Management of Hand Surgery Services during the Novel Coronavirus Disease 2019 Pandemic.

Introduction The novel coronavirus disease 2019 (COVID-19) pandemic is an international public health emergency. Health systems must plan for the increasing requirements for critical care during the COVID-19 pandemic. The aim of this article is to offer strategies for hand surgeons to planning and implementing their response during the COVID-19 pandemic and in the subsequent phases to preserve health care system functioning. Materials and Methods Assessment of the principles of management related to COVID-19 management to develop pandemic preparedness and response protocols pertinent to patients, health care workers, and health systems. Results Strategies for the reorganizing hand surgery practice and a set of recommendations that should facilitate the process of rescheduling both out-patient service and surgical activities during the COVID-19 and its subsequent phases are suggested. Conclusion During the COVID-19 pandemic, management of patients requiring specialist care for hand conditions should be adapted to limit the risks associated with the virus without jeopardizing outcomes. These expedient recommendations during extraordinary circumstances are a foundation for further discussion on the topic as the COVID-19 pandemic evolves.

Examining trends in the evidence base for the treatment of burns and a quality assessment of randomised controlled trials over an 11-year period.

BACKGROUND: Previous articles assessed the evidence-base for the treatment of burns, but the latest was published in 2010, examining data up to and inclusive of 2008. The aim of this article is to examine the trend in the number of high-evidence publications over the subsequent 11-year period and quality-assess RCTs within this timeframe. MATERIALS AND METHODS: All articles published in Burns and Journal of Burn Care and Research (JBCR) were identified using PubMed Search Tools and its Single Citation Matcher function. These journals were manually screened from 01/01/2009-01/06/2020 inclusive. Additionally, a PubMed search was conducted searching for RCTs and meta-analyses in English with the MESH term burns to identify meta-analyses and RCTs in all other journals. The reporting of RCTs was assessed using a modified CONsolidated Standards of Reporting Trials (CONSORT) checklist. RESULTS: A total of 5145 articles were evaluated from Burns and JBCR, with 3230 (62.78%) from Burns and 1915 (37.22%) from JBCR. 0.012% were meta-analyses of RCTs, 0.30% were other meta-analyses, and 2.52% were initially identified as RCTs. Whilst a significant increase in the number of high-evidence publications is observed, these represent 2.83% (n = 237) of the total. An additional 95 RCTs were identified in other journals, 58 being included in quality-analysis. A total 128 RCTs were thus eligible for quality-assessment, the most popular individual topic being wound healing (n = 28; 21.88%). The most highly reported criterion was listed inclusion and exclusion criteria (n = 111; 86.72%) and the least reported criterion was allocation concealment (n = 22; 13.92%). CONCLUSIONS: This study observes a positive trend in high-evidence publications. The reporting of several CONSORT criteria in RCTs remains poor. Observation to standard reporting guidelines is advocated to improve the quality of reporting.

Breast reconstruction during the COVID-19 pandemic in resource-limited settings.

The coronavirus disease 2019 (COVID-19) is a novel, rapidly changing pandemic. It has affected specialized medical services in unprecedented ways. Surgical decision making, always the most important aspect of care has taken on an added layer of complexity in the face of the COVID-19 pandemic. Therefore, recommendations for breast reconstruction during COVID-19 remain challenging and unclear. This article reviews the impact of the COVID-19 pandemic and suggests potential approaches that could be considered in the absence of validated strategies in breast reconstruction.

