Clinical Experience with COVID-19 at a Specialty Orthopedic Hospital Converted to a Pandemic Overflow Field Hospital

Background

COVID-19, the illness caused by the novel coronavirus, SARS-CoV-2, has sickened millions and killed hundreds of thousands as of June 2020. New York City was affected gravely. Our hospital, a specialty orthopedic hospital unaccustomed to large volumes of patients with life-threatening respiratory infections, underwent rapid adaptation to care for COVID-19 patients in response to emergency surge conditions at neighboring hospitals.

Purposes

We sought to determine the attributes, pharmacologic and other treatments, and clinical course in the cohort of patients with COVID-19 who were admitted to our hospital at the height of the pandemic in April 2020 in New York City.

Methods

We conducted a retrospective observational cohort study of all patients admitted between April 1 and April 21, 2020, who had a diagnosis of COVID-19. Data were gathered from the electronic health record and by manual chart abstraction.

Results

Of the 148 patients admitted with COVID-19 (mean age, 62 years), ten patients died. There were no deaths among non-critically ill patients transferred from other hospitals, while 26% of those with critical illness died. A subset of COVID-19 patients was admitted for orthopedic and medical conditions other than COVID-19, and some of these patients required intensive care and ventilatory support.

Conclusion

Professional and organizational flexibility during pandemic conditions allowed a specialty orthopedic hospital to provide excellent care in a global public health emergency.

     

Effect of Preoperative Diabetes on the Achievement of Forgotten Knee Status in Patients with Total Knee Arthroplasty

BackgroundForgotten knee is the terminology which is used to describe a post-TKA patient who is completely unaware of his knee implant. The aim of the study is to determine whether preoperative diabetes negatively influences the achievement of forgotten knee status.MethodsThis is a retrospective cohort study. 300 patients (240 F:60 M) were studied. Patients were evaluated by an independent observer with FJS-12 score 2 weeks preop and at 6 weeks and 12 months after the operation. The patients with a FJS-12 score of ≥ 55 were considered to have achieved forgotten knee status. Out of 240 females, 96 had diabetes and out of 60 males, 18 had diabetes. Preoperative factors such as preop HBA1c, ROM, degree of deformity, VAS score and other associated co morbidities and postoperative factors such as HBA1c, ROM and hip–knee–ankle alignment were studied. Study was started with null hypothesis. The statistical difference was measured with Binominal proportion test and comparison of means t test.Results96 out of 144 non-diabetic females (66.67%) and 51 out of 96 diabetic females (53%) achieved forgotten knee status (statistically significant, p value = 0.0336, Binominal proportion test). 27 out of 42 (65%) non-diabetic males and 12 out 18 diabetic males (66%) achieved forgotten knee status (p value = 0.9411). The FJS-12 score at 1 year for non-diabetic females and diabetic females was 58.6 mean ± 12.6 SD and 53.8 ± 17.6, respectively, which is statistically significant, p value 0.0145. The FJS-12 at 1 year in non-diabetic and diabetic males was 60.1 ± 14.8 and 59.6 ± 17.3, respectively, p value = 0.9097.ConclusionDiabetic females have less chance of achieving a forgotten knee status than non-diabetic females. This understanding will help the operating surgeon in the preoperative patient counseling and modify the patient expectations.     

An Early Experience with a Novel Technique of Total Knee Arthroplasty for Osteoarthritic Knee with Coexistent Traumatic Tibia Diaphysis Fracture

BackgroundTreatment of tibia (upper third and diaphysis) fracture together with severe osteoarthritis (OA) poses challenge to an orthopedic surgeon. Traditionally, it is treated through three-stage surgeries, first fracture fixation followed by implant removal and finally surgery of total knee arthroplasty (TKA). Herein, we describe a novel TKA procedure using long-stemmed tibia component. This one-step technique not only addresses arthritis of the knee joint but also helps in assisting fixation of the fracture.Materials and MethodsWe reported outcomes of three female non-diabetic patients with OA who developed tibia shaft fracture following trauma. Range of motion and quadriceps strengthening exercise were initiated immediately after the procedure. X-rays anteroposterior and lateral views of the operated limbs were obtained at post-operative week-6 and week-12. We allowed the patients’ toe touch weight-bearing immediately after the surgery. The patients were progressed to full weight-bearing after confirming radiological union on the X-rays.ResultsAt follow-up, all treated patients were able to mobilize with good range of motion of the operated knee and with union of the fracture. The American Knee society scores and WOMAC pain and stiffness scores improved significantly.ConclusionThis novel technique offers one-stage solution to the complex situation of osteoarthritis of the knee with associated tibia shaft fracture, thereby reducing future hospital admissions/surgeries and associated costs and complications. Further, it allows faster rehabilitation.     

Laparoscopic sleeve gastrectomy improves brain connectivity in obese patients

Journal of Neurology - Obese individuals have shown functional abnormalities in frontal–limbic regions, and bariatric surgery is an effective treatment for morbid obesity. The aim of the...     

Evaluative distractors modulate attentional disengagement: People would rather stay longer on rewards

Attentional disengagement is of great significance to individuals adapting to their environment who can benefit from disregarding the attraction of salient and task-irrelevant objects. Previous studies have suggested that, in addition to causing greater financial loss compared with neutral distractors, reward distractors hold attention longer than neutral distractors. However, few studies have directly compared the attentional disengagement differences between reward-associated and loss- or punishment-associated stimuli. In the current study, we used different color singleton stimuli tied to reward or punishment outcomes; the stimuli were present in the center of the screen. Participants were required to respond to a line within the target at a peripheral location. The results showed that the response to the target was slower when the central distractor was associated with a reward than with punishment. This finding reflects that, although participants understand that reward-associated and punishment-associated stimuli have an equal opportunity for the same economic benefit, they still take longer to disengage from a reward distractor compared with a punishment distractor.     

