Pregnancy and lactation-associated osteoporosis (PLO) is a rare disease that occurs in late pregnancy or early postpartum and is associated with multiple vertebral fractures. We present a case of a 34-year-old woman with a history of Systemic Lupus Erythematosus and Antiphospholipid Syndrome, who started postpartum back pain. After an ineffective response to analgesic escalation, she performed imaging exams with evidence of multiple dorsal and lumbar vertebral fractures. After an exhaustive etiological study, PLO represented the most likely diagnosis. Early diagnosis, interruption of breastfeeding, and initiation of targeted anti-osteoporotic therapy are essential for symptomatic control, increase the quality of life of these patients, and prevent new fractures in the future.
Diffuse idiopathic skeletal hyperostosis (DISH) and axial spondyloarthritis (axial SpA) are differential diagnoses of lower back pain. While the latter is considered to be an inflammatory disease, DISH is thought to be a metabolic condition. The authors report a case of a 34-year-old man who presented with a one-year history of axial lower back pain associated to migratory polyarthritis, buttock and heel pain. Imaging revealed contiguous calcification of the anterior longitudinal ligament of the cervical segment, meeting major criteria for DISH. However, he also exhibited signs of bilateral sacroiliitis highly suggestive of axial SpA for which he initiated biological therapy.
Introduction: Acute kidney injury is frequent in patients with COVID-19 and is associated with a higher mortality than in patients without acute kidney injury. Therefore we aimed to compare the creatinine and cystatin C initial values and trend in COVID-19 patients admitted to the Intensive Care Unit (ICU), in order to understand how renal dysfunction affects the prognosis. Methods: Longitudinal retrospective, single-center study of COVID-19 patients admitted to a tertiary care hospital ICU, between April 2020 and April of 2021. Demographic variables comorbidities, serum urea, creatinine, cystatin C values, as well as outcome were studied. Statistical analysis performed in SPSS 27. Results: The sample consists of 207 ICU patients, with mean age of 68 years, 68.6% male. Had chronic kidney disease, 11.5% (n=25) and the most prevalent comorbidities were hypertension, dyslipidemia and obesity. The median (interquartile range) length of stay at the ICU was 11 (6 - 19) days. The values of creatinine, cystatin C, urea adjusted for age and sex, at the time of hospital admission, were not significant for mortality. However, the variation