Angiotensin-converting enzyme 2 gene expression in human male urological tissues: implications for pathogenesis and virus transmission pathways.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection occurs through binding and internalization of the viral spike protein to the angiotensin-converting enzyme 2 (ACE2) receptor on the host cell membrane. Pathological changes are caused by damage and failure of vital organs that express high levels of ACE2, including the lungs, the heart and the kidneys. The aim of this study was to investigate ACE2 gene expression in the human male urogenital tract using a public database. METHODS: A search of transcriptomic datasets from a database to investigate ACE2 gene expression in human urogenital tract tissue. RESULTS: The gene expression profile demonstrated that ACE2 gene expression was higher in human kidney cortex and testis than human lung tissue. The gene expression profile demonstrated that ACE2 gene expression in the human bladder and prostate was comparable to human lung tissue. CONCLUSIONS: Male urogenital tissues are directly susceptible to SARS-CoV-2 infection through the expression of ACE2. Moreover, the SARS-Cov-2/ACE2 interaction may disturb the male genital and reproductive functions.

Angiotensin-Converting Enzyme 2 Gene Expression in Breast Tissue.

OBJECTIVE: Binding to angiotensin-converting enzyme 2 (ACE2) receptor is a critical step for severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) to mediate its entry into target cells. ACE2 is expressed in many human tissues, including the lungs. However, no research has demonstrated that SARS-CoV-2 can infect human breast tissue. This study aimed to investigate ACE2 gene expression in human breast tissue using a public database. MATERIALS AND METHODS: A search of a public gene expression database was performed to investigate ACE2 gene expression in in human breast tissue. RESULTS: The gene expression profile demonstrated that ACE2 gene expression was higher in human breast tissue than human lung tissue. CONCLUSION: Our knowledge about coronavirus disease-2019 (COVID-19) is expanding rapidly. Clinicians are eager for vetted information regarding all aspects of this new illness, and this study demonstrates that the level of ACE2 expression in human breast tissue is higher than that in the lung tissue, a major target tissue affected by SARS-CoV-2 infection. This finding strongly suggests that SARS-CoV-2 infection causes breast pathology.

Evidence-based Plastic Surgery: Assessing Progress over Two 5-year Periods from 2009 to 2019.

Publications on evidence-based medicine have increased. Previous articles have examined evidence-based plastic surgery, but the latest was published in 2013. The aim of this study was to examine the trend in the number of high-evidence publications over two 5-year periods across 3 main plastic surgery journals. Further, this study aimed to quality-assess randomized controlled trials (RCTs) published in the latter period. METHODS: All articles were identified using PubMed Search Tools and Single Citation Matcher. Three journals were manually screened from May 15, 2009, to May 15, 2014, and from May 16, 2014, to May 16, 2019. The reporting of RCTs was assessed using a modified Consolidated Standards of Reporting Trials (CONSORT) checklist. RESULTS: Of a total of 17,334 publications, 6 were meta-analyses of RCTs, 120 were other meta-analyses, and 247 were initially identified as RCTs. Although a significant increase in the number of higher-evidence publications is observed, these represent 2.09% (n = 363) of the total. An estimated 86 RCTs were eligible for quality-assessment, with the most popular sub-specialty being breast surgery (n = 30). The most highly reported criteria were inclusion/exclusion criteria and blinding (both n = 67; 77.91%), and the least reported criterion was allocation concealment (n = 21; 24.42%). CONCLUSIONS: This study observes a positive trend in high-evidence publications. The number of RCTs published has increased significantly over a breadth of sub-specialties. The reporting of several CONSORT criteria in RCTs remains poor. Observation to standard reporting guidelines is advocated to improve the quality of reporting.

Gene Expression of Angiotensin-Converting Enzyme 2 Receptor in Skin and the Implications for COVID-19.

BACKGROUND: Binding to the angiotensin-converting enzyme 2 (ACE2) receptor is a critical step for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to enter target cells. This enzyme is expressed in many human tissues including the lungs, but no research has demonstrated that SARS-CoV-2 can infect human skin or subcutaneous fat tissue, despite the increasing number of reported skin manifestations. The aim of this study was to investigate ACE2 gene expression in skin using a public database. METHODS: A search of transcriptomic data sets from a public gene expression database to investigate ACE2 gene expression in human tissues. RESULTS: Human skin keratinocytes and basal cells express more ACE2 than lung epithelial cells. In contrast, both fibroblasts and melanocytes from human skin express less ACE2 than human lung epithelial cells. CONCLUSIONS: The high expression of ACE2 in keratinocytes and basal cells of human skin indicates that they may be directly susceptible to SARS-CoV-2 infection via the ACE2 receptor, especially in conditions of skin barrier dysfunction, and are therefore a potential target for the coronavirus.

