3-D Printing in Orthopaedic Surgery: Book Review

This is a book review on 3-D printing in orthopedic surgery which is a novel technique on patient care.

Good Uptake of the COVID-19 Vaccine Among Patients with Rheumatic Diseases in the United Arab Emirates (UAE)

Background: Many patients with rheumatic diseases are immunosuppressed and take forms of immunomodulator medication. Hence, these patients might be at a heightened risk of Covid-19 and have special concerns in regard to vaccines, such as safety and efficacy. Vaccines have been available for the population of UAE as of January 2021, these being Pfizer (the United States and Europe), Sinopharm (China), and AstraZeneca (United Kingdom). The aim of our paper was to examine the rate of vaccine uptake among our patients with rheumatic conditions in the United Arab Emirates. Methods: A questionnaire was distributed among patients with rheumatic diseases attending a rheumatology specialised clinic in the United Arab Emirates. We collected data on 149 consecutive patients who were seen during a one-month period from 10/06/2021 to 10/07/2021 in Dubai. Results: The mean age of the patients was 45.9 +/- 41.3. The majority of the patients had underlying rheumatic diseases (86.9%), the rest having conditions such as soft tissue pain or to rule out rheumatic conditions. 48.5% were taking immunomodulators. 41.7% of respondents had other chronic diseases. It was also found that 18.9% had Covid-19 previously, all of whom recovered, with the average duration of the illness being 11 days. 99.1% of individuals reported that receiving the Covid-19 vaccine was extremely important, and 95.0% had already received the vaccination. Their reasoning for receiving the vaccination varied from medical advice (17.5%), general worry about infection/ reinfection of Covid-19 (65.3%), in order to travel (8.4%), employee requirement (5.6%), and other reasons (3.2%). Specifically, 48.3% chose the Pfizer vaccine, 39.8% had Sinopharm, and 11.9% had AstraZeneca. These decisions on which vaccine to choose were influenced by the availability of the vaccine (35.1%), medical advice (16.9%), effectiveness (15.5%), safety and side effect profile (18.2%), age restrictions (2.7%), experience/ advice from friends and family (8.1%) and other reasons (3.4%). Conclusion: Overall, an overwhelming majority of our patients (95.0%) with rheumatic diseases in the specialised muscular-skeletal clinic in the UAE have received the Covid-19 vaccine. This reflects good public health service messaging and concentrated efforts from the medical community, UAE government, and the patient’s rheumatologists.

Healthcare Professional’s Perceptions of E-Learning during the COVID-19 Pandemic

Background: COVID-19 has a significant impact on lives worldwide. Owing to the adverse effect of this pandemic, there has been a major shift from in-person learning activities to virtual learning. Different methods of virtual learning or e-learning, such as online classes and webinars, have emerged rapidly. Objective: The aim of this study is to identify the perceptions of healthcare professionals regarding e-learning during the COVID-19 pandemic. Method: An online survey was conducted using Microsoft Forms sent via a text link to mobile phones and emails to healthcare professionals. The questionnaire had multiple-choice questions and five-point scaling to determine perceptions about virtual learning. Data in the form of responses were collected, analyzed, and summarized as mean ± standard deviation and percentage. Results: Responses were received from a total of 410 participants, out of which 240 (58.54%) were females, and 170 (41.46%) were males. Among all participants, 294 (71.71%) were doctors. A vast majority of participants (90%) attended online webinar/e-conferences since the pandemic. The mobile phone was the most commonly used device for e-learning. More than half of the participants opined that in-person meetings are more effective than virtual meetings. In terms of medical learning, 40.48% of participants believed that virtual conferences are more convenient compared to conventional in-person attendance. According to 42.2% of participants, lack of personal interaction in virtual meetings affected their ability to acquire knowledge and experience. Conclusion: Our survey demonstrated the acceptance of virtual learning by healthcare professionals as a new learning method. The majority of participants seem willing to adapt to this new medium.

