Telemedicine in Orthopedic Surgery: A Systematic Review of Current Evidence.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has triggered transformative changes in how clinicians interact with patients. There has been a shift toward virtual consultations. The evidence to support this change in practice is unclear. The aim of this study was to systematically review the evidence base for virtual consultations for orthopedics. Materials and Methods: Two independent reviewers performed a literature search based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing the MEDLINE, EMBASE, and Scopus databases. Only studies reporting outcomes following the use of telemedicine for diagnosis, consultation, rehabilitation, and follow-up were included. Outcomes analyzed were: (1) patient and clinician satisfaction, (2) clinical outcome measures, and (3) cost analysis of traditional versus teleconsultation. Results: A total of 41 studies were included. Fifteen studies compared clinical outcomes of telemedicine against a matched traditional cohort. Of these 15 studies, 2 demonstrated noninferiority, 9 showed no statistically significant difference, and 4 found telemedicine to be superior. Eleven studies recorded patient reported outcomes, which demonstrated high patient satisfaction. Nine studies reported decreased costs when telemedicine was compared to traditional care. The remaining six studies had varied aims and methodologies that didn't fit well with any of these subheadings. Discussion: While the available evidence is limited, the studies assessed here show that telemedicine can deliver high quality health care with good clinical outcomes and high patient satisfaction in a cost-effective manner. Our team thinks what this has highlighted is that communication technology is advancing rapidly and that we as a community of surgeons need to be able to adapt rapidly and adopt innovative technology to continue to improve patient experience and outcomes.

Femoral head disengagement from Accolade femoral stem in MOM Arthroplasty: a case study and literature review.

BACKGROUND: Metal on Metal Hip arthroplasty was commonly used until the last decade. However Hip Arthroplasty registries of many countries showed increased revision rates of MOM Hips - these high rates of revision caused by trunnionosis, adverse tissue reactions (ALTRs) and Pseudotumor formation. The Case: Our Case is 73 years old gentleman who had left MOM THR in 2008, and was doing fine till the beginning of 2018 when his left leg stuck while getting out of the car. Despite he heard the pop and his leg was shortened and externally rotated, but he was still walking on it for a while. On reviewing him in our orthopedic clinic and after getting the CT-scan showed that he had dislocated femoral head from the stem.

Epididymis of Viscacha (Lagostomus maximus maximus): A Morphological Comparative Study in Relation to Sexual Maturity.

The morphological variations and the androgen receptor (AR) expression were studied in viscacha epididymis in relation to sexual maturity. The animals were divided into immature, pre-pubertal and adult, according to their corporal weight and testicular histology. The epididymides were studied by light microscopy, immunohistochemistry for AR and morphometric analysis. In pre-pubertal and adult animals, four well-differentiated segments (initial, caput, corpus and cauda) were observed, while in immature animals, three segments were identified (initial-caput segment, corpus and cauda). In each segment, the structural parameters and the relative cell distribution were different between the groups. The serum testosterone levels of pre-pubertal and adults showed a very significant increase related to sexual maturity. The AR expression in epithelial and fibromuscular stromal cells was different between the groups. In conclusion, the present work demonstrates that the morphological characteristics of the viscacha epididymis vary while sexual maturity is reached, the development of initial and caput is subsequent to corpus and cauda development and the androgens might play an important role during this process.

Effects of melatonin and gonadal androgens on cell proliferation in the pituitary of viscachas (Lagostomus maximus maximus).

OBJECTIVES: Melatonin and androgens are involved in the regulation of cell proliferation. However, effects of these hormones on pituitary pars distalis (PD) of male viscachas is not fully understood. In the present study, we analysed melatonin and gonadal androgens' effects on proliferating cell nuclear antigen (PCNA) expression. MATERIALS AND METHODS: Pituitary glands from foetuses, immature individuals, prepubertal individuals and adult viscachas during their reproductive cycle, after melatonin administration and after castration, were used. PCNA-ir cells were detected by immunocytochemistry and morphometrically quantified using image analysis. RESULTS: Total percentage of PCNA-ir cells varied seasonally in the adult pituitary, with maximum values during the reproductive period and minima during gonadal regression periods. Percentages of PCNA-ir cells increased after melatonin administration, whereas it decreased after castration. Caudal end and ventral regions were the PD zones which were most affected by seasonal variations and castration. PCNA expression was highest in foetal pituitary from midpregnancy. Numbers of PCNA-ir cells decreased during sexual maturity. CONCLUSIONS: Our results demonstrate the effect of gonadal androgens on cell proliferation during the reproductive period and sexual maturity of these animals. Exogenous melatonin increased PD cell proliferation in adults. Thus, these hormones seem to be involved in different mechanisms that regulate cell renewal of PD in this seasonally breeding rodent.

