Evaluation of early complications, outcome, and mortality in Coronavirus Disease 2019 (COVID-19) infection in patients who underwent orthopedic surgery.

BACKGROUND: A higher mortality and morbidity rate has been reported in COVID-19 patients undergoing surgery. To reduce the morbidity and mortality rate in COVID-19 patients undergoing orthopedic procedures, we aimed to increase the threshold for surgical planning. METHODS: In a prospective cohort study, COVID-19 patients who underwent elective or emergent orthopedic surgery in three orthopedic surgery centers from February 2020 to September 2020 were included. In this period, 6751 patients were scheduled for orthopedic surgery. To increase surgical threshold planning, all patients with grade 5 of the American Society of Anesthesiologists (ASA) classification and patients with COVID-19 related moderate to severe pulmonary involvement were identified as high-risk patients and were excluded. RESULTS: 35 deaths occurred during the study. The frequency of deaths was significantly higher in patients with COVID-19, 6 (9.4%) than patients without COVID-19, 29 (0. 43%). The average hospitalization stay was 12.8 ± 12.1 days. The odds ratio (OR) for death was significantly higher in patients with COVID-19 than patients without COVID-19. [OR: 8.13, Confidence interval 95% (CI95%) (5.02-11.25), P: 0.001]. Four (6.3%) COVID-19-associated complications were recorded in this series that all were respiratory failure requiring unexpected postoperative ventilation. Twenty surgical complications (31.3%) were recorded. The odds ratio for ICU admission was significantly higher in patients with COVID-19 than patients without COVID-19. [OR: 5.46, CI 95% (2.68-8.68), P: 0.001]. CONCLUSIONS: An increased threshold for orthopedic surgery is suggested for COVID-19 patients with a mortality rate of 9.3%, which is less than the mortality rate in other studies. Level of evidence III.

Arthroscopic Posteromedial Corner Reconstruction: A Novel Technique and Case Series.

Objectives: This study aimed to introduce a novel arthroscopic treatment for medial and posteromedial instability of the knee and present the primary and follow-up results. Methods: All patients who underwent the arthroscopic approach to treat medial and posteromedial corner instability from 2007 to 2017 were included in this report. Overall, 45 patients were included, among which 75.6% were male. The mean age of patients was 32.2 ± 8.4 years. Overall, 44.4% and 15.6% of patients had associated meniscal injuries and chondral lesions, respectively. The mean follow-up duration of patients was 84.2 ± 25.3 months. Results: Overall, 37 patients developed a full range of motion (82.2%), and most patients (95.6%) showed excellent quadriceps strength (grades 4 and 5). All patients had a normal or 1+ posterior drawer test, Pivot shift test, and Lachman test on physical examination. Moreover, 60% had an associated isolated anterior cruciate ligament injury, 17.8% had an isolated posterior collateral ligament injury, and 17.6% had a combination of more than one ligament injury. One patient developed septic arthritis. Two patients experienced pain, and one pain patient developed pain with a bony spur formation in the medial epicondyle. Three patients showed a 2+ medial collateral ligament (MCL) test (moderate instability) at the final follow-up, all of whom had multi-ligament injuries. All patients, except the three patients who had a failed MCL reconstruction, returned to their previous activities. Conclusion: This study described a novel arthroscopic treatment of MCL injury, and the results showed acceptable postoperative and clinical outcomes. As the use of minimally invasive surgery may minimize multiple complications associated with open surgery, it is suggested that further studies be conducted regarding this approach when faced with patients who have MCL injuries requiring surgery.

Two-Year Functional Outcomes of Nonsurgical Treatment in Concomitant Anterior Cruciate Ligament and Medial Collateral Ligament Injuries: A Case-Control Study.

The anterior cruciate ligament (ACL) is a common knee injury in high-intensity sports, which can cause early career loss in young athletes. Concomitant damage to other knee stabilizers may occur, such as the medial collateral ligament (MCL). Recent studies have shown that knee stability can increase without surgical intervention in patients with ACL and MCL injuries. Regarding the importance of functional tests in return to exercise prediction, this study aims to measure nonsurgical approach's long-term outcome for concomitant ACL and MCL injuries with a focus on functional tests. This is a case-control study with a 2-year follow-up. The case group consisted of patients who had provided written consent and completed their 2-year follow-up, and the control group was made up of healthy people who did not have any knee medical conditions and were matched by age, gender, and activity level. Physical examinations, Tegner and International Knee Documentation Committee questionnaires, and knee magnetic resonance imaging were conducted, and functional performance tests were performed after a 10-minute warm-up. Lody's index (the ratio of injured-to-uninjured knee results) was calculated. The data were analyzed using independent t-test, one-way analysis of variance, chi-squared test, and Fisher's exact test. The study involved 11 patients in each concomitant ACL and MCL injury cases and healthy control groups with a mean age of 32.4 and 28 years, respectively. None of the patients reported knee instability symptoms in the 2-year follow-up. More than half of the patients continued their sports field without reinjury, with no significant difference in activity levels between case and control groups. The 6-meter hop test and single-leg hop test showed no significant difference between case and control groups (p-value: 0.326, 0.859), and no significant difference was observed in the three Carioca, cocontraction, and Shuttle tests in the 2-year follow-up. Functional tests in ACL and MCL injuries revealed normal outcomes, implying a nonsurgical approach for patients with proximal ACL tears, better knee stability, and no significant differences between the injured and control groups.

The effect of high hydrostatic pressure on the structure of whey proteins-guar gum mixture.

