Fatality Rates After Infection With the Omicron Variant (B.1.1.529): How Deadly has it been? A Systematic Review and Meta-Analysis.

Background: Since late 2019, the global community has been gripped by the uncertainty surrounding the SARS-CoV-2 pandemic. In November 2021, the emergence of the Omicron variant in South Africa added a new dimension. This study aims to assess the disease's severity and determine the extent to which vaccinations contribute to reducing mortality rates. Methods: A systematic review and meta-analysis of the epidemiological implications of the omicron variant of SARS-CoV-2 were performed, incorporating an analysis of articles from November 2021that address mortality rates. Results: The analysis incorporated data from 3,214,869 patients infected with omicron, as presented in 270 articles. A total of 6,782 deaths from the virus were recorded (0.21%). In the analysed articles, the pooled mortality rate was 0.003 and the pooled in-house mortality rate was 0.036. Vaccination is an effective step in preventing death (odds ratio: 0.391, p < 0.01). Conclusion: The mortality rates for the omicron variant are lower than for the preceding delta variant. mRNA vaccination affords secure and effective protection against severe disease and death from omicron.

Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis.

INTRODUCTION: The diagnosis of cardiac contusion, caused by blunt chest trauma, remains a challenge due to the non-specific symptoms it causes and the lack of ideal tests to diagnose myocardial damage. A cardiac contusion can be life-threatening if not diagnosed and treated promptly. Several diagnostic tests have been used to evaluate the risk of cardiac complications, but the challenge of identifying patients with contusions nevertheless remains. AIM OF THE STUDY: To evaluate the accuracy of diagnostic tests for detecting blunt cardiac injury (BCI) and its complications, in patients with severe chest injuries, who are assessed in an emergency department or by any front-line emergency physician. METHODS: A targeted search strategy was performed using Ovid MEDLINE and Embase databases from 1993 up to October 2022. Data on at least one of the following diagnostic tests: electrocardiogram (ECG), serum creatinine phosphokinase-MB level (CPK-MB), echocardiography (Echo), Cardiac troponin I (cTnI) or Cardiac troponin T (cTnT). Diagnostic tests for cardiac contusion were evaluated for their accuracy in meta-analysis. Heterogeneity was assessed using the I2 and the QUADAS-2 tool was used to assess bias of the studies. RESULTS: This systematic review yielded 51 studies (n = 5,359). The weighted mean incidence of myocardial injuries after sustaining a blunt force trauma stood at 18.3% of cases. Overall weighted mean mortality among patients with blunt cardiac injury was 7.6% (1.4-36.4%). Initial ECG, cTnI, cTnT and transthoracic echocardiography TTE all showed high specificity (> 80%), but lower sensitivity (< 70%). TEE had a specificity of 72.1% (range 35.8-98.2%) and sensitivity of 86.7% (range 40-99.2%) in diagnosing cardiac contusion. CK-MB had the lowest diagnostic odds ratio of 3.598 (95% CI: 1.832-7.068). Normal ECG accompanied by normal cTnI showed a high sensitivity of 85% in ruling out cardiac injuries. CONCLUSION: Emergency physicians face great challenges in diagnosing cardiac injuries in patients following blunt trauma. In the majority of cases, joint use of ECG and cTnI was a pragmatic and cost-effective approach to rule out cardiac injuries. In addition, TEE may be highly accurate in identifying cardiac injuries in suspected cases.

Is it financially efficient to lose the ring-fenced elective orthopaedic ward?

BACKGROUND: In an effort to rationalize National Health Service (NHS) funds in the United Kingdom, some hospitals have used the orthopaedic elective ring-fenced ward to admit general acute emergencies, admitting elective arthroplasty patients to general wards. OBJECTIVE: The aim of this study was to analyse the financial effect and length of stay of elective arthroplasty patients admitted to general wards rather than 'ring-fenced' orthopaedic wards. STUDY DESIGN: Retrospective observational study SETTING: Hospital care PATIENTS: During the period between 01 November 2010 and 31 March 2011, 194 consecutive patients were admitted for elective total hip and total knee arthroplasties. Due to increased bed pressures, 35 (18.04 %) of the patients were admitted to general wards instead of our standard elective ring-fenced orthopaedic ward. Data was collected and analysed for type of surgery, age, sex, length of stay, and ward. RESULTS: The average length of stay in the general wards was 1.89 days longer (range 3-22 days; p < 0.001) than in the elective orthopaedic ward. CONCLUSIONS: We conclude that losing the ring-fenced ward and admitting elective arthroplasty patients to general wards results in longer length of stay and a financial loss of 6.82 % per hip and knee arthroplasty patient.

Modification of the explant system for the removal of well fixed hip resurfacing sockets.

A major concern during revision hip arthroplasty is acetabular bone loss during the extraction of well-fixed acetabular components. Despite the good early survivorship of resurfacing prostheses, revision surgery may be necessary. We recommend the use of the Explant acetabular extraction system (Zimmer, Warsaw, Ind) with a trial liner to preserve acetabular bone stock. We present 2 cases of revised resurfacings using this technique, demonstrating minimal interference to the remaining acetabular bone.

Early complications from the use of porcine dermal collagen implants (Permacol) as bridging constructs in the repair of massive rotator cuff tears. A report of 4 cases.

The repair of massive rotator cuff tears can be very challenging. Different surgical techniques are described in the literature, including debridement of the cuff with subacromial decompression, attempts at direct partial repair, various tendon transfers, shoulder hemiarthroplasty, reversed shoulder arthroplasty and allograft augmentation. Following favourable published evidence of the use of porcine dermal collagen implants, Permacol (Tissue Science Laboratories, Hampshire, UK, now known as Collagen Repair Patch, Zimmer, Warsaw, Ind) as a bridging device to repair massive defects, we used it in four of our patients. However, we have seen with great concern that in all four cases, the grafts failed between 3-6 months after a promising early postoperative period. We report on these 4 cases giving clinical, radiographic and histological findings. We conclude that although Permacol has man obvious advantages, it should not be used to bridge irreparable massive rotator cuff tears.