Chitinophaga pendula, sp. nov., from an air conditioner condensate drain line.

A Gram-negative, rod-shaped and filamentous bacterium designated MD30BT was isolated from a biofilm hanging in water flowing from an air conditioner condensate drain line in Honolulu, Hawai'i. Based on 1517 nucleotides of the strain's 16S rRNA gene, its nearest neighbours are Chitinophaga rhizosphaerae T16R-86T (96.7 %), Chitinophaga caseinilytica S-52T (96.6 %), Chitinophaga lutea ZY74T (96.6 %), Chitinophaga niabensis JS13-10T (96.6 %) and Chitinophaga ginsengisoli Gsoil 052T (96.5 %). MD30BT cells are non-motile, strictly aerobic, and catalase and oxidase positive. Growth occurs between 10 and 45 °C. Major fatty acids in whole cells of MD30BT are 13-methyl tetradecanoic acid (34.1 %), cis-11-hexadecenoic acid (30.3 %), and 3-hydroxy, 15-methyl hexadecanoic acid (13.3 %). The quinone system contains predominantly menaquinone MK-7. The polar lipid profile contains the major lipids phosphatidylethanolamine, one unidentified lipid lacking a functional group, and two unidentified aminolipids. sym-Homospermidine is the major polyamine. The G+C content of the genome is 47.58 mol%. Based on phenotypic and genotypic differences between MD30BT and extant species in the Chitinophaga, we propose that MD30BT represents a new Chitinophaga species, for which the name Chitinophaga pendula sp. nov. is proposed to accommodate strain MD30BT as the type strain (DSM 112477T=NCTC 14606T).

Effects of elevated temperatures on the development of immature stages of Anopheles gambiae (s.l.) mosquitoes.

OBJECTIVE: This study investigated the effects of temperature on the development of the immature stages of Anopheles gambiae (s.l.) mosquitoes. METHODS: Mosquito eggs were obtained from laboratory established colonies and reared under eight temperature regimes (25, 28, 30, 32, 34, 36, 38 and 40°C), and 80 ± 10% relative humidity. Larvae were checked daily for development to the next stage and for mortality. Pupation success, number of adults produced and sex ratio of the newly emerged adults were recorded. Larval survival was monitored every 24 h, and data were analysed using Kaplan-Meier survival analysis. Analysis of variance was used where data followed normal distribution, and a Kruskal-Wallis test where data were not normally distributed. Larval and pupal measurements were log-transformed and analysed using ordinary least square regression with robust standard errors. RESULTS: Increasing the temperature from 25 to 36°C decreased the development time by 10.57 days. Larval survival (X2 (6) = 5353.12, p < 0.001) and the number of adults produced (X2 (5) = 28.16, p < 0.001) decreased with increasing temperature. Increasing temperatures also resulted in significantly smaller larvae and pupae (p < 0.001). At higher temperatures, disproportionately more male than female mosquitoes were produced. CONCLUSIONS: Increased temperature affected different developmental stages in the life cycle of An. gambiae (s.l.) mosquitoes, from larval to adult emergence. This study contributes to the knowledge on the relationship between temperature and Anopheles mosquitoes and provides useful information for modelling vector population dynamics in the light of climate change.

Using ultrasonic attenuation in cortical bone to infer distributions on pore size.

In this work we infer the underlying distribution on pore radius in human cortical bone samples using ultrasonic attenuation data. We first discuss how to formulate polydisperse attenuation models using a probabilistic approach and the Waterman Truell model for scattering attenuation. We then compare the Independent Scattering Approximation and the higher-order Waterman Truell models' forward predictions for total attenuation in polydisperse samples. Following this, we formulate an inverse problem under the Prohorov Metric Framework coupled with variational regularization to stabilize this inverse problem. We then use experimental attenuation data taken from human cadaver samples and solve inverse problems resulting in nonparametric estimates of the probability density function on pore radius. We compare these estimates to the "true" microstructure of the bone samples determined via microCT imaging. We find that our methodology allows us to reliably estimate the underlying microstructure of the bone from attenuation data.

Characterizing Particle Evacuation in the Setting of Positive-pressure Body Exhaust Suit Using a Novel Gloving Technique.