The effect of high hydrostatic pressure (HHP) on the structural properties of whey protein concentrate (WPC) and guar gum mixture has been investigated at pH 5. WPC (6 % w/v) and guar gum (0.25 % w/v) mixture was freeze dried after adjusting pH and treated at different pressure levels (0-600 MPa) for 0-30 min. The solubility of treated powders decreased significantly (p < 0.05) as treatment time and pressure levels increased. Thermal analysis showed an increase in denaturation temperature after HHP treatment at 600 MPa. A more crystalline structure was observed in samples treated with 600 MPa for 20 and 30 min. With increasing pressure and time, particle size of the samples increased and the highest particle size was belonged to sample treated at 600 MPa for 30 min (759.66 nm). SEM results exhibited that by applying the pressure, irregularity of shapes and particle size increased while the apparent cracks decreased. FTIR results indicated that HHP treatment changed shift in bond and peak intensity. As reported in the current study, the application of HHP treatment as a green physical technology on protein-polysaccharide mixture could be used to improve interaction of protein and polysaccharide.

Unhappy triad of the knee: What are the current concepts and opinions?

The association between injuries to the anterior cruciate ligament, medial collateral ligament, and medial meniscus (MM) has been known to orthopedic surgeons since 1936; O'Donoghue first used the term "unhappy triad" of the knee to describe this condition in 1950. Later studies revealed that involvement of the lateral meniscus is more common than MM in these cases, leading to a change in the definition. Recent studies have revealed that this triad may be primarily linked to knee anterolateral complex injuries. Although there is not a definite management protocol for this triad, we try to mention the most recent concepts about it in addition to expert opinions.

Combined medial patellofemoral ligament and medial patellotibial ligament reconstruction in recurrent patellar instability: A systematic review and meta-analysis.

BACKGROUND: The medial patellofemoral ligament (MPFL), along with the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament, aid in the stabilization of the patellofemoral joint. Although the MPFL is the primary stabilizer and the MPTL is a secondary limiter, this ligament is critical in maintaining joint stability. There have been few studies on the combined MPFL and MPTL reconstruction and its benefits. AIM: To look into the outcomes of combined MPFL and MPTL reconstruction in frequent patellar instability. METHODS: By May 8, 2022, four electronic databases were searched: Medline (PubMed), Scopus, Web of Science, and Google Scholar. General keywords such as "patellar instability," "patellar dislocation," "MPFL," "medial patellofemoral ligament," "MPTL," and "medial patellotibial ligament" were co-searched to increase the sensitivity of the search. RESULTS: The pooled effects of combined MPFL and MPTL reconstruction for Kujala score (12-mo follow-up) and Kujala score (24-mo follow-up) were positive and incremental, according to the findings of this meta-analysis. The mean difference between the Cincinnati scores was also positive, but not statistically significant. The combination of the two surgeries reduces pain. According to cumulative meta-analysis, the trend of pain reduction in various studies is declining over time. CONCLUSION: The combined MPFL and MPTL reconstruction has good clinical results in knee function and, in addition to providing good control to maintain patellofemoral joint balance, the patient's pain level decreases over time, making it a valid surgical method for patella stabilization.

Phase behavior and rheological properties of basil seed gum/whey protein isolate mixed dispersions and gels.

Many food formulations comprise proteins and polysaccharides simultaneously, contributing in the functional properties in food systems. In this study, the effects of basil seed gum (BSG) addition to whey protein isolate (WPI) dispersions were investigated through phase behavior, steady shear flow, and small amplitude oscillatory shear tests (SAOS). The phase behavior of WPI-BSG mixed solutions was dependent on the initial concentration of biopolymers, while the effect of BSG was predominant. Herschel-Bulkley model characterized the flow behavior of ternary mixtures, very well. Furthermore, apparent viscosity, the extent of thixotropy and viscoelastic behavior enhanced with increase in BSG concentration, significantly (p Ë‚ .05). Temperature sweep measurements showed a reduction in WPI gelling temperature by increase in BSG concentration. SEM results depending on BSG concentration revealed the protein continuous, bicontinuous, and polysaccharide continuous networks. Phase separation may be attributed to depletion flocculation and thermodynamic incompatibility of WPI and BSG molecules. The results confirmed the occurrence of phase separation and weak-gel formation through mixtures, but the rate of gelation was more than the phase separation. In consequence, these results may open up new horizons in developing novel food products and delivery systems as well as utilizing as emulsifying, thickening and gelling agents in food and pharmaceutical industry.

Utilization of chickpea protein isolate and Persian gum for microencapsulation of licorice root extract towards its incorporation into functional foods.

This study aimed at the fabrication of licorice extract (LE)-loaded microparticles by complex coacervation, using chickpea protein isolate (CPI) and soluble fraction of Persian gum (SFPG). The LE-loaded microparticles with the highest encapsulation efficiency (97.87%) and loading capacity (11.35%) were obtained at pH 3 and CPI: SFPG ratio, core: coating ratio, and polymer concentration of 2, 1.5, and 2, respectively. The LE-loaded microparticles (2-15 µm) possessed heterogeneous microstructure, and the Fourier-transform infrared spectroscopy data confirmed the pronounced effect of electrostatic interactions and hydrogen bonding. The thermostability, amorphous structure, and color of the LE-loaded microparticles were significantly enhanced, compared to free LE. The sensory evaluation of the model beverages containing LE-loaded microparticles revealed that the microencapsulation was able to mask the bitter aftertaste and color of the extract. Thus, the results of this research confirm the potential of CPI-SFPG complex coacervates for the efficient delivery of glycyrrhizin via incorporation into functional food products.