Thyroidal Angiotensin-Converting Enzyme 2 Protein Expression and Thyroid Function Tests in Patients with COVID-19: Results from a Retrospective Case Series and a Prospective Cohort Study.

Background: Infection with SARS-CoV-2 has initially been known as a respiratory disease but in the course of the pandemic the understanding has emerged that severity is owing to fatal inflammatory responses apart from lung injury. In this context, endocrine disorders such as thyroiditis as well as pituitary dysfunction in addition to nonthyroidal illness syndrome have been described. Furthermore, angiotensin-converting enzyme 2 (ACE2), the SARS-CoV-2 cell receptor, has been detected in most endocrine tissues, including the thyroid gland. Objective: To evaluate histopathologic changes and compare thyroidal ACE2 protein expression in thyroid tissue from patients who died from severe COVID-19 with thyroid tissue from patients without SARS-CoV-2 infection in a retrospective case series. Furthermore, to assess and compare alterations in thyroid function tests (TFTs) between patients with or without SARS-CoV-2 infection as well as association of TFTs with the severity of the disease in a prospective cohort study. Methods: Thyroid tissue of deceased COVID-19 patients (n = 23) was analyzed for histopathology and ACE2 expression by immunohistochemical staining. A total of 153 patients with confirmed SARS-CoV-2 were evaluated regarding TFTs and divided into a severe (intubation, intensive care treatment) and an intermediate group. Results: Thyroidal ACE2 expression was detected in 87% of the deceased COVID-19 patients. Normal thyroid tissue from patients without SARS-CoV-2 infection showed no ACE2 protein expression. Half of the severely ill COVID-19 patients had low free triiodothyronine (fT3) levels. Combination of low fT3 and thyrotropin (TSH) was associated significantly with deadly disease. Conclusion: The high percentage of positive ACE2 immunostaining in deceased patients compared with normal thyroid tissue of patients without SARS-CoV-2 infection suggests involvement of the thyroid in COVID-19, although further research will have to show the pathogenic role of thyroidal ACE2 in COVID-19. Abnormal fT3 and a TSH of ≤0.5 mU/L were associated with a fatal outcome in our severely ill SARS-CoV-2 patient cohort. Therefore, assessment of TFTs is crucial in the treatment of severely ill COVID-19 patients. Trial Registration: COVID-19 Registry of the LMU University Hospital Munich (CORKUM), WHO trial ID DRKS00021225.

PREOPERATIVE ANALYSIS OF RADIOGRAPHIC FINDINGS IN 516 PATIENTS WITH HALLUX VALGUS DEFORMITY.

OBJECTIVE: This is a descriptive study to report our method of operative correction for patients with hallux valgus deformities. METHODS: From 2006 to 2012, 516 consecutive patients (601 feet) with hallux valgus deformities were treated surgically in our department after conservative treatments were exhausted. The hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and degree of osteoarthritis in the first metatarsophalangeal joint were measured on preoperative plain radiographs of the weight-bearing forefoot. RESULTS: Young patients with severe intermetatarsal deviation received a combined proximal and distal osteotomy of the first metatarsal (n = 21). Patients with low intermetatarsal deviation received a distal metatarsal chevron osteotomy (n = 196), whereas patients with severe intermetatarsal deviation and less flexible deformities without osteoarthritis received a basal metatarsal osteotomy with a distal soft tissue procedure (n = 173). Elderly active patients with osteoarthritis in the first metatarsophalangeal joint received an arthrodesis (n = 100) or resection arthroplasty (n = 58). CONCLUSION: Determining a few simple angles on plain radiographs of the weight-bearing forefoot in combination with the age and level of activity of patients can help simplify the operative correction method by using the schema we developed. Level of evidence IV, case series.