The sterility of the gown-glove interface during total joint arthroplasty is a key factor in preventing contamination of the surgical field. To compare the potential of gown-glove interface contamination with a novel gloving technique versus standard gloving technique. We performed a study quantifying potential gown-glove interface contamination using two different gloving techniques. A 5 µm fluorescent powder simulated potential bacterial contamination. Each group gowned and gloved each hand using a modified technique versus traditional technique. Ultraviolet light was used to measure contamination at the gown-glove interface after performing a simulated surgery. The modified gloving technique did not statistically reduce the contamination at the gown-glove interface compared to the traditional gloving technique (p = 0.27). Despite using a gloving technique recently described as decreasing contamination, we noted contamination at the interface after performing a simulated surgery with a positive pressure exhaust suit. Further study is needed. (Journal of Surgical Orthopaedic Advances 30(3):166-169, 2021).

Cholesterol and neurodegeneration: longitudinal changes in serum cholesterol biomarkers are associated with new lesions and gray matter atrophy in multiple sclerosis over 5 years of follow-up.

BACKGROUND AND PURPOSE: Cholesterol is an important structural component of myelin and essential for brain homeostasis. Our objective was to investigate whether longitudinal changes in cholesterol biomarkers are associated with neurodegeneration in multiple sclerosis (MS). METHODS: This prospective, longitudinal study (n = 154) included 41 healthy controls, 76 relapsing-remitting MS subjects and 37 progressive MS subjects. Neurological examination, brain magnetic resonance imaging and blood samples were obtained at baseline and at 5-year follow-up visits. Cholesterol biomarkers measured included plasma total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol and the apolipoproteins ApoA-I, Apo-II, ApoB, ApoC-II and ApoE. Key cholesterol pathway single nucleotide polymorphisms were genotyped. RESULTS: Greater percentage increases in HDL-C and ApoA-I levels were associated with a lower rate of gray matter and cortical volume loss. Greater percentage increases in low-density lipoprotein cholesterol were associated with increases in new T2 lesions. The percentage increases in HDL-C (P = 0.032) and ApoA-I (P = 0.007) were smaller in patients with relapsing-remitting MS at baseline who converted to secondary progressive MS during the 5-year follow-up period. Changes in HDL-C and ApoA-I were associated with lipoprotein lipase rs328 genotype status. CONCLUSIONS: Increases in HDL-C and ApoA-I have protective associations with magnetic resonance imaging measures of neurodegeneration in MS.

Noise Exposure and Risk of Noise Induced Hearing Loss to the Adult Reconstruction Surgeon: Recommendations for Prevention and Monitoring.

Goal of the study was to determine the average noise exposure to the orthopaedic surgeon performing hip and knee arthroplasty and the benefit of customized hearing protection. Data from dosimeters (3MTM Edge 4) worn by three adult reconstruction orthopedic surgeons for a total of 27 operative day recordings was analyzed using 3MTM Detection Management Software (product version 2.7.152.0). Westone TRU custom hearing protection was used with different filters according to noise reduction rating (NRR). The overall average decibel level was 80.64 dB (73.6-87.2 dB, +/- 4.18). The peak decibel level averaged 103.66 dB (97.30-110.30, +/-3.02). The authors subjective trial of custom hearing protection determined the NRR 10 and 15 filters were most effective at noise reduction with adequate ability to communicate effectively. Our study demonstrates that the daily exposure to the total joint surgeon exceeds safe levels. (Journal of Surgical Orthopaedic Advances 29(4):202-204, 2020).

A Bundle Protocol to Reduce the Incidence of Periprosthetic Joint Infections After Total Joint Arthroplasty: A Single-Center Experience.

BACKGROUND: Periprosthetic joint infection (PJI) represents a devastating complication of total hip arthroplasty (THA) or total knee arthroplasty (TKA). Modifiable patient risk factors as well as various intraoperative and postoperative variables have been associated with risk of PJI. In 2011, our institution formulated a "bundle" to optimize patient outcomes after THA and TKA. The purpose of this report is to describe the "bundle" protocol we implemented for primary THA and TKA patients and to analyze its impact on rates of PJI and readmission. METHODS: Our bundle protocol for primary THA and TKA patients is conceptually organized about 3 chronological periods of patient care: preoperative, intraoperative, and postoperative. The institutional total joint database and electronic medical record were reviewed to identify all primary THAs and TKAs performed in the 2 years before and following implementation of the bundle. Rates of PJI and readmission were then calculated. RESULTS: Thirteen of 908 (1.43%) TKAs performed before the bundle became infected compared to only 1 of 890 (0.11%) TKAs performed after bundle implementation (P = .0016). Ten of 641 (1.56%) THAs performed before the bundle became infected, which was not statistically different from the 4 of 675 (0.59%) THAs performed after the bundle that became infected (P = .09). CONCLUSION: The bundle protocol we describe significantly reduced PJIs at our institution, which we attribute to patient selection, optimization of modifiable risk factors, and our perioperative protocol. We believe the bundle concept represents a systematic way to improve patient outcomes and increase value in total joint arthroplasty.

