Targeted protein S-nitrosylation of ACE2 inhibits SARS-CoV-2 infection.

Prevention of infection and propagation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a high priority in the Coronavirus Disease 2019 (COVID-19) pandemic. Here we describe S-nitrosylation of multiple proteins involved in SARS-CoV-2 infection, including angiotensin-converting enzyme 2 (ACE2), the receptor for viral entry. This reaction prevents binding of ACE2 to the SARS-CoV-2 spike protein, thereby inhibiting viral entry, infectivity and cytotoxicity. Aminoadamantane compounds also inhibit coronavirus ion channels formed by envelope (E) protein. Accordingly, we developed dual-mechanism aminoadamantane nitrate compounds that inhibit viral entry and, thus, the spread of infection by S-nitrosylating ACE2 via targeted delivery of the drug after E protein channel blockade. These non-toxic compounds are active in vitro and in vivo in the Syrian hamster COVID-19 model and, thus, provide a novel avenue to pursue therapy.

Efficacy of Triglyceride Glucose Index-Neck Circumference and Triglyceride Glucose Index-Neck-to-Height Ratio in the Diagnosis of Cardiovascular Diseases and Metabolic Syndrome.

BACKGROUND: A group of characteristics known as metabolic syndrome raises the chance of developing diabetes and cardiovascular disease. Insulin resistance (IR) and obesity are regarded as critical metabolic syndrome pathophysiology. OBJECTIVES: The diagnostic accuracy of IR indicators, triglyceride (TG) glucose index-neck circumference (TyG-NC), and TG glucose index-neck-to-height ratio (TyG-NHtR) to be evaluated for the detection of cardiovascular diseases and metabolic syndrome in nondiabetic individuals. MATERIALS AND METHODS: A cross-sectional study was conducted and passed by the Ethics Committee of the institute. The age should be 18 years or older, and subjects should not have diabetes. Each patient's clinical information was gathered, and lab tests were run. The study was done for a period of 1 year. RESULTS: The study has 100 participants. Around 74% of the group was women. Only 26.5% of the group had an obesity diagnosis. Poor fasting plasma glucose levels were found in 19.4% of the research team. Receiver operating characteristic (ROC)-area under the curve (AUC) testing revealed that all examined IR indices can differentiate individuals with metabolic syndrome from those who are healthy. Our analysis laid out the soaring high area under the ROC curve for TyG index and the low stunted area under the ROC curve for TyG-NC. For obesity, all indices showed appreciable diagnostic efficacy, indicating the maximum achieved area under the ROC curve for TyG index and the minimum recorded metabolic score for IR. The AUC in the case of the metabolic score for IR (METS-IR) male sample population was found to be not statistically compelling. CONCLUSION: The exploration of indirect indices, the proposed ones, namely TyG-NC and TyG-NHtR, emphasized an intricate link between cardiovascular diseases and metabolic syndrome.

Cross-sectional study on the role of public awareness in preventing the spread of COVID-19 outbreak in India.

BACKGROUND: WHO has recommended personal hygiene (respiratory hygiene, using face masks, washing hands with warm water and soap, use of alcohol-based hand sanitizers, avoid touching mouth, eyes & nose, cleanliness), social distancing and careful handling of purchased products as an effective preventive measure for COVID-19 disease. The growing pandemic of COVID-19 disease requires social distancing and personal hygiene measures to protect public health. But this message is not clear and well understood among people. The aim of this study is to determine the awareness, knowledge and attitude about COVID-19 and relate the behaviour of Indian society, especially when the country is restarting all its economic activities, after the complete lockdown. METHOD: The present paper is based on an extensive survey among 21 406 adult participants of various sections of Indian society with different age groups between 18 and 80 years to introspect the level of public awareness with respect to cause, spread, prevention and treatment of disease caused by spread of COVID-19 viral outbreak, which will be automatically reflected in the societal behavioural response of rigorous precautionary measures. CONCLUSIONS: There is a need to extend the knowledge base among individuals to enhance their active participation in the prevention mechanisms with respect to the spread of the pandemic. There is a need to elaborate the Indian socio-cultural aspects, so that society starts appreciating and voluntarily following social distancing. This should improve the adaptability of people with livelihood resilience to let them protect themselves not only from the present pandemic but also from all other unforeseen infections, and to provide care to patients.