OBJETIVO: Este é um estudo descritivo para relatar nosso método de correção cirúrgica para pacientes com deformidades de hálux valgo. MÉTODOS: De 2006 a 2012, 516 pacientes consecutivos (601 pés) com deformidade de hálux valgo foram tratados cirurgicamente em nosso departamento, depois que os tratamentos conservadores foram esgotados. O ângulo do hálux valgo, o ângulo intermetatarsal, o ângulo articular metatarsal distal e o grau de osteoartrite da primeira articulação metatarsofalângica foram medidos em radiografias pré-operatórias simples do antepé com apoio de peso. RESULTADOS: Os pacientes jovens com desvio intermetatarsal grave foram submetidos à combinação de osteotomia distal e proximal do primeiro metatarso (n = 21). Os pacientes com desvio intermetatarsal menor foram submetidos a osteotomia de Chevron no metatarso distal (n = 196), enquanto que os pacientes com desvio intermetatarsal grave e deformidades menos flexíveis e sem osteoartrite foram submetidos a osteotomia da base do metatarso com um procedimento distal no tecido mole (n = 173). Nos pacientes idosos ativos com osteoartrite na primeira articulação metatarsofalângica realizou-se artrodese (n = 100) ou artroplastia de ressecção (n = 58). CONCLUSÃO: Determinar alguns ângulos com radiografias simples do antepé com apoio de peso em combinação com idade e nível de atividade dos pacientes pode ajudar e simplificar o método de correção cirúrgica, usando o esquema que desenvolvemos. Nível de Evidência IV, Série de casos.

Preoperative analysis of radiographic findings in 516 patients with hallux valgus deformity / Análise pré-operatória de achados radiográficos em 516 pacientes com deformidade de hallux valgus

ABSTRACT Objective: This is a descriptive study to report our method of operative correction for patients with hallux valgus deformities. Methods: From 2006 to 2012, 516 consecutive patients (601 feet) with hallux valgus deformities were treated surgically in our department after conservative treatments were exhausted. The hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and degree of osteoarthritis in the first metatarsophalangeal joint were measured on preoperative plain radiographs of the weight-bearing forefoot. Results: Young patients with severe intermetatarsal deviation received a combined proximal and distal osteotomy of the first metatarsal (n = 21). Patients with low intermetatarsal deviation received a distal metatarsal chevron osteotomy (n = 196), whereas patients with severe intermetatarsal deviation and less flexible deformities without osteoarthritis received a basal metatarsal osteotomy with a distal soft tissue procedure (n = 173). Elderly active patients with osteoarthritis in the first metatarsophalangeal joint received an arthrodesis (n = 100) or resection arthroplasty (n = 58). Conclusion: Determining a few simple angles on plain radiographs of the weight-bearing forefoot in combination with the age and level of activity of patients can help simplify the operative correction method by using the schema we developed. Level of evidence IV, case series.

RESUMO Objetivo: Este é um estudo descritivo para relatar nosso método de correção cirúrgica para pacientes com deformidades de hálux valgo. Métodos: De 2006 a 2012, 516 pacientes consecutivos (601 pés) com deformidade de hálux valgo foram tratados cirurgicamente em nosso departamento, depois que os tratamentos conservadores foram esgotados. O ângulo do hálux valgo, o ângulo intermetatarsal, o ângulo articular metatarsal distal e o grau de osteoartrite da primeira articulação metatarsofalângica foram medidos em radiografias pré-operatórias simples do antepé com apoio de peso. Resultados: Os pacientes jovens com desvio intermetatarsal grave foram submetidos à combinação de osteotomia distal e proximal do primeiro metatarso (n = 21). Os pacientes com desvio intermetatarsal menor foram submetidos a osteotomia de Chevron no metatarso distal (n = 196), enquanto que os pacientes com desvio intermetatarsal grave e deformidades menos flexíveis e sem osteoartrite foram submetidos a osteotomia da base do metatarso com um procedimento distal no tecido mole (n = 173). Nos pacientes idosos ativos com osteoartrite na primeira articulação metatarsofalângica realizou-se artrodese (n = 100) ou artroplastia de ressecção (n = 58). Conclusão: Determinar alguns ângulos com radiografias simples do antepé com apoio de peso em combinação com idade e nível de atividade dos pacientes pode ajudar e simplificar o método de correção cirúrgica, usando o esquema que desenvolvemos. Nível de Evidência IV, Série de casos.