Cost Analysis of Sending Routine Pathology Specimens following Total Joint Arthroplasty in the Age of Bundled Payments.

Bundled payment plans are being developed as a means to curb healthcare spending. Routine histology following total hip arthroplasties (THA) and total knee arthroplasties (TKA) is standard practice at many institutions. Recently, the value of this practice has been questioned as histologic diagnoses in THA and TKA rarely differ from the clinical diagnoses. The goal of this study is to identify discrepant and discordant diagnoses following THA and TKA at an academic medical center and to calculate the cost-saving potential in the setting of a bundled payment plan. A retrospective chart review was conducted on 1,213 primary THA and TKA performed by two orthopaedic surgeons from 2012 to 2014. The clinical and histologic diagnoses were compared and classified as concordant, discrepant, or discordant. Cost information was obtained from the institutional billing office. One thousand one hundred and sixty-six THA and TKA were analyzed in the final cohort. Nineteen (1.6%) diagnoses were classified as discrepant while none were discordant. The cost of histologic examination per specimen was estimated to be $48.56. The total cost of all arthroplasties was $14,999,512.46, of which histologic examination made up 0.31% of the total cost. The results of this study corroborate the results of previous studies and support the proposition that routine histologic examination is not cost-effective. The cost incurred to perform histologic examination will become a cost deduction from future bundled payments. The practice of sending routine histologic specimens following TJA should be decided upon by the operating orthopaedic surgeon.

Conceptualizing Sexual Wellbeing: A Qualitative Investigation to Inform Development of a Measure (Natsal-SW).

Despite increasing scientific and policy interest in sexual wellbeing, it remains poorly conceptualized. Many studies purporting to measure it instead measure related but distinct concepts, such as sexual satisfaction. This lack of conceptual clarity impedes understanding, measuring, and improving sexual wellbeing. We present qualitative research from multi-stage, mixed-methods work to develop a new measure of sexual wellbeing (Natsal-SW) for the fourth British National Survey of Sexual Attitudes & Lifestyles. Literature review and discussion generated a conceptual framework with seven proposed domains: respect, self-esteem, comfort, self-determination, safety and security, forgiveness, and resilience. Semi-structured interviews with 40 adults aged 18-64 then explored whether and how these domains aligned with participants' own understandings, experiences, and language of sexual wellbeing. Data were analyzed thematically. Participants conceptualized sexual wellbeing as distinct from sexual satisfaction and sexual health and as multidimensional, dynamic, and socially and structurally influenced. All seven proposed domains resonated with accounts of sexual wellbeing as a general construct. The personal salience of different domains and their dimensions varied between individuals (especially by gender and sexual orientation) and fluctuated individually over time. This study clarifies dimensions of domains that participants considered important, providing an empirical basis to inform development of a new measure of sexual wellbeing.

Susceptibility of Capsicum varieties to Thaumatotibia leucotreta (Lepidoptera: Tortricidae) infestation for production optimization.

Thaumatotibia leucotreta Meyrick (Lepidoptera: Tortricidae) is a major threat to the production and marketing of pepper (Capsicum spp.) in Ghana. To reduce the damage of the pest on pepper farming, it is important to find appropriate control methods, which may include the use of resistant host plants. This study investigated the relative susceptibility of 6 pepper varieties commonly cultivated in Ghana: Legon 18, Bird's eye, Scotch bonnet, Cayenne, KA2, and sweet pepper (Yolo wonder+ variety). Choice and no-choice ovipositional preference tests were conducted and the population growth rate of T. leucotreta was determined by establishing life table parameters including the net reproductive rates (R0), the mean generation time (G), intrinsic rate of natural increase (rm), the population doubling time (T), and the finite rate of increase (λ). In the no-choice test, females exhibited oviposition preference for sweet pepper (12.08 eggs/fruit), while Bird's eye was the least preferred (5.00 eggs/fruit). The same results were observed in the choice test. However, the population growth rate of T. leucotreta was highest on the Scotch bonnet and Cayenne, with rm of 0.124 and 0.127, respectively, while the Bird's eye and sweet pepper recorded the least rm of 0.116. Thus, the tested varieties had varying levels of susceptibility to T. leucotreta infestation. Bird's eye was the least susceptible variety, while Cayenne and Scotch bonnet were the most susceptible varieties. These findings could direct farmers on the choices of pepper varieties for cultivation and proffer potential opportunities to breed new varieties resistant to T. leucotreta infestation.