Characterization of a class III peroxidase from Artemisia annua: relevance to artemisinin metabolism and beyond.

KEY MESSAGE: A class III peroxidase from Artemisia annua has been shown to indicate the possibility of cellular localization-based role diversity, which may have implications in artemisinin catabolism as well as lignification. Artemisia annua derives its importance from the antimalarial artemisinin. The -O-O- linkage in artemisinin makes peroxidases relevant to its metabolism. Earlier, we identified three peroxidase-coding genes from A. annua, whereby Aa547 showed higher expression in the low-artemisinin plant stage whereas Aa528 and Aa540 showed higher expression in the artemisinin-rich plant stage. Here we carried out tertiary structure homology modelling of the peroxidases for docking studies. Maximum binding affinity for artemisinin was shown by Aa547. Further, Aa547 showed greater binding affinity for post-artemisinin metabolite, deoxyartemisinin, as compared to pre-artemisinin metabolites (dihydroartemisinic hydroperoxide, artemisinic acid, dihydroartemisinic acid). It also showed significant binding affinity for the monolignol, coniferyl alcohol. Moreover, Aa547 expression was related inversely to artemisinin content and directly to total lignin content as indicated by its transient silencing and overexpression in A. annua. Artemisinin reduction assay also indicated inverse relationship between Aa547 expression and artemisinin content. Subcellular localization using GFP fusion suggested that Aa547 is peroxisomal. Nevertheless, dual localization (intracellular/extracellular) of Aa547 could not be ruled out due to its effect on both, artemisinin and lignin. Taken together, this indicates possibility of localization-based role diversity for Aa547, which may have implications in artemisinin catabolism as well as lignification in A. annua.

Establishment of a tele-evidence facility at the post graduate institute of medical education and research, Chandigarh: A unique initiative.

Doctors are duty bound to assist the delivery of justice by providing expert opinion/evidence in a court of law. However, the time spent in doing so comes at the cost of patient care. The healthcare sector and the judiciary are seized of the matter, and the use of technology as an avenue to ease the process is desirable. Tele-evidence or testimony through video conference can be that breakthrough. The Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, has institutionalized the mechanism of tele-evidence with the concurrence of the High Court of Punjab and Haryana. This was made possible after many permutations and combinations were tried, because the existing information technology infrastructure of the stakeholders was not compatible. The desired solution was achieved, and other institutions working to establish similar facilities can learn from the experience of PGIMER to achieve faster results.

Catalytic Asymmetric Epoxidation of Aldehydes with Two VANOL-Derived Chiral Borate Catalysts.

A highly diastereo- and enantioselective method for the epoxidation of aldehydes with α-diazoacetamides has been developed with two different borate ester catalysts of VANOL. Both catalytic systems are general for aromatic, aliphatic, and acetylenic aldehydes, giving high yields and inductions for nearly all cases. One borate ester catalyst has two molecules of VANOL and the other only one VANOL. Catalysts generated from BINOL and VAPOL are ineffective catalysts. An application is shown for access to the side-chain of taxol.

Glycemic Control in Patients with Diabetic Kidney Disease; Time to Recognize Perils of Iatrogenic Hypoglycemia?Moving away from Intensive Glycemic Control.

