A 19-year-old farmer presented with acute hepatitis and deep vein thrombosis before being diagnosed as MRSA induced septic knee arthritis

We introduce this case presented as fever and acute hepatitis in a 19 year old male. Soon after admission, signs of DVT of the left lower limb appeared and was confirmed with Doppler ultrasound. Low molecular weight heparin was introduced in addition to empirical ciprofloxacin and paracetamol given orally in therapeutic doses with no improvement. Then, the attendant physician noticed effusion and tenderness in the left knee, and the diagnosis of septic arthritis was confirmed after ultrasound of the knee and examination by the orthopedic physician. The patient was referred for drainage and wash of the infected left knee. The aspirated fluid was sent for culture and sensitivity that revealed MRSA sensitive to vancomycin and linezolid. Treatment of MRSA along with anticoagulant caused rapid relief of both hepatitis and arthritis and improvement of DVT. The patient returned to normal after finishing courses of antibiotics and anticoagulants. Thus, we'd like to raise the index of suspicion that septic arthritis might induce DVT and hepatic dysfunction in the form of acute hepatitis.     

Elective Joint Arthroplasty Should be Delayed by One Month After COVID-19 Infection to Prevent Postoperative Complications

BackgroundIt remains unclear whether a history of recent COVID-19 infection affects the outcomes and risks of complications of total joint arthroplasty (TJA). The purpose of this study was to compare the outcomes of TJA in patients who have and have not had a recent COVID-19 infection.MethodsA large national database was queried for patients undergoing total hip and total knee arthroplasty. Patients who had a diagnosis of COVID-19 within 90-days preoperatively were matched to patients who did not have a history of COVID-19 based on age, sex, Charlson Comorbidity Index, and procedure. A total of 31,453 patients undergoing TJA were identified, of which 616 (2.0%) had a preoperative diagnosis of COVID-19. Of these, 281 COVID-19 positive patients were matched with 281 patients who did not have COVID-19. The 90-day complications were compared between patients who did and did not have a diagnosis of COVID-19 at 1, 2, and 3 months preoperatively. Multivariate analyses were used to further control for potential confounders.ResultsMultivariate analysis of the matched cohorts showed that COVID-19 infection within 1 month prior to TJA was associated with an increased rate of postoperative deep vein thrombosis (odds ratio [OR]: 6.50, 95% confidence interval: 1.48-28.45, P = .010) and venous thromboembolic events (odds ratio: 8.32, confidence interval: 2.12-34.84, P = .002). COVID-19 infection within 2 and 3 months prior to TJA did not significantly affect outcomes.ConclusionCOVID-19 infection within 1 month prior to TJA significantly increases the risk of postoperative thromboembolic events; however, complication rates returned to baseline after that time point. Surgeons should consider delaying elective total hip arthroplasty and total knee arthroplasty until 1 month after a COVID-19 infection.     

脉络舒通颗粒预防全髋关节置换术后深静脉血栓的临床研究

深静脉血栓（Deep Vein Thrombosis,DVT）是血液在深静脉内不正常的凝结,阻塞管腔,导致静脉回流障碍的一种急性病。全髋关节置换术（total hip arthroplasty,THA）作为目前对髋部病变治疗的一个主要手段,     

腹腔镜胃肠道手术患者术中双下肢抬高联合3M升温仪预防DVT的作用

目的探讨腹腔镜胃肠道手术过程中双下肢抬高联合3M升温仪对预防下肢深静脉血栓形成(DVT)的作用。方法回顾性分析2017年1月至2019年10月行腹腔镜胃肠道手术治疗患者198例,按术中血栓预防方法分为4组。A组应用双下肢抬高联合3M升温仪(n=55),B组应用双下肢抬高(n=51),C应用3M升温仪(n=48),D组为对照组(n=44,不采用双下肢抬高及3M升温仪)。采用彩色多普勒超声动态定点监测围术期下肢DVT形成及变化情况,分别在手术结束0h,24h,48h,72h,120h,>120h,行下肢DVT监测。结果A组形成率7.3%,B组15.7%、C组18.8%,D组38.6%,4组间比较差异有统计学意义(P=0.001);且A组明显低于D组(P<0.001)、B组明显低于D组(P=0.013)、C组明显低D组(P=0.026)。结论术中双下肢IPC联合3M升温仪的应用可有效预防腹腔镜胃肠道手术患者术后下肢DVT形成。