Wireless In-Ear Communication for Total Joint Arthroplasty: A Simulated Operating Room Evaluation.

Effective communication is vital for patient safety, yet failures are common, often due to outdated methods. This study aimed to assess whether in-ear communication devices improve communication in orthopedic surgery simulations compared to traditional loud voice methods. Fifteen participants underwent simulations using both in-ear wireless devices and standard communication. Results showed significant improvements with in-ear devices in correctly identifying phrases (78.6% vs 44%), effectiveness (7.9/10 vs 4.9/10), and clarity (8/10 vs 4/10), all P < .001. Participants also favored in-ear devices in usability assessments. Sound levels recorded were comparable between groups. In conclusion, in-ear communication is safe and effective in orthopedic settings, potentially enhancing efficiency and safety. These devices can mitigate loud noises, benefiting surgeon well-being and patient outcomes.

A useful tool for retained washer retrieval when removing iliosacral screws.

Iliosacral screw removal is occasionally necessary during index or revision pelvic ring surgery. This procedure can necessitate a two-step process: screw removal followed by retained washer removal. On attempted removal of the screw-washer complex, the washer will not uncommonly dissociate itself from the screw. Its retrieval can be challenging, add unnecessary operative time, and result in larger incisions and increased soft tissue disruptions. This article introduces a simple technique for retained washer retrieval when removing or exchanging iliosacral screws. This technique involves an "interference fit" between the retained washer and a screw or tap of larger diameter, allowing for reliable and simple washer extraction. Advantages of this technique include removal through the same soft tissue tract as initial screw insertion and subsequent screw removal. It also obviates the need for introduction of various clamps to extract the washer, which can result in soft tissue injury and increased reliance on fluoroscopy.

Randomized controlled trial of intrathecal oxytocin on speed of recovery after hip arthroplasty.

ABSTRACT: Recovery from surgery is quicker in the postpartum period, and this may reflect oxytocin action in the spinal cord. We hypothesized that intrathecal injection of oxytocin would speed recovery from pain and disability after major surgery. Ninety-eight individuals undergoing elective total hip arthroplasty were randomized to receive either intrathecal oxytocin (100 µg) or saline. Participants completed diaries assessing pain and opioid use daily and disability weekly, and they wore an accelerometer beginning 2 weeks before surgery until 8 weeks after. Groups were compared using modelled, adjusted trajectories of these measures. The study was stopped early due to the lack of funding. Ninety patients received intrathecal oxytocin (n = 44) or saline (n = 46) and were included in the analysis. There were no study drug-related adverse effects. Modelled pain trajectory, the primary analysis, did not differ between the groups, either in pain on day of hospital discharge (intercept: -0.1 [95% CI: -0.8 to 0.6], P = 0.746) or in reductions over time (slope: 0.1 pain units per log of time [95% CI: 0-0.2], P = 0.057). In planned secondary analyses, postoperative opioid use ended earlier in the oxytocin group and oxytocin-treated patients walked nearly 1000 more steps daily at 8 weeks ( P < 0.001) and exhibited a clinically meaningful reduction in disability for the first 21 postoperative days ( P = 0.007) compared with saline placebo. Intrathecal oxytocin before hip replacement surgery does not speed recovery from worst daily pain. Secondary analyses suggest that further study of intrathecal oxytocin to speed functional recovery without worsening pain after surgery is warranted.

Dynamic efficiency assessment of the Chinese hotel industry.