The chronic complications of Diabetes Mellitus (DM), which may be present in as many as 50% of the patients at the time of diagnosis, are a major burden for both individuals with the disease and health systems and it has been estimated that as much as 60-70% of healthcare expenditure related to diabetes (about 670 billion dollars a year) is currently attributable to chronic complications of the disease. These high prevalence rates are widely acknowledged to further rise as poor lifestyle choices and their consequences continue to rise. Adding to that is an aging population and urbanization that together will make situation even more challenging. Type 2 diabetes affects about 90-95% of newly diagnosed patients of diabetes and accounts for majority of cases of Chronic Kidney Disease (CKD). In other words, CKD affects about 20-40% of individuals with diabetes making it one of the most common complication related to the disease. The risk of renal failure is 25 times higher in diabetic patients than in the non-diabetic population. Thus patients with diabetes and renal failure represent a special risk group as they have higher morbidity and mortality and are at a higher risk of hypoglycaemia than diabetic individuals with normal renal function. In addition, for all the physicians who are taking care of patients of diabetes and kidney disease, formulation of comprehensive plan of management directed at modification of risk factors of cardiovascular disease (CVD) is of utmost importance as majority of patients with CKD die as a result of cardiovascular complications rather than progression to ESRD, (accounting for about 70% of deaths over the age of 65). The contrasting results available from clinical trials in recent years have generated perplexity amid concerns that glucose-lowering therapies, under certain circumstances, might even be detrimental; in light of the fact that intensive glycemic control increased the risk for death by 22% in the ACCORD trial. Moreover it should be pooled data of some extensive reviews which has been carried in last one and half year have demonstrated that intensive glycemic control significantly increases the risk of cardiovascular and all-cause mortality in patients of CKD. So it is increasingly problematic for clinicians to continue aggressive glycemic control for the treatment of renal outcome in patients of advanced renal insufficiency with multiple co-morbidities. Thus, a lower survival benefit due to multiple comorbidities combined with general lower life expectancy necessitates a balanced approach. Suggesting the need for revised and extended target of HBA1C in this patient population.

Pyro-Borates, Spiro-Borates, and Boroxinates of BINOL-Assembly, Structures, and Reactivity.

VANOL and VAPOL ligands are known to react with three equivalents of B(OPh)3 to form a catalytic species that contains a boroxinate core with three boron atoms, and these have proven to be effective catalysts for a number of reactions. However, it was not known whether the closely related BINOL ligand will likewise form a boroxinate species. It had simply been observed that mixtures of BINOL and B(OPh)3 were very poor catalysts compared to the same mixtures with VANOL or VAPOL. Borate esters of BINOL have been investigated as chiral catalysts, and these include meso-borates, spiro-borates, and diborabicyclo-borate esters. Borate esters are often in equilibrium, and their structures can be determined by stoichiometry and/or thermodynamics, especially in the presence of a base. The present study examines the structures of borate esters of BINOL that are produced with different stoichiometric combinations of BINOL with B(OPh)3 in the presence and absence of a base. Depending on conditions, pyro-borates, spiro-borates, and boroxinate species can be generated and their effectiveness in a catalytic asymmetric aziridination was evaluated. The finding is that BINOL borate species are not necessarily inferior catalysts to those of VANOL and VAPOL but that, under the conditions, BINOL forms two different catalytic species (a boroxinate and a spiro-borate) that give opposite asymmetric inductions. However, many BINOL derivatives with substitutents in the 3- and 3'-positions gave only the boroxinate species and the 3,3'-Ph2BINOL ligand gave a boroxinate catalyst that gives excellent inductions in the aziridination reaction. BINOL derivatives with larger groups in the 3,3'-position will not form either spiro-borates or boroxinate species and thus are not effective catalysts at all.

Catalyst-Controlled Multicomponent Aziridination of Chiral Aldehydes.

A highly diastereoselective and enantioselective method for the multicomponent aziridination of chiral aldehydes has been developed with BOROX catalysts of the VANOL (3,3'-diphenyl-2,2'-bi-1-naphthol) and VAPOL (2,2'-diphenyl-(4-biphenanthrol)) ligands. Very high to perfect catalyst control is observed with most all substrates examined including aldehydes with chiral centers in the α- and ß-positions. High catalyst control was also observed for a number of chiral heterocyclic aldehydes allowing for the preparation of epoxy aziridines, bis(aziridines) and ethylene diaziridines. Application of this reaction in the synthesis of ß3 -homo-d-alloisoleucine and ß3 -homo-l-isoleucine is reported.

