SARS-CoV-2 genome variations and evolution patterns in Egypt: a multi-center study.

A serious global public health emergency emerged late November 2019 in Wuhan City, China, by a new highly pathogenic virus, SARS-CoV-2. The virus evolution spread has been tracked by three developing databases: GISAID, Nextstrain and PANGO to understand its circulating variants. In this study, 110 diagnosed positive COVID-19 patient's samples, were collected from Kasr Al-Aini Hospital and the Children Cancer Hospital Egypt 57357 between May 2020 and January 2021, with clinical severity ranging from mild to severe. The viral genomes were sequenced by next generation sequencing, and phylogenetic analysis was performed to understand viral transmission dynamics. According to Nextstrain clades, most of our sequenced samples belonged to clades 20A and 20D, which in addition to clade 20B were present from the beginning of sample collection in May 2020. Clades 19A and 19B, on the other hand, appeared in the mid and late 2020 respectively, followed by the disappearance of clade 20B at the end of 2020. We identified a relatively high prevalence of the D614G spike protein variant and novel patterns of mutations associated together and with different clades. We also identified four mutations, spike H49Y, ORF3a H78Y, ORF8 E64stop and nucleocapsid E378V, associated with higher disease severity. Altogether, our study contributes genetic, phylogenetic, and clinical correlation data about the spread of the SARS-CoV-2 pandemic in Egypt.

Corrective osteotomy and in situ fusion for late-presenting nonunion of lateral condyle fractures of the humerus in adults.

BACKGROUND: Late presentation of lateral condylar fractures of the humerus is not an uncommon problem in children, and to lesser extent, in adults. The various surgical interventions for repairing the fracture, correcting the deformity, or even performing anterior transposition of the ulnar nerve as a single procedure or in combination, especially in adults, is still a controversial topic, with a paucity of literature regarding this. There is a risk of loss of the available preoperative range of motion, nonunion, and avascular necrosis. METHODS: In 19 patients with late presentation of lateral humeral condyle fracture, we assessed the results of only corrective osteotomy and internal fixation with lateral incision without anterior transposition of the ulnar nerve with regard to deformity correction, union, and functional results using the Mayo Elbow Performance Score with at least 24 months of follow-up. All patients (14 men, 5 women; average age, 29.1 years) had Milch type 2, 18 patients presented with cubitus valgus deformity, 1 presented with cubitus varus deformity, and 8 patients had tardy ulnar nerve symptoms. RESULTS: Late-presenting lateral condylar fractures could be managed surgically with our procedure alone even if they have a tardy ulnar neuritis, with excellent results in 17 patients and good results in 2 patients. CONCLUSION: In situ fusion, deformity correction, and internal fixation is a valuable method for the management of late-presenting lateral condylar fractures in adults.