Functional Near-Infrared Spectroscopy Neurofeedback of Cortical Target Enhances Hippocampal Activation and Memory Performance

Dear Editor, Neuromodulation,a rapidly expanding field attracting wide attention over recent decades,facilitates human cognition,behavior,and pathology by modif...     

Ventromedial Prefrontal Cortex Drives the Prioritization of Self-Associated Stimuli in Working Memory

Humans show a pervasive bias for processing self- over other-related information, including in working memory (WM), where people prioritize the maintenance of self- (over other-) associated cues. To elucidate the neural mechanisms underlying this self-bias, we paired a self- versus other-associated spatial WM task with fMRI and transcranial direct current stimulation (tDCS) of human participants of both sexes. Maintaining self- (over other-) associated cues resulted in enhanced activity in classic WM regions (frontoparietal cortex), and in superior multivoxel pattern decoding of the cue locations from visual cortex. Moreover, ventromedial PFC (VMPFC) displayed enhanced functional connectivity with WM regions during maintenance of self-associated cues, which predicted individuals'' behavioral self-prioritization effects. In a follow-up tDCS experiment, we targeted VMPFC with excitatory (anodal), inhibitory (cathodal), or sham tDCS. Cathodal tDCS eliminated the self-prioritization effect. These findings provide strong converging evidence for a causal role of VMPFC in driving self-prioritization effects in WM and provide a unique window into the interaction between social, self-referential processing and high-level cognitive control processes.SIGNIFICANCE STATEMENT People have a strong tendency to attend to self-related stimuli, such as their names. This self-bias extends to the automatic prioritization of arbitrarily self-associated stimuli held in working memory. Since working memory is central to high-level cognition, this bias could influence how we make decisions. It is therefore important to understand the underlying brain mechanisms. Here, we used neuroimaging and noninvasive neurostimulation techniques to show that the source of self-bias in working memory is the ventromedial PFC, which modulates activity in frontoparietal brain regions to produce prioritized representations of self-associated stimuli in sensory cortex. This work thus reveals a brain circuit underlying the socially motivated (self-referential) biasing of high-level cognitive processing.     

Diagnostic difficulties in the management of H-type tracheoesophageal fistula

Purpose: To evaluate the diagnostic difficulties and pitfalls in establishing the diagnosis of congenital H-type tracheoesophageal fistula.

Material and Methods: A retrospective review of all cases of H-type tracheoesophageal fistula that were diagnosed in a single unit over a 6-year period. The variables assessed were age at presentation, presenting symptoms, time to diagnosis, investigations, and time to surgical repair of H-type fistula. The investigations leading to a definitive diagnosis are assessed and discussed.

Results: Between 1998 and 2004, five cases of H-type tracheoesophageal fistula presented to our unit. All cases had an upper gastrointestinal contrast study/tube esophagogram. In addition, four cases had a chest radiograph, three cases had a bronchoscopy, and one case an esophagoscopy. The median delay from the time of first presentation to diagnosis of H-type tracheoesophageal fistula was 14 days (7-58 days). Median age at surgery was 15 days (8-60 days).

Conclusion: Although symptoms are usually present from birth, the diagnosis of H-type fistula is difficult and often delayed. The various diagnostic techniques are not entirely reliable and fistula identification can be elusive. The authors present recommendations for the diagnostic work-up, which may increase the diagnostic potential and avoid unnecessary delays in the diagnosis and management of H fistula.     

Are we sensitive to valence differences in emotionally negative stimuli? Electrophysiological evidence from an ERP study

The present study investigated whether the human brain is sensitive to valence differences in emotionally negative stimuli by recording event-related potentials (ERPs) for extremely negative (EN), moderately negative (MN), and neutral pictures while subjects perform a standard/deviant categorization task, irrespective of the emotional valence of the deviants. Using the same design, we also investigated the sensitivity of the human brain to valence differences in emotionally positive stimuli. Experiment 1 showed that EN stimuli elicited more negative deflections than MN stimuli in the early P2 and N2, later P3, and slow negative wave (SNW) components. In contrast, there were no differences in amplitude or latency in these components during the extremely positive (EP) and moderately positive (MP) conditions of Experiment 2. This suggests that humans are only sensitive to valence differences in negative stimuli, and that these negative valences could be processed differentially throughout the information processing stream even when individuals are highly engaged in a non-emotional task.     

The neural basis of conditional reasoning: an event-related potential study

The spatiotemporal analysis of brain activation during the execution of conditional reasoning tasks (the four inference forms: Modus Ponens (MP), Modus Tollens (MT), affirming the consequent (AC), and denying the antecedent (DA)) and one baseline task (BS) was performed in 12 normal young adult participants using high-density event-related brain potentials (ERPs). Results showed that the early components elicited by the five task types were not significantly different. Reasoning tasks elicited a more negative EPR deflection (N600) than did the BS task in the time window of 500-700 ms after onset of the minor premise. Dipole source analysis of the difference wave (MP-BS) suggested that a generator localized in the left anterior cingulate cortex (BA 24) was involved in the activation and the application of the inference rules. ERP components of the five tasks were similar in the subsequent time period between 700 and 1700 ms. Following that period, a greater negativity in the reasoning tasks, in comparison to the BS task, developed between 1700 and 2000 ms poststimulus over the left fronto-central scalp regions. A generator of this effect was located in the right anterior cingulate cortex (BA 24) and was possibly related to cognitive control. The results indicate that the cingulate cortex was activated by conditional reasoning tasks with purely abstract materials and support the view that human reasoning is not a unified phenomenon but is content-sensitive.