Multicomponent Catalytic Asymmetric Synthesis of trans-Aziridines.

A multicomponent trans-aziridination of aldehydes, amines, and diazo compounds with BOROX catalysts is developed. The optimal protocol is slightly different for aryl aldehydes than for aliphatic aldehydes. The key to the success with aryl aldehydes was allowing the catalyst, aldehyde, and amine to react for 20 min before addition of the diazo compound. A variety of 11 different electron-poor and electron-rich aryl aldehydes were screened to give trans-aziridines in 73-90% yield with 82-99% ee and trans/cis selectivities of 19:1 to >99:1. The optimal protocol for the trans-aziridination of aliphatic aldehydes did not require prereaction of the catalyst, aldehyde, and amine, and instead, the diazo compound could be added directly. The scope of the reaction is limited to unbranched aliphatic aldehydes and was tolerant of a number of functional groups including ethers, esters, epoxides, carbamates, and phthalimides. A total of 10 aliphatic aldehydes were examined and found to give trans-aziridines in 60-88% yield with 60-98% ee and trans/cis selectivities of 6:1 to >99:1. Alkenyl aldehydes did not react, but an alkynyl aldehyde gave a 71% yield and 95% ee of an aziridine that was found to be the cis- and not the trans-diastereomer. The aryl and aliphatic aldehydes both gave the trans-aziridines with the same absolute configuration with the same catalyst; however, in those cases where cis-aziridines were formed, the configuration was opposite for those formed from aryl versus aliphatic aldehydes.

Salicylic acid induces differential antioxidant response in spring maize under high temperature stress.

High temperature is one of the important stress factors that affect crops in tropical countries. Plants do evolve or adopt different mechanisms to overcome such stress for survival. It is an interesting subject and has attracted many researchers to work upon. Here, we studied the effect of salicylic acid (SA) on seedling growth and antioxidative defense system in two spring maize (Zea mays L.) genotypes viz., CML-32 (relatively heat tolerant) and LM-11 (relatively heat susceptible), under high temperature stress. High temperature induced greater reduction in dry biomass of LM-1 1 seedlings as compared to those of CML-32. There was a parallel increase in ascorbate peroxidase and glutathione reductase activities in the roots of CML-32 seedlings. However, the activities of catalase and superoxide dismutase decreased and the contents of H202, proline and malonaldialdehyde (MDA) increased in seedlings of both the genotypes. Application of SA (400 µM) led to increased dry biomass in heat stressed CML-32 seedlings. It improved the efficiency of Halliwell-Asada pathway in roots of CML-32 seedlings as was evidenced by the enhanced ascorbate peroxidase and glutathione reductase activities. The activities of catalase and superoxide dismutase increased in both the tissues of LM-11 seedlings, whereas in CML-32, it was only in shoots, after SA application. Peroxidase activity increased in SA treated seedlings of both the genotypes, though the increase was comparatively higher in CML-32. The contents of H2O2 and MDA decreased and that of proline increased in SA treated seedlings of both the genotypes, under stress conditions. It may be concluded that SA induced differential antioxidant response by upregulating Halliwell-Asada pathway in roots and attaining high POX activity in both the tissues of CML-32 seedlings, under high temperature stress.

Biological knee reconstruction for combined malalignment, meniscal deficiency, and articular cartilage disease.