Cutaneous habronemiasis in horses and domestic donkeys (Equus asinus asinus).

Cutaneous habronemiasis in 15 horses and 5 donkeys is described. The lesions were distributed in many parts of the body involving the medial canthus, shoulder and pectoral regions, knee and fetlock joints, abdominal wall and prepuce. Some animals had more than one lesion. The lesions were ulcerative and filled with soft light red granulation tissue. When curretted, the deeper layers revealed a dense fibrous tissue with calcified foci. Close examination of the lesions showed that the superficial layer of this dense fibrous tissue contained small caseated and necrotic foci. The same features prevailed in lesions involving the muscular areas, but the deeper layers consisted of a dense granuloma with no evidence of cicatrization. Curretted material digested in potassium hydroxide revealed fragments of larvae of the nematode suggestive of Draschia or Habronema. The histopathological changes were severe and comprised: necrotic foci in a dense fibrous stroma infiltrated with eosinophils, macrophages and few giant cells. Sections of the larvae surrounded by eosinophils were encountered in lesions of the muscular areas. Curretting and excision of the lesion were effective and produced complete healing of the wound by scar tissue formation.

Studies of pituitary-adrenal-testis interaction in sheep. I. The effects of repeated injections of adrenocorticotrophic hormone during the breeding season.

The administration of 0.5 mg of long-acting adrenocorticotrophic hormone (ACTH, Synacthen-Depot) twice daily for 5.5 d to four adult rams during the breeding season had no consistent effect on plasma follicle stimulating hormone (FSH) concentrations. In contrast, it suppressed both plasma luteinizing hormone (LH) and testosterone concentrations. The responses to injections of 5 ug of gonadotrophin releasing hormone (GnRH), as measured by maximum concentrations reached and areas under the response curves, were also suppressed. These findings suggest that ACTH exerts its suppressive efects on LH at the pituitary level.

Studies of pituitary-adrenal-testis interaction in sheep. II. The effects of repeated injections of adrenocorticotrophic hormone outside the breeding season.

The administration of 0.5 mg of long-acting adrenocorticotrophic hormone (ACTH, Synacthen-Depot) twice daily for 5.5 d to four rams outside the breeding season caused marked rises in plasma cortisol without any evidence of adrenal depletion. This treatment also caused marked rises in basal plasma follicle stimulating hormone (FSH) concentrations which remained high even after cessation of treatment. Plasma FSH responses to 5 ug of gonadotrophin releasing hormone (GnRH) were consistently observed and ACTH treatment increased the FSH response to GnRH. In contrast, spontaneous fluctuations in the plasma luteinizing hormone (LH) and testosterone concentrations were abolished by ACTH treatment. The quantity of testosterone released after GnRH (estimated by the maximum values reached and by the area under the response curve) was also suppressed while that of LH was only slightly lower. A comparison of the results of this experiment with those obtained in rams during the breeding season showed that the effects of ACTH on LH and testosterone were more marked during the breeding season. In contrast, the effect of ACTH on FSH is to increase the latter during the nonbreeding season, whereas no effect was observed during the breeding season.

Studies of pituitary-adrenal-testis interaction in sheep. III. The effects of repeated injections of adrenocorticotrophic hormone in recently castrated rams.

Twice daily for 5.5 d, 0.5 ug of long-acting adrenocorticotrophic hormone (ACTH, Synacthen-Depot) was administered to four rams castrated 17 d earlier. There was a progressive diminution in basal plasma follicle stimulating hormone (FSH) during and after treatment. ACTH also suppressed basal plasma luteinizing hormone (LH) concentrations and the maximum LH values reached and the quantity of LH released in response to the injection of 5 ug of gonadotrophin releasing hormone (GnRH). There was, however, evidence that the LH concentrations returned to pretreatment levels after ACTH treatment ceased. This experiment demonstrated that the effects of ACTH on LH are modulated by castration, but throughout this series of experiments ACTH always depressed LH activity. In contrast, FSH is affected by ACTH in different ways, depending on the season and the presence or absence of a testis.

Mycetomas in goats.

Naturally occurring mycetomas were found in 3 goats. Two had mycetomas on their hind legs and the third on its left scapula. In 2 goats the causative agents were identified by culture, histopathology and serology as Actinomadura madurae. In the remaining goat diagnosis was based only on histopathology and the causative agent was considered to be A. pelletierii. Despite minor differences between goat and human strains of A. madurae, it would seem that goats could be useful experimental models.