The paper introduces for the first time a totally dynamic two-stage approach to analyzing the hotel industry's technical efficiency at the sub-national level. The first stage uses data envelopment window analysis (DEWA) to assess regional hotel sectors' technical efficiency over time. Unlike previous studies, the second stage uses a dynamic Tobit model to investigate the impact of macro contextual factors on the hotel sector efficiency. The study chooses the Chinese hotel industry during the period 2001-2006 as its application setting. The findings of the investigation indicate that the Chinese hotel industry is approaching an efficient operation in general, recovering from a major dip in 2003 resulting from the Severe Acute Respiratory Syndrome (SARS) outbreak. In addition, the study introduces a novel two-dimensional efficiency-based matrix to assess the competitive advantage of different regions of the Chinese hotel sector. The paper presents strategic market implications for hoteliers, government decision-makers, and destination management organizations. The proposed methods are applicable for situations in which an exogenous event of a destabilizing impact (e.g., SARS) does occur.

Closing Time: One Last Call for Patient Preference.

Background: Wound closure method in total hip and knee arthroplasty is a controversial topic with no differences in clinical outcomes between surgical staples (SS) and subcutaneous sutures with Dermabond (SCD). When clinically appropriate, providers should focus more on what the patient may prefer. This study aimed to collect data on patient preference between SS and SCD and analyze differences in preference based on gender and previous surgical histories. Methods: Patients were surveyed on their wound closure preferences prior to surgery. The handout given collected preference and patient demographics. Risk ratios and risk difference with 95% confidence intervals (95% CI) were calculated along with Firth-corrected logistic regressions. Results: A total of 163 participants were analyzed (53% female) (average age = 63.8 years), in which 12 participants selected SS as their preferred method. Males demonstrated no difference in relative risk (risk ratio: 2.3 [95% CI: 0.7, 7.3], P = .150) or absolute risk (risk difference: 5.9 [-2.2, 14.1], P = .156) in choosing SS over SCD. Patients that previously sustained SS for other surgeries demonstrated no difference in adjusted odds (adjusted: 0.9 [95% CI: 0.2, 3.2], P = .839) in choosing SS over SCD. Conclusion: More patients favored SCD over SS. There was no difference in preferences based on gender or previous surgical history. Current literature shows that successful wound closure is achieved with minimized risks for infection and other complications using both methods. Providers should adopt a patient-centric approach and perform the closure method that most patients prefer when medically warranted.

Factors associated with late-stage presentation of cervical cancer in Ghana.

Objective: To explore factors associated with late clinical presentation among Ghanaian women with cervical cancer. Design: This is a cross-sectional survey using a paper questionnaire. Setting: Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. Participants: Participants were women presenting for cervical cancer care at KATH. Inclusion criteria were histologically diagnosed cervical cancer and age ≥18 years. The exclusion criteria was age <18. All women presenting from August 2018-August 2019 were recruited. Main outcome measures: The primary outcome was the proportion of participants presenting with late-stage cervical cancer, defined as stage II or higher. Results: Of 351 total participants, 33.6% were unemployed, 35.3% had no formal education, and 96.6% had an average monthly income of less than five hundred Ghana cedis ($86 USD). Time from symptoms to seeing a doctor ranged from fewer than two weeks (16.0%) to more than twelve months (8.6%). Participants' most common barrier in seeking healthcare was financial constraints (50.0%). Most participants presented at late-stage cervical cancer (95.2%, n=334), with only 4.8% (n=17) presenting at stage I. Of participants presenting with late-stage cervical cancer, the vast majority had never had a Papanicolaou (Pap) smear (99.1%) nor a recent gynecologic exam (99.3%). After adjusting for age, parity, and distance to a healthcare facility, a late-stage presentation was associated with lower income and living in a rural area. Conclusions: In Ghana, 95% of women with cervical cancer seek care at a late clinical stage, defined as stage II or greater, when the cancer is inoperable. Funding: None declared.

Effects of Elevated Temperatures on the Growth and Development of Adult Anopheles gambiae (s.l.) (Diptera: Culicidae) Mosquitoes.