PURPOSE: The aim of this study was to analyze patient-reported outcomes in those undergoing the triad of simultaneous osteotomy, meniscal transplantation, and articular cartilage repair. METHODS: Patients undergoing simultaneous meniscal transplantation, distal femoral or proximal tibial osteotomy, and articular cartilage surgery by a single surgeon (B.J.C.) were analyzed. Meniscal transplantation was performed using bone-in-slot techniques. Distal femoral and high tibial osteotomies were performed for valgus and varus malalignment, respectively. Microfracture, autologous chondrocyte implantation, and osteochondral autograft or allograft were performed for articular cartilage disease. Validated patient-reported and surgeon-measured outcomes were collected. Preoperative and postoperative outcomes and medial versus lateral disease were compared using Student t tests. RESULTS: Eighteen participants (mean age, 34 ± 7.8 years; symptomatic patients, 7.4 ± 5.6 years; 2.4 ± 1.0 surgical procedures before study enrollment; mean follow-up, 6.5 ± 3.2 years) were analyzed. Two thirds of participants had medial compartment pathologic conditions and one third had lateral compartment pathologic processes. At final follow-up, there were statistically significant clinically meaningful improvements in International Knee Documentation Committee (IKDC) subjective classification, Lysholm score, and 4 Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores. Postoperative 12-item short form (SF-12) physical and mental component scores were not significantly different from preoperative scores. The Kellgren-Lawrence classification grade was 1.5 ± 1.1 at 2.5 ± 3.0 years after surgery. There was a significantly higher preoperative SF-12 physical composite score (PCS) in participants with lateral compartment pathologic conditions (v medial compartment conditions) (P = .011). Although there were 13 reoperations in 10 patients (55.5% reoperation rate), only one patient was converted to knee arthroplasty (5.6%) and one to revision cartilage surgery and meniscal transplantation (5.6% revision rate). The most common complication was arthrofibrosis (16.7%). CONCLUSIONS: Statistically significant and clinically meaningful improvements in validated patient-reported clinical outcome scores at long-term follow-up were observed in 18 participants undergoing combined meniscal transplantation, osteotomy, and articular cartilage surgery. Although there was a low rate of cartilage or meniscal revision (or both) and total knee arthroplasty, there was a high rate of reoperation. There was no significant difference in outcomes between participants with medial versus lateral pathologic conditions. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

A rapid, one step molecular identification of Trichoderma citrinoviride and Trichoderma reesei.

Trichoderma species are widely used as production hosts for industrial enzymes. Identification of Trichoderma species requires a complex molecular biology based identification involving amplification and sequencing of multiple genes. Industrial laboratories are required to run identification tests repeatedly in cell banking procedures and also to prove absence of production host in the product. Such demands can be fulfilled by a brief method which enables confirmation of strain identity. This communication describes one step identification method for two common Trichoderma species; T. citrinoviride and T. reesei, based on identification of polymorphic region in the nucleotide sequence of translation elongation factor 1 alpha. A unique forward primer and common reverse primer resulted in 153 and 139 bp amplicon for T. citrinoviride and T. reesei, respectively. Simplification was further introduced by using mycelium as template for PCR amplification. Method described in this communication allows rapid, one step identification of two Trichoderma species.

Differential response of wild and cultivated wheats to water deficits during grain development: changes in soluble carbohydrates and invertases.

Wheat, staple food crop of the world, is sensitive to drought, especially during the grain-filling period. Water soluble carbohydrates (WSCs), stem reserve mobilization and higher invertase activity in the developing grains are important biochemical traits for breeding wheat to enhance tolerance to terminal drought. These traits were studied for three accessions of Triticum dicoccoides(a tetraploid wheat progenitor species) - acc 7054 (EC 171812), acc 7079 (EC 171837) and acc 14004 (G-194-3 M-6 M) selected previously on the basis of grain filling characteristics. Check wheat cultivars- PBW-343 (a popular bread wheat cultivar for irrigated environments) and C-306 (widely adapted variety for rain-fed agriculture) were also included in this set. Analysis of variance revealed significant genotypic differences for the content of water soluble carbohydrates, activity of acid invertase and alkaline invertase. Acc 7079 was found to be a very efficient mobilizer of water soluble carbohydrates (236.43 mg g(-1) peduncle DW) when averaged over irrigated and rain-fed conditions. Acid invertase activity revealed marked genotypic differences between wild and cultivated wheats. Alkaline invertase activity was highest in Acc 7079 when pooled across both the environments. On the whole, acc 7079 qualifies as a suitable donor for enhancing tolerance of bread wheat to terminal drought. The association of physio-biochemical differences observed with grain filling attributes on one hand and molecular markers on the other could be of use in improving wheat for water stress conditions.