Negative pressure rooms and COVID-19.

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes 2019 novel coronavirus disease (COVID-19), has rapidly developed into a global pandemic and public health emergency. The transmission and virulence of this new pathogen have raised concern for how best to protect healthcare professionals while effectively providing care to the infected patient requiring surgery. Although negative pressure rooms are ideal for aerosol-generating procedures, such as intubation and extubation, most operating theatres are generally maintained at a positive pressure when compared with the surrounding areas. This article compares negative and positive pressure rooms and the advantages of a negative pressure environment in optimising clinical care and minimising the exposure of patients and health care professionals to SARS-CoV-2.

Pathophysiology of coronavirus disease 2019 for wound care professionals.

There is pressing urgency to understand the pathogenesis of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes Coronavirus disease 2019 (COVID-19). The tissue tropism of SARS-CoV-2 includes not only the lung but also the vascular and integumentary systems. Angiotensin-converting enzyme 2 (ACE2) appears to be the key functional receptor for the virus. There is a prominent innate immune response to SARS-CoV-2 infection, including inflammatory cytokines, chemokines, the complement system, and acute phase proteins. The pathophysiologic significance of SARS-COV-2 and host immune system interaction, and COVID-19-associated coagulopathy instigating microvascular injury syndrome mediated by activation of complement pathways, and an associated procoagulant state is important for wound care professionals to understand.

The origins of modern plastic surgery.

There is an old saying that if you think you have discovered something new then it is because you don't read the German literature and there is some truth in this. When Plastic Surgery is mentioned the usual reply is "Ah, Gillies" as though he was the fons et origo of Plastic and Reconstructive surgery. The fact is that there were many more pioneering plastic surgeons outside the British Empire, whose work preceded and even surpassed Gilles. In 1818, Karl Ferdinand von Gräefe published "Rhinoplastik" and coined the term plastic surgery (Plastische Chirurgie). Eduard Zeis, in 1838 published the textbook "Handbuch der plastischen Chirurgie" and established its meaning based on hundreds of references. Undoubtably, the first decades of the 20th century, especially the war between 1914 and 1918, were the genesis of most modern developments in plastic surgery and there were many more pioneering plastic surgeons outside the British Empire, whose work preceded, equalled and even surpassed Gillies, despite his admirable achievements.

Association of high level gene expression of ACE2 in adipose tissue with mortality of COVID-19 infection in obese patients.

INTRODUCTION: Obese patients have an increased risk of COVID-19 critical illness leading to ICU admission or death compared to normal weight individuals. SARS-CoV-2 binding to angiotensin-converting enzyme 2 (ACE2) receptor is a critical step mediate virus entry into target cells. Articles have alluded that the level of ACE2 gene expression in adipose tissue is higher than lung tissue, but a PubMed search found no results in articles to demonstrate this. The aim of this study was to investigate ACE2 gene expression in adipose tissue and lung tissue using a public database. MATERIAL AND METHODS: A search of a public gene expression database to investigate ACE2 gene expression in human tissues. RESULTS: ACE2 gene expression was present in both visceral and subcutaneous adipose tissues. The gene expression profile demonstrated that ACE2 gene expression was higher in human visceral and subcutaneous adipose tissues than human lung tissue. CONCLUSION: This study demonstrates that ACE2 gene expression is higher in visceral and subcutaneous adipose tissue than that in lung tissue, a major target tissue affected by SARS-CoV-2 infection. This suggests a mechanism by which excess adiposity may drive greater infection severity in patients with COVID-19.