Higher temperatures expected in a future warmer climate could adversely affect the growth and development of mosquitoes. This study investigated the effects of elevated temperatures on longevity, gonotrophic cycle length, biting rate, fecundity, and body size of Anopheles gambiae (s.l.) (Diptera: Culicidae) mosquitoes. Anopheles gambiae (s.l.) eggs obtained from laboratory established colonies were reared under eight temperature regimes (25, 28, 30, 32, 34, 36, 38, and 40°C), and 80 ± 10% RH. All adults were allowed to feed on a 10% sugar solution soaked in cotton wool; however, some mosquitoes were provided blood meal using guinea pig. Longevity was estimated for both blood-fed and non-blood-fed mosquitoes and analyzed using the Kaplan-Meier survival analysis. One-way ANOVA was used to test the effect of temperature on gonotrophic cycle length, biting rate, and fecundity. Adult measurement data were log-transformed and analyzed using ordinary least square regression with robust standard errors. Increasing temperature significantly decreased the longevity of both blood-fed (Log-rank test; X2(4) = 904.15, P < 0.001) and non-blood-fed (Log-rank test; X2(4) = 1163.60, P < 0.001) mosquitoes. In addition, the fecundity of mosquitoes decreased significantly (ANOVA; F(2,57) = 3.46, P = 0.038) with an increase in temperature. Body size (ß = 0.14, 95% CI, 0.16, 0.12, P < 0.001) and proboscis length (ß = 0.13, 95% CI, 0.17, 0.09, P < 0.001) significantly decreased with increasing temperature from 25 to 34°C. Increased temperatures expected in a future warmer climate could cause some unexpected effects on mosquitoes by directly influencing population dynamics and malaria transmission.

Overview and future research needs for development of effective biocontrol strategies for management of Bactrocera dorsalis Hendel (Diptera: Tephritidae) in sub-Saharan Africa.

Infestation of fruits by native and invasive fruit flies causes significant economic losses. In most cases, incidence of 'regulated' dangerous fruit flies in orchards results in restrictions on export of fruits from such places to international markets. Unfortunately, use of insecticides applied on foliage and fruits does not kill the fruit-to-soil stages of fruit flies. However, diverse biological control agents (BCAs) do so. Thus, prevalence of native and invasive fruit flies in orchards will require that a combination of BCAs is included in integrated pest management (IPM) programmes. In the case of Bactrocera dorsalis Hendel and other economically important fruit flies found in sub-Saharan Africa (SSA), use of classical biocontrol approach involves concomitant releases of two exotic parasitoids (Fopius arisanus Sonan and Diachasmimorpha longicaudata Ashmead). These non-native wasps may have complemented the indigenous parasitoids in combination with application of entomopathogenic fungi (EPFs) and conservation of predatory ants (Oecophylla longinoda Latreille, with O. smaragdina) in fruit fly IPM plans. Consequently, some levels of decline in fruit infestation have been observed. Although interspecific interactions between BCAs against several insect pests have produced varying results, including threatening the survival of other BCAs, the prevalence of B. dorsalis in orchards across SSA requires further research to investigate effects of coalescing biocontrol approaches in IPM strategies. Therefore, future research into combining parasitoids, EPFs and entomopathogenic nematodes, in addition to conservation of predatory ants (O. longinoda, O. smaragdina and others) in IPM plans may improve the effectiveness of currently used strategies for the management of fruit-infesting tephritids. © 2021 Society of Chemical Industry.

Removing Well-Fixed, Collared and Noncollared Tapered Hip Stems Without an Extended Trochanteric Osteotomy Using a Novel Stem Removal System.

Improvements in materials, components, and surgical techniques in cementless total hip arthroplasty are resulting in improved femoral stem fixation through bony ongrowth or ingrowth. While improved femoral stem fixation is one reason for the current excellent total hip survivorship, indications for stem removal such as infection, implant fracture, or osteolysis remain. A commonly used technique for fully ingrown femoral stems is an extended trochanteric osteotomy which can result in comminuted fractures of the proximal femur during stem removal requiring additional fixation. Therefore, a novel hip stem removal was developed to facilitate removal of these well-ingrown stems without the need for an extended trochanteric osteotomy. This study describes the removal system and surgical technique and presents a case series of successfully removed ingrown stems.

Prolonged Weakness and Paresthesia After Revision Total Hip Arthroplasty in a Patient with Sickle Cell Anemia Receiving Spinal Anesthesia: A Case Report.

CASE: This report describes a case of prolonged neurologic deficit of primarily the nonoperative lower extremity in a patient with sickle cell disease (SCD) who received spinal anesthesia during revision total hip arthroplasty (THA). The patient initially showed bilateral lower extremity neurologic deficits localized to the L5/S1 nerve root, with the eventual persistence of symptoms in the nonoperative extremity for >1 year. CONCLUSIONS: This report describes an unusual complication after THA and spinal anesthesia. This case highlights the rare occurrence of nerve root injury after spinal anesthesia and emphasizes the importance of close perioperative monitoring in patients with SCD undergoing orthopaedic surgery.