Regio- and chemoselective intermolecular hydroamination of allyl imines for the synthesis of 1,2-diamines.

The synthesis of 1,2-diamines via a Rh-catalyzed intermolecular hydroamination of N-allyl imines with cyclic amines is presented. Coordinating groups proximal to the olefin bind to the catalyst and promote the transformation. The reaction affords 1,2-diamines in very good yields and is functional-group-tolerant and highly diastereoselective.

Potential of organ donation from deceased donors: study from a public sector hospital in India.

Deceased donor organ programme is still in infancy in India. Assessing deceased donation potential and identifying barriers to its utilization are required to meet needs of patients with organ failure. Over a 6-month period, we identified and followed all presumed brainstem dead patients secondary to brain damage. All patients requiring mechanical ventilation with no signs of respiratory activity and dilated, fixed and nonreacting pupils were presumed to be brainstem dead. All events from suspicion of brainstem death (BSD) to declaration of BSD, approach for organ donation, recovery and transplants were recorded. Subjects were classified as possible, potential and effective donors, and barriers to donation were identified at each step. We identified 80 presumed brainstem dead patients over the study period. The mean age of this population was 35.9 years, and 67.5% were males. When formally asked for consent for organ donation (n = 49), 41 patients' relatives refused. The conversion rate was only 8.2%. The number of possible, potential and effective donors per million population per year were 127, 115.7 and 9.5, respectively. The poor conversion rate of 8.2% suggests a huge potential for improvement. Family refusal in majority of cases reflects poor knowledge and thus warrants interventions at community level.

Current status of evidence-based sports medicine.

PURPOSE: The purpose of this investigation is to determine the proportion of sports medicine studies that are labeled as Level I Evidence in 5 journals and compare the quality of surgical and nonsurgical studies using simple quality assessment tools (Consolidated Standards of Reporting Trials [CONSORT] and Jadad). METHODS: By use of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines over the prior 2 years in the top 5 (citation and impact factor based) sports medicine journals, only Level I Evidence studies were eligible for inclusion and were analyzed. All study types (therapeutic, prognostic, diagnostic, and economic) were analyzed. Study quality was assessed with the level of evidence, Jadad score, and CONSORT 2010 guidelines. Study demographic data were compared among journals and between surgical and nonsurgical studies by use of χ(2), 1-way analysis of variance, and 2-sample Z tests. RESULTS: We analyzed 190 Level I Evidence studies (10% of eligible studies) (119 randomized controlled trials [RCTs]). Therapeutic, nonsurgical, single-center studies from the United States were the most common studies published. Sixty-two percent of studies reported a financial conflict of interest. The knee was the most common body part studied, and track-and-field/endurance sports were the most common sports analyzed. Significant differences (P < .05) were shown in Jadad and CONSORT scores among the journals reviewed. Overall, the Jadad and CONSORT scores were 2.71 and 77%, respectively. No differences (P > .05) were shown among journals based on the proportion of Level I studies or appropriate randomization. Significant strengths and limitations of RCTs were identified. CONCLUSIONS: This study showed that Level I Evidence and RCTs comprise 10% and 6% of contemporary sports medicine literature, respectively. Therapeutic, nonsurgical, single-center studies are the most common publications with Level I Evidence. Significant differences across sports medicine journals were found in study quality. Surgical studies appropriately described randomization, blinding, and patient enrollment significantly more than nonsurgical studies. LEVEL OF EVIDENCE: Level I, systematic review of Level I studies.

Evidence of capsular defect following hip arthroscopy.

