Post-COVID-19 return to elective orthopaedic surgery-is rescheduling just a reboot process? Which timing for tests? Is chest CT scan still useful? Safety of the first hundred elective cases? How to explain the "new normality health organization" to patients?

PURPOSE: The long incubation period and asymptomatic spread of COVID-19 present considerable challenges for health care institutions when patients return to elective surgery. METHODS: A retrospective review of the first adult elective cases performed between May 18, 2020 and June 14, 2020, after the end of lockdown was analysed in Belgium to answer the following questions: (1) for the 236 cancelled patients during the outbreak, how easy was rescheduling? (2) How useful was universal RT-PCR testing and chest CT scan for the 211 orthopaedic and trauma admissions? (3) How were surgical difficulty category, number of operations and complications different when compared to the pre-COVID period? (4) How would patients balance the benefit of surgery against the unknown risk of developing COVID-19? RESULTS: Before surgery, blood tests for anaesthesiology and imaging related to the surgical procedure were scheduled prior to universal testing (COVID-19 PCR and chest CT) performed 72-120 hours before surgery. Among the 211 asymptomatic patients who were tested before surgery, six had positive PCR, while no abnormality was found on the chest CT scan of all the patients. With this timing for tests, the 104 patients included in the current study for elective surgery were free of disease before undergoing surgery and remained without COVID-19 after surgery. Among the 366 cancelled patients during the outbreak, only 12% of the patients accepted to proceed with rescheduling immediately. Therefore, this resulted in a 70% reduction for elective surgery and in a 50% reduction for arthroplasties as compared to pre-COVID period. The rate of complications was not increased during the post-COVID period. A portion of patients have confused idea of screening and have difficulty to perceive the new rules of health organization. CONCLUSIONS: Resumption of elective surgical procedures appears more difficult for patients than for surgeons with a low percentage of cancelled patients accepting to reschedule surgery. Universal testing allowed securing patients; however, surgeons must explore better patient perceptions regarding COVID-19 to facilitate a fully informed decision in the current period.

Hematogenous septic arthritis of a non-prosthetic shoulder caused by Capnocytophaga canimorsus: A case report and review of the literature.

Capnocytophaga canimorsus, oral inhabitants of dogs and cats is a cause of zoonotic infections. It is transmitted to humans by bites, scratches, licks, or close exposure to these animals. Infections due to Capnocytophaga canimorsus have a wide range of severity and can sometimes be fatal. We report the case of an 89-years-old man who suffered from a sudden swollen native right shoulder. The blood test revealed an inflammatory syndrome and cytologic evaluation of joint aspiration showed an elevated nucleated cells count suspicious of infection. A Gram-negative bacillus grew after 48 h in the arthrocentesis and was identified as Capnocytophaga canimorsus. After 4 days, blood culture also grew Capnocytophaga canimorsus leading to the diagnosis of hematogenous septic arthritis of a non-prosthetic right shoulder. Antimicrobial therapy was empirically started with cefuroxime then switched to doxycycline for seven weeks with good clinical outcomes. It is important to inquire about patients' environment including their proximity to animals as it can lead to zoonotic infections that can be of high severity. Moreover, hygiene rules must be applied when dog scratches or lick wounds occurred to avoid the spread of zoonotic germs. Prophylactic antibiotic therapy should be given for animal bites.

Assessment of growth hormone gene polymorphism effects on reproductive traits in Holstein dairy cattle in Tunisia.

Research to assess the effect of single genes on reproductive traits in bovine species is imperative to elucidate genes' functions and acquire a better perspective of quantitative traits. The present study was undertaken to characterize genetic diversity in the bovine growth hormone (GH) gene in a population of 410 Holstein dairy cows in Tunisia. The analyses were based on single nucleotide polymorphisms, and GH-AluI and GH-MspI detections and genotyping were carried out using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Data were analyzed using a mixed linear model with the MIXED procedure to reveal the possible effect of GH genotypes on reproductive traits. The frequency data of AluI(L//V) and MspI( + // - ) alleles were 87.04//12.96 and 70.06//29.94, respectively. The distribution of the frequency of GH genotypes for LL/LV/VV and ( - / - )//( + / - )//( + / + ) were 77.75//18.59//3.66 and 15.37//29.13//55.50, respectively. The results of the statistical analyses proved that GH-AluI showed a substantial favorable effect on exanimate traits except for the age at first calving; however, only a suggestive effect of GH-MspI on the calving interval (CI) and the days open (DI) was found. The homozygous LL genotype seemed to be advantageous with respect to the CI and the DI compared with LV and VV genotypes. Heterozygous MspI( + / - ) cows tended to have a longer CI and DI than MspI( + / + ) and MspI( - / - ) cows, but the difference was not statistically significant. A significant effect of different GH-AluI-MspI combined genotypes was found on the number of inseminations per conception, the CI and the DI, and the LL/- combined genotype seemed to be associated with better reproductive performance. Based on these results, the LL genotype of the GH locus can be considered to be a favorable genotype for reproductive traits in Holstein dairy cattle, although these findings need to be confirmed by further research before polymorphisms can be used in a marker-assisted selection program.