We report here an in vitro pharmacologic profile for MDMA (3,4-methylenedioxymethamphetamine) at various brain recognition sites. The rank order of affinities of MDMA at various brain receptors and uptake sites are as follows: 5-HT uptake greater than alpha 2-adrenoceptors = 5-HT2 serotonin = M-1 muscarinic = H-1 histamine greater than norepinephrine uptake = M-2 muscarinic = alpha 1-adrenoceptors = beta-adrenoceptors greater than or equal to dopamine uptake = 5-HT1 serotonin much greater than D-2 dopamine greater than D-1 dopamine. MDMA exhibited negligible affinities (greater than 500 microM) at opioid (mu, delta and kappa), central-type benzodiazepine, and corticotropin-releasing factor receptors, and at choline uptake sites and calcium channels.

Category: Ankle; Trauma Introduction/Purpose: Socioeconomic status has been recognized throughout the medical literature, both within orthopedics and beyond, as a factor that influences outcomes after surgery, and can result in substandard care. Within the foot and ankle subspecialty, there is limited data regarding socioeconomic status and post-operative outcomes, with the current literature focusing on outcomes for diabetic feet. However, ankle fractures are among the most common fractures encountered by orthopedic surgeons. While a few studies have explored the impact of ankle fractures on employment and disability status, the effect of socioeconomic status on return to work post operatively has not yet been investigated. The purpose of this study was to determine the impact of low socioeconomic status on return to work. Methods: We retrospectively reviewed 592 medical charts of patients with CPT code 27766, 27792, 27814, 27822, 27823, 27827, 27829, 27826, 27828 from 2015-2018. Included were patients >18 yrs of age who sustained an acute ankle fracture, were employed prior to the injury, and with information on return to work after ankle surgery, zip code, race, ethnicity and insurance status. Excluded were patients who were not employed prior to their injury. Socioeconomic status was either defined by insurance status - Medicaid/Medicare, commercial, or workman’s compensation -, or by assessing socioeconomic status (SES) using medial household per capita income by zip code as generated and reported by the US National Census Bureau’s 2013-2017 American Community Survey 5-Year Estimates. The national dataset was divided into quartiles with the lowest quartile defined as low SES. Patients who had income that fell within this income category were classified as low SES. Results: 174 patients were included with an average follow-up of 10.2months. 22/174 (12.6%) patients didn’t return to work post-operatively. Univariate analysis identified non-sedentary work to decrease the likelihood of return to work (HR:0.637; p=0.03). Patients with a low SES were more prevalent in the no return group compared to the return to work group (86% vs 60%; p=0.028). 95% of patients with low SES were a minority compared to 56% with average/high SES (p<0.005). Patients with low SES had a higher BMI (p=0.026), a longer hospitalization (p=0.04) and more wound complications (p=0.032). Insurance type didn’t affect return to work (p=0.158). Patients with workman’s compensation had a longer follow-up time and a longer time to return to work compared to other insurances (p<0.005 for each comparison). Conclusion: Low socioeconomic status based on income, not insurance type, affected return to work after an ankle fracture ORIF. Patients with workman’s compensation took a longer time to return to work compared to other insurance types. These findings warrants the need to consider socioeconomic status when allocating resources to treat these patients.

No abstract

Category: Other; Ankle Introduction/Purpose: On March 1, 2020, the first case of novel coronavirus (COVID-19) in New York City (NYC) was confirmed. By March 16, the NYC mayor and New York State Governor issued executive orders to postpone elective surgeries. At our tertiary care academic medical care center in the Bronx, the densely populated community of 1.4 million saw many COVID-19 positive cases. In response, the hospital quickly accommodated these patients, while maintaining outpatient orthopedic care. Consequently, only emergent orthopedic cases were granted permission to rapidly proceed to surgery. Most foot and ankle cases were deemed amenable to non-surgical or delayed surgical care. The purpose of this study is to characterize a series of patients with foot and ankle pathology whose orthopedic care was altered due to the pandemic. Methods: This is a retrospective chart review from February 2020-May 2020 encompassing the time that elective surgery was on hold and one month prior, to capture those patients were scheduled for surgery prior to the pandemic. Included were patients with foot and ankle pathology that required urgent orthopedic care, who were seen in the foot and ankle clinic, fracture clinic, and subsequently in the general orthopedic clinic that was instituted on an emergent bases. Excluded were patients who required intervention to address elective foot and ankle issues such as osteoarthritis, or ankle instability, and those were referred to an outside institution for further treatment. Throughout the pandemic, contact was made with patients either directly in clinic, via a telehealth portal or telephone. Descriptive statistics are taken. Results: Of the 17 patients included in this series, 11 (65%) patients were managed non operatively. Of these, 4 chose nonoperative management due to shared decision making between the patient and surgeon. 2 patients could not have surgery due to complications related to COVID-19. As the zenith of the pandemic passed 2 patients remained fearful of infection and therefore chose non operative management. 3 patients that had been in contact with the orthopedic department refused further imaging. 6 patients were managed operatively. 2 patients had surgery during the peak of the pandemic, both of whom tested positive for COVID and who failed conservative management. 4 patients had delayed surgery. Of these four cases, 3 were malunion corrections that would have benefitted from more prompt surgery. Conclusion: There was an overall decrease in foot & ankle cases. Non- emergent foot and ankle surgery was delayed to divert resources to patients who were stricken with the COVID-19 virus. While every attempt was made to provide the appropriate care for all, a personalized approach to foot and ankle health was developed to address health concerns, preferences, and logistics. As the course of this global pandemic is still uncertain, it is imperative to have a strategy in place to deal with urgent cases, should a second wave of cases once again affect our ability to provide routine care.