PURPOSE: The purpose of this study is to identify the incidence of capsular defects in patients undergoing revision hip arthroscopy. METHODS: A radiographic and anatomical analysis of MR arthrograms of patients undergoing revision arthroscopy was performed to assess for the presence of capsular defect. Intra-operative images and findings were reviewed. Patients with persistent cam and pincer lesions were excluded. RESULTS: From October 2011 to October 2012, 25 patients underwent revision hip arthroscopy surgery, and 9 patients met our inclusion criteria. Within this series, all patients had post-surgical capsular irregularities and seven patients (78 %) had radiographic evidence of capsule and iliofemoral defects on MR arthrogram. Gross capsular defects were confirmed at revision surgery in two patients. CONCLUSION: The findings of this study demonstrate post-surgical radiographic and anatomical evidence of capsular defects in a select group of patients following hip arthroscopy.

Complication rates comparing primary with revision reverse total shoulder arthroplasty.

BACKGROUND: Complication rates after reverse total shoulder arthroplasty (RTSA) have, in previous series, been reported to be high. The purpose of this study was to describe the complication rates, types, timing, and risk factors after revision RTSA, as compared with primary RTSA. METHODS: We performed a retrospective review of patients who underwent primary or revision RTSA to determine early (within 90 days) complication rates. Complications were subdivided into medical versus surgical and minor versus major. RESULTS: One hundred thirty-seven patients met the inclusion criteria. Of these, 111 underwent primary RTSA and 26 underwent RTSA as a revision from a previous arthroplasty. The overall complication rates were 25% after primary RTSA and 69% after revision RTSA. Minor complications accounted for 80% of the complications after primary RTSA and 94% after revision RTSA. Surgical complications were more frequent than medical complications in revision patients, occurring in 18% of primary cases and 62% of revisions. Revision patients more frequently required transfusions, with rates of 5% and 31% for primary cases and revisions, respectively. Overall, minor, surgical, intraoperative, perioperative, and postoperative complications were all significantly more frequent after revision RTSA. Multivariate logistic regression showed that revision status was the most significant predictor of overall (P < .001), minor (P < .001), surgical (P < .001), intraoperative (P = .002), and postoperative (P < .001) complication rates. Medical complications were predicted by body mass index (P < .001). CONCLUSION: Revision RTSA has a significantly higher rate of complications than primary RTSA. These patients are significantly more likely to require transfusions. Patients should be aware that minor complications are frequent after revision RTSA and should be counseled accordingly.

Reverse total shoulder arthroplasty in patients of varying body mass index.

BACKGROUND: Body mass index (BMI) is an independent predictor of complications after hip and knee arthroplasty. Whether similar trends apply to patients undergoing reverse total shoulder arthroplasty (RTSA) is unknown. METHODS: A retrospective review of primary RTSAs with a minimum 90-day follow-up were included. Complications were classified as major or minor and medical or surgical. Patients were classified into 3 groups: normal BMI (BMI <25 kg/m(2)), overweight or mildly obese (BMI 25-35 kg/m(2)), and moderately or severely obese (BMI >35 kg/m(2)). RESULTS: Of the 119 patients met our inclusion criteria, 30 (25%) had a BMI of less than 25 kg/m(2); 65 (55%) had a BMI of 25 to 35 kg/m(2), and 24 (20%) had BMI exceeding 35 kg/m(2). Complications occurred in 30 patients (25%), comprising major in 11 (9%), minor in 19 (16%), surgical in 21 (18%), and medical in 14 (12%). The most common surgical complications were acute blood loss anemia requiring transfusion (8.4%) and dislocation (4.2%). The most common medical complications were atelectasis (2.5%) and acute renal insufficiency (2.5%). Patients with a BMI exceeding 35 kg/m(2) had a significantly higher overall complication rate (P < .05) and intraoperative blood loss (P = .05) than the other groups. Patients with BMI of less than 25 kg/m(2) had a greater overall complication rate than those with a BMI of 25 to 35 kg/m(2) (P < .05). Multivariate regression analysis demonstrated BMI was the only significant determinant of overall complication rates and medical complication rates (P < .05). CONCLUSION: Patients with a BMI exceeding 35 kg/m(2) (severely obese) or a BMI of less than 25 kg/m(2) have higher rates of complication after RTSA.