COVID-19 lockdown and hip arthroplasty rehabilitation changes: mid-term clinical outcomes.

OBJECTIVE: Hip arthroplasty is one of the most performed surgeries in orthopedics. Rehabilitation process after surgery allows rapid recovery of joint functions in absence of pain in most patients. During COVID-19 pandemic, rehabilitation clinics have reduced the number of beds available. Thus, an increasing number of patients were forced to home rehabilitation programs. Our study aimed at determining any significant differences in clinical and functional outcomes between those patients who underwent a home rehabilitation program and those others who were granted a place in a Rehabilitation clinic during COVID-19 pandemic, at mid-term follow-up. PATIENTS AND METHODS: An observational retrospective single-center study was designed. The patients included were 63, divided into two groups: Group A (29 patients) for home rehabilitation, and Group B (34 patients) for clinic rehabilitation. Follow-up was performed at 1, 6 and 12 months after surgery. Clinical evaluation was assessed through Oxford Hip Score for hip function, Visual Analogue Scale (VAS) for pain and hip range of motion (ROM) to evaluate joint recovery. RESULTS: ROM was compared at follow-up with significant differences 12 months after surgery (107.93° group A vs. 104.7° group B; p=0.0168). Pain felt by patients according to the VAS scale showed no significant differences at follow-up (1 month 3.27 vs. 3.65 p=0.1489; 6 months 1.89 vs. 2.18 p=0.105; 12 months 0.58 vs. 0.68 p=0.6263). Regarding the Oxford Hip score, significant differences emerged at 1-month follow-up (38.75 group A vs. 37.94 group B; p=0.0498). CONCLUSIONS: At mid-term follow-up, little differences were found between patients who went through home rehabilitation and those who went to a rehabilitation clinic. Therefore, decreasing the number of beds available in rehab clinics during COVID-19 pandemic was not an obstacle for elective surgery for orthopedic surgeons.

A case of hemolytic anemia associated with interstitial lung disease, arthralgia and fever caused by Mycoplasma pneumoniae

Pulmonary interstitiopathies became the most diagnosed forms of pneumonia in 2020 due to the coronavirus (COVID-19) pandemic. The spectrum of interstitiopathies is broad and includes idiopathic diseases and secondary forms. In April 2020, a 36-year-old man was admitted to our department for arthralgias, fever, asthenia, cough, and dyspnea. In January 2020, fever, cough, arthralgias, and asthenia appeared. In April, his general condition worsened with the development of macrohematuria, malaise, and intense asthenia. On admission, the patient presented pale, asthenic, and symptomatic for dyspnea and arthralgias. There was objective joint pain in the small joints of the hands, elbow, and knees with morning stiffness and decreased strength. Computed tomography of the chest documented ground-glass opacities in both lung fields. He performed 2 swabs for severe acute respiratory syndrome-related coronavirus 2, which were negative. On hematochemical examination: immunoglobulin (IgM) 332 mg/dL and ferritin 700.2 ng/mL. At venous blood smear peripheral venous blood, agglutination of erythrocytes. The serology (IgM) for Mycoplasma pneumoniae was positive with agglutinins in the serum;doxaciclina was started. There was a progressive normalization of hemoglobin levels, cold agglutinins were gradually reduced and were no longer detected at 15 days after the start of treatment. At one month after discharge, pulmonary function had fully recovered, and the picture of hemolytic anemia was resolved.

Neurological involvement in SARS-CoV2 infection

Description of the case: We report a case of stroke in old patientwho presented to our emergency room due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cough,headache, and chills lasting 1 week developed in a 81-year-oldwoman. She then had progressive dysarthria with numbness andweakness in the right arm over a period of 24 hours. When shere-admitted to the hospital, score on the National Institutes ofHealth Stroke Scale (NIHSS) was 0 (scores range from 0 to 42,with higher numbers indicating greater stroke severity), and computed tomography (CT) showed absence of hyperdensity lesionintra and extra-assial. Symptoms rapidly ameliorated with anticoagulation therapy and resolved clinical issue in three days.Conclusions: Coagulopathy and vascular dysfunction have beenproposed as complications of Covid-19. The association betweenlarge-vessel stroke and Covid-19 requires further investigation. Themore dramatic neurologic symptoms, such as stroke, ataxia,seizure, and depressed level of consciousness, all were more common in severely affected patients, accounting for the increased incidence in these patients. However, these associations should beconsidered in light of our understanding that patients with severecomplications from SARS-COV-2 are more likely to have medicalcomorbidities, especially vascular risk factors such as hypertension. The occurrence of cerebrovascular events in critically ill patients with underlying high blood pressure and cardiovasculardisease is therefore potentially unrelated to a direct effect of theinfection itself or an inappropriate host response.