The COVID-19 pandemic has affected most healthcare systems around the world. Routine care operations such as outpatient clinics and elective surgery remain badly hit. This situation cannot continue for long as it puts patients at a higher risk for complications due to delayed management. Hence, it is essential to resume routine, especially elective surgery. Regarding orthopaedic practice, various authors and organisations have come out with guidelines to resume elective surgeries. However, clear consensus and common strategies need be derived. With this motive, we conducted a review of the literature for guidelines to resume elective orthopaedic surgery amid COVID-19 pandemic and shortlisted scholarly publications and information from regional organisations. We have summarised the information and derived an organised algorithm considering the guidelines provided by various sources. In this extraordinary time, guidelines come in as a relief for every surgeon who is in a dilemma whether to resume electives or not. Putting safety first, these guidelines or suitable versions should be followed at all levels wherever possible to avoid the lack of trained manpower in the event of staff morbidity.
The genus Henneguya is the second largest within the class Myxosporea, which infects marine and freshwater fish. One hundred Clarias gariepinus specimens were collected alive from a branch of the Nile River in Kafrelsheikh, Egypt. Microscopic and molecular procedures were used to describe how Henneguya fusiformis infects the ovaries of C. gariepinus. The infected fish showed no pathogenic changes except for macroscopic creamy whitish nodules in their ovaries with the highest prevalence during the spring season. The mature spores are spindle-shaped. The total spore length, spore body length and width are 53.4 ± 0.8 (52.5-54.3) µm, 29.8 ± 0.5 (29.2-30.4) µm and 6.5 ± 0.3 (6.1-6.9) µm, respectively. The spore anterior end consisted of two equal polar capsules, located in a tandem position, each one measuring 4.2 × 2.1 µm. The polar filament formed a coil with 6-8 turns. The measurement of the spore end with two extended processes was 24.3 ± 0.4 (23.9-24.8) µm. Phylogenetic analyses of the 18S ribosomal RNA gene sequence revealed that H. fusiformis are clustered together with other myxobolids that are histozoic in channel catfish, Ictalurus punctatus, and Asian Redtail catfish, Hemibagrus nemurus" (Clariidae) in the United States and Malaysia, respectively. To the best of our knowledge, this is the first record of H. fusiformis in Egypt. Additionally, our study is the first record of H. fusiformis in the ovaries of C. gariepinus.
Spinal muscular atrophy is a neuromuscular genetic condition associated with progressive muscle weakness and atrophy. Nusinersen is an antisense oligonucleotide therapy approved for the treatment of 5q spinal muscular atrophy in pediatric and adult patients. The objective of this clinical case series is to describe the efficacy and safety of nusinersen in treating spinal muscular atrophy in 20 pediatric and 18 adult patients across six treatment centers in Kuwait. Functional motor assessments (Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders, Hammersmith Functional Motor Scale Expanded, and Revised Upper Limb Module) were used to assess changes in motor function following nusinersen treatment. The safety assessment involved clinical monitoring of adverse events. The results demonstrate clinically meaningful or considerable improvement in motor performance for nearly all patients, lasting over 4 years in some cases. A total of 70% of patients in the pediatric cohort and 72% of patients in the adult cohort achieved a clinically meaningful improvement in motor function following nusinersen treatment. Additionally, nusinersen was well-tolerated in both cohorts. These findings add to the growing body of evidence relating to the clinical efficacy and safety of nusinersen.