Preventing the Catastrophe: Aberrant Carotid in Adenoid and Tonsil Surgery: Two Case Reports

Background: Adenoid and tonsil surgeries are the most commonly done surgical procedures, with haemorrhage being an important complication. Fatalities due to haemorrhage almost never occur, but the occasional devastating outcomes that are life-threatening become a frequent source of litigations and audits. Catastrophic bleeds are usually due to an aberrant vessel or carotid protruding in the pharyngeal airway. The aberrant carotid poses a risk during routine pharyngeal surgeries like adenoidectomy, tonsillectomy, Quincy and Para-pharyngeal abscess drainage, UPPP, pharyngeal biopsies, etc. and injuries during routine pharyngeal surgical procedures can be catastrophic due to massive bleeding. Case report: We report two cases of routine Adeno-tonsillectomy surgeries where aberrant carotid vessels protruding in the adeno-tonsil surgical area were identified by endoscopic transoral evaluation intraoperatively. The surgery in these cases was postponed for further investigation due to the risk of injury and catastrophic bleeding. Conclusion: Aberrant carotids are usually clinically silent, and adenoid removal in most cases is a blind procedure done by curettage. There are no guidelines to identify aberrant vessels pre or intraoperatively, and preventing injury and catastrophic bleeding depends on surgeon’s experience and caution. These cases underline the importance of due vigilance and taking steps before starting the procedures, particularly pre-and intraoperative transoral endoscopic assessment for identifying aberrant vessels in the upper airway area, thus preventing injury and avoiding devastating complications. We report these cases and underline the steps to identify aberrant vessels in the upper airway surgical field before starting surgery to prevent a potentially catastrophic complication.

EBV Reactivation in A Case of DRESS Syndrome Associated with Lamotrigine – A Case Report

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) is a rare, T-cell mediated hypersensitivity reaction that develops secondary to a drug reaction. Several drugs have been associated with DRESS syndrome, most commonly carbamazepine. The mechanism is not clearly understood. It is a life-threatening condition that can present with skin rash, hematologic abnormalities, lymphadenopathy, and organ failure. Case Presentation: The authors report a case of 43-year-old gentleman who developed DRESS syndrome secondary to lamotrigine and was found to have EBV reactivation. Patient was managed with supportive care; topical steroids and the culprit drug were discontinued. He had full recovery almost 2 weeks following treatment. DRESS syndrome can occur 2 weeks following exposure to an offending drug in susceptible individuals. Conclusion: Lamotrigine and EBV reactivation are not frequently reported in patients with DRESS syndrome. Therefore, physicians should be vigilant about this rare drug related hypersensitivity reaction in order to prevent life threatening complications.

The Use of Intermittent Non-Invasive Ventilation as an Alveolar Recruitment Method for Patient with Severe COVID 19 Pneumonia

Background: The use of non-invasive ventilation (NIV) as a therapy for acute respiratory distress syndrome (ARDS) secondary to COVID 19 pneumonia has been controversial. NIV is an aerosol generating procedure which may increase the risk of viral transmission amongst patients and staff. Because of fear of aerosolizing the virus and transmitting the disease, initial expert recommendation was to avoid NIV and proceed with early intubation. With further experience of the virus, this recommendation has been challenged and NIV has been used widely with some retrospective studies quoting between 11 to 56 percent of COVID 19 related respiratory failures being treated with NIV. Objective: The objective of this study is to assess the efficacy and safety of using non-invasive mechanical ventilation as an alveolar recruitment method for patients with severe COVID 19 pneumonia. This method was used by our respiratory team on selected patients during the early phase of the COVID 19 pandemic. Methods: We reviewed the charts of patients that were admitted to the American Hospital Dubai intensive care unit, or our medical step-down unit who had diffuse bilateral infiltrates requiring oxygen supplementation between March and October 2020. We identified patients who were on intermittent BiPAP in addition to standard care. We also monitored the rate of infection among staff taking care of these patients. Results: Average length of stay after starting BIPAP therapy was 6.8 days, while the average total length of stay was 13.6 days. Only one patient was transferred to the ICU after being on the BIPAP protocol and did not need intubation. All patients were discharged home either without oxygen or with their chronic baseline home oxygen requirement. Radiological improvement in aeration was seen in 100% of patients at follow-up x-ray post-intervention. There were no reported pulmonary complications from barotrauma, such as pneumothorax or pneumomediastinum. There were no reported cases of staff infection to the health care workers that were taking care of these patients Conclusion: Our first of its kind observational study showed clearly that using BIPAP therapy for one hour three times daily during nebulization therapy in addition to standard care resulted in a significant reduction in hospital length of stay and hastened the clinical and radiological improvement of patients with severe COVID 19 pneumonia.

Methemoglobinaemia in Diabetic Ketoacidosis Patient

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common X-linked genetic disorder. Case Presentation: In this paper, we report a case of a 41-years-old male patient with non-insulin-dependent diabetes and a family history of G6PD deficiency never known to have any previous hemolytic episodes, presented as a case of diabetic ketoacidosis with features of hemolytic anemia due to G6PD deficiency manifesting as methemoglobinemia and anemia. Conclusion: Our patient successfully managed with ascorbic acid and red blood cell transfusion. Clinicians should, therefore, be aware of the possibility of this uncommon association between diabetic ketoacidosis, G6PD deficiency, and methemoglobinemia which may be present in patients with G6PD deficiency and severe hemolysis.

A Rare Case Report of Inguinal Herniation with Urinary Bladder as its Content

Background: Although inguinal hernias are common, cases of inguinal hernia involving the bladder were observed to be very rare (<5%). Diagnosis of Inguinal Bladder Herniation (IBH) is very challenging, and it was reported to be identified only in ≤10% of cases prior to an operation and ≤20% during surgical intervention. The majority of the patients are asymptomatic or have non-specific symptoms, making the condition difficult to diagnose pre-operatively. In many cases, the condition is usually diagnosed intraoperatively. Therefore, diagnosis, surgical planning, and careful management can play a vital role in avoiding any unwanted complications. Case Presentation: In the present case, a 60-year-old male patient with a known history of malignancy was presented to our hospital without any symptoms related to inguinal hernias. Conclusion: During his routine check-ups, the patient was fortuitously diagnosed with IBH. The patient underwent surgery, and the defect was repaired using Bassini hernioplasty without any complications. Postoperative recovery was uneventful. On follow-up, no pain or urinary-related symptoms were reported.

Postnatal Growth Restriction in Preterm Infants: A Major Impact of Nutritional Practices and Methods of Assessment

Background: Nutritional management of preterm infants represents a significant challenge for most practitioners caring for sick and/or premature babies. Despite aggressive parenteral and enteral alimentation, a considerable number of preterm infants continue to fall far short of expected growth trajectories that match infants of similar gestation in-utero. Postnatal growth failure may be associated with future neurodevelopmental and cognitive impairments. Objective: The aim of the research is to investigate the incidence of postnatal growth restriction (PNGR) and characteristics of nutritional practices and growth parameters in a cohort of preterm infants born <32 weeks’ gestational age (GA) in a single neonatal intensive care unit (NICU). Methodology: This prospective study included 130 preterm infants born <32 weeks’ GA and admitted to the NICU between February 2018 and January 2020. The infants were divided into two groups: A (GA 23–26+6 weeks [n=50]) and B (27–31+6 weeks [n=80]). The association between PNGR and predicting risk factors was evaluated using logistic regression models. Results: PNGR was found in 62 (47%) infants at 28 days of life and increased to 73% of infants at 36 weeks’ postmenstrual age. Low birth weight and GA were independent factors predicting growth failure. PNGR was significantly correlated with birth weight (p < 0.01), length (p < 0.002), and GA (p < 0.03) at birth; however, HC was not a predictor of PNGR at 28 days. At 36 weeks’ PMA or discharge, PNGR was more pronounced in length, with a mean Z-score of -3.0, followed by weight, with a mean Z-score of -2.1, and an HC Z-score of -1.4. Conclusion : PNGR was significantly high in preterm infants <32 weeks’ gestation. A significant nutritional gap still exists between the recommended and actual caloric and protein supplementation, especially in the first few days after birth. Delayed optimization of caloric intake may be insufficient to promote growth trajectories, especially in preterm infants with significant morbidities.

Subacute Thyroiditis Post-Covid-19 Infection: A Case Report

Background: Subacute thyroiditis (SAT) or granulomatous thyroiditis is usually a self-limiting inflammatory condition. The clinical presentation varies from person to person, but is usually associated with pain and systemic symptoms. Case Report: Herein, a case of a previously healthy 40 years old male who presented with unilateral right neck pain of gradual onset and progressive course has been described. The patient had recovered from a symptomatic Covid-19 infection 5 months back. The clinical examination, imaging and histopathological examination were consistent with the clinical diagnosis of subacute thyroiditis. The patient received medication in the form of pain killer, Celebrex and paracetamol, without corticosteroids, and completely recovered. Conclusion: The possibility of subacute thyroiditis post-COVID-19 infection should be considered.