCS 55 m/sec. Sensitive latency 2.8 on the right and 2.6 on the left. Amplitude 17 on the right and 24 on the left. MRI detected an increase in signal in PDFS sequences in both median nerves, in the carpal tunnel, with no detected variations in cross-sectional areas or masses. The treatment was a 30 days 150 mg benfotiamine in two daily doses. Discussion: There is a wide variation in the clinical presentation of SARS-CoV-2 infection, ranging from asymptomatic patients to death. Most frequent symptoms are fever, dry cough, sore throat, dyspnea, myalgia, fatigue, chills, diarrhea, chest pain and vomiting, and the most common complications pneumonia and acute respiratory distress syndrome. Neurological manifestations of viral infection can occur in about 36.4% and in 45.5% in severe disease. They include Guillán-Barré and Miller Fischer syndrome; however, these conditions usually occur in more severe cases of the disease, but this patient hadn’t the typical picture of ataxia, ophthalmoplegia and areflexia. Benfotiamine is a synthetic derivative of thiamine with a multifaceted therapeutic profile, with a therapeutic role especially in diabetic neuropathy. Conclusion: Knowledge and recognition of neurological manifestations of SARS-CoV-2 infection and early detection of secondary peripheral neuropathies result in improvement of patients' clinical results and development of ideal ways of treatment. Although only a small percentage of patients develop peripheral neuropathy, in a pandemic this can result in a major social and health impact. The reported case is the first case of bilateral secondary median nerve neuritis in the literature. Level of evidence 4.

Kidney Stone Disease of Non Gouty Origin in 264 Popes (34-2005 AD): A Historical Review

A total of 11 non-gouty popes out of 264 (4.1%) died of kidney stones (very probably calcium stones) between the years 34-2005 AD. The prevalence of kidney stones was lower than expected on the basis of recent population-based data. The discrepancy might be due to the changing nutritional habits. Causes of death included acute kidney injury, chronic kidney disease, and stroke. The disease was highly recurrent in 9 of 11 (88.1%). Recurrences were observed 1 to 30 years after the first attack. Mean age at death was 63.1 years, much shorter than expected in popes. Clinically recurrent back-flank-groin pain emerged as a hallmark indicator of kidney stones in the narratives. It was sometimes associated with fever, hematuria, purulent urine and/or frequent urination and dysuria. Some popes were obese, sedentary, voracious and wine drinkers; others were lean, took long walks, ate frugal meals and practiced restraint when it came to drinking alcohol. They were cured with bed rest, diets, donkey milk, mineral waters, decongestant, purgatives, thermal baths, blood-letting, and surgery.

Effect of BMI on Postoperative Outcome, after Off-Pump CABG, A Prospective Observational Study

Background: Obesity and its complications are global health concerns with rising interests, and in Bangladesh, the scenario is not different. This study was designed to analyze the effect of BMI on postoperative outcomes in patients who underwent Off-Pump Coronary Artery Bypass (OPCAB)graft surgery. Methods: This prospective observational study was conducted from September 2017 to August 2018 in the department of cardiac surgery, NICVD & 90 patients were divided into two groups. 43 patients in group A, with BMI ≥ 25 kg/m2 and 47 patients in group B, with BMI<25 kg/m2. Results: In between groups, homogenous distribution was noted in terms of age and sex. Pre-operative risk factors, such as hypertension, dyslipidemia, and sternal wound infection, harvest site infection along with post-operative AF, were significantly higher in group A in comparison to group B. Conclusion: Obese patients undergoing OPCAB surgery should undergo maximum care. Meticulous tissue handling during OPCAB surgery in obese patients is needed to avoid or minimize sternal, and harvest site wound infection.

Conversion to Reverse Total Shoulder Arthroplasty with and without Humeral Stem Retention: Mid-to Long-Term Results

Background: Over the past decade, conversion to Reverse Total Shoulder Arthroplasty (RTSA) has become the preferred treatment for revision of an Anatomic Hemi (HA) or Total Shoulder Arthroplasty (TSA). However, conversion of failed stemmed shoulder arthroplasty to RTSA is still a highly demanding procedure and carries unique technical challenges and risks. Questions/Purposes: This study aimed to analyze the mid- to long-term results after conversion of failed anatomical shoulder arthroplasty to RTSA and investigate whether preserving the humeral stem offers advantages over revising the humeral stem. Materials and Methods: Between 2005 and 2018, 99 hemiarthroplasties and 62 total shoulder arthroplasties (total =161 shoulders; 157 patients) were revised to RTSA without (n=47) or with (n=114) stem exchange. Complications and revisions were documented from medical and surgical records. Longitudinal pre- and post-operative clinical (Constant-Murley (CS) score, Subjective Shoulder Value (SSV)), and radiographic outcomes were assessed. Complete clinical and radiographic follow-up was available on 80% of shoulders (127 patients; 128 of 161 procedures, 46 without and 82 with stem exchange) at a minimum of 24 months and a mean of 70 months (range, 24 to 184 months). Results: Humeral stem retention was associated with a significantly reduced surgical time (193 min vs. 227 min, p=0.001, less blood loss (591 mL vs. 753 mL, p=0.037), less intraoperative complications (13% vs. 19%; Odds Ratio (OR), 1.4, p=0.32) and fewer subsequent reinterventions (19% vs. 28%; OR, 2.3, p=0.06). The complication/revision rate leading to drop out from the study was considerable in the stem revision group (ten patients; ten of 114 shoulders (9%)), but there were no complication-related dropouts in the stem-retaining group. Conclusion: Our findings suggest that humeral stem revision is associated with decreased surgical time, less blood loss, less intra- and postoperative complications, and a lower revision rate compared to humeral stem retention. Based on these findings, a shoulder arthroplasty system modularity offers substantial benefit if conversion to reverse total shoulder arthroplasty becomes necessary. Level of Evidence: Level III, therapeutic study.