Background & aims: Diabetic Foot Disease (DFD) management had to be redefined during COVID-19. We aim to evaluate the impact of this on diabetic foot care services and the strategies adopted to mitigate them. Methods: We have performed a comprehensive review of the literature using suitable keywords on the Search engines of PubMed, SCOPUS, Google Scholar and Research Gate in the first two weeks of May 2020. We have reviewed how the diabetic foot service in the hospital and community setting has been affected by the current Coronavirus outbreak. Results: We found considerable disruption in diabetic foot service provisions both in the primary care and in the hospital settings. Social distancing and shielding public health guidelines have impacted the delivery of diabetic foot services. Conclusion: As the COVID-19 pandemic spreads worldwide, health care systems are facing the tough challenges in delivering diabetic foot service to patients. Public health guidelines and the risk of virus transmission have resulted in reconfiguration of methods to support and manage diabetic foot patients including remote consultations.

Aims In the UK, deaths associated with COVID-19 have occurred in two waves. Evidence has shown an increase in 30-day mortality for hip fracture patients co-infected with COVID-19. However, there are no studies analysing mortality trends between the first two waves of the UK pandemic. Additionally, hospital versus community acquired COVID-19 infection between the two waves has not been analysed. Furthermore, predictive factors of 30-day mortality have not been fully evaluated. Methods Data from two audits conducted by the CHIP collaborative group were used: a published regional audit in England of nine hospitals providing the COVID-19 negative cases and an unpublished UK national audit of 43 hospitals, which provided the COVID-19 positive cases. Data collection for the COVID-19 positive cases was from 23 March to 31 December 2020. September 1, 2020 was used to define the transition between the two waves. Results There were 517 COVID-19 positive hip fracture patients and 1445 COVID-19 negative hip fracture patients. Overall, 30-day mortality rates were 5.7% in the COVID-19 negative group and 22.4% in the COVID-19 positive patients ( p < 0.001). A difference in survival function between the first and second waves was found ( p = 0.038). To allow for significant demographic differences, a matched analysis of 185 patients found a 26.5% 30-day mortality in the first wave compared to 21.1% in the second wave ( p = 0.222). Within the COVID-19 positive groups, the virus was hospital acquired in 66.7% of cases in the first wave and 72.8% of cases in the second wave ( p = 0.130). Independent predictors of mortality were found to include COVID-19 positive status, AMTS ≤ 6, male gender and age. Conclusion There was a reduction in 30-day mortality for hip fracture patients co-infected with COVID-19 between the two UK pandemic waves but this was not statistically significant. There was no reduction in hospital acquired COVID-19 infection between the two waves.

Aims Despite the COVID-19 pandemic, incidence of hip fracture has not changed. Evidence has shown increased mortality rates associated with COVID-19 infection. However, little is known about the outcomes of COVID-19 negative patients in a pandemic environment. In addition, the impact of vitamin D levels on mortality in COVID-19 hip fracture patients has yet to be determined. Methods This multicentre observational study included 1,633 patients who sustained a hip fracture across nine hospital trusts in North West England. Data were collected for three months from March 2020 and for the same period in 2019. Patients were matched by Nottingham Hip Fracture Score (NHFS), hospital, and fracture type. We looked at the mortality outcomes of COVID-19 positive and COVID-19 negative patients sustaining a hip fracture. We also looked to see if Vitamin D levels had an impact on mortality. Results The demographics of the 2019 and 2020 groups were similar, with a slight increase in proportion of male patients in the 2020 group. The 30-day mortality was 35.6% in COVID-19 positive patients and 7.8% in the COVID-19 negative patients. There was a potential association of decreasing vitamin D levels and increasing mortality rates for COVID-19 positive patients although our findings did not reach statistical significance. Conclusion In 2020 there was a significant increase in 30-day mortality rates of patients who were COVID-19 positive but not of patients who were COVID-19 negative. Low levels of vitamin D may be associated with high mortality rates in COVID-19 positive patients.

Bioengineering (BE) technology has significant influence on the healthcare environment. This has grown steadily particularly since the medical practice has become more technology based. We have tried to assess the impact of bioengineering in tackling the COVID-19 pandemic. The use of bioengineering principles in healthcare has been evaluated. The practical implications of these technologies in fighting the current global health pandemic have been presented. There has been a shared drive worldwide to harness the advancements of bioengineering to combat COVID-19. These efforts have ranged from small groups of volunteers to large scale research and mass production. Together the engineering and medical fields have worked to address areas of critical need including the production and delivery of personal protective equipment, ventilators as well as the creation of a viable vaccine. The fight against COVID-19 has helped highlight the work and contributions of so many professionals in the bioengineering fields who are working tirelessly to help our health services cope. Their innovation and ingenuity are paving the way to successfully beat this virus. We must continue to support these fields as we evolve our health systems to deal with the challenges of healthcare in the future.

COVID-19 pandemic had a significant impact on providing Trauma and Orthopedic surgery around the world. The orthopedic community had to reconfigure emergency and urgent trauma services safely but also support strategies to prevent person-to-person coronavirus transmission. Various organizations including British Orthopedic Association (BOA), American Academy of Orthopedic Surgeons (AAOS) and Public Health England (PHE) have provided guidelines for conducting safe essential surgery in operating theatres. One of the areas that have not been debated enough is the type of ventilation systems that should be used in operating theatres during this global pandemic. We review the current evidence in the literature particularly in the challenges faced by health care professionals in current COVID-19 pandemic in deciding and implementing an effective operating theatre ventilation system protecting both our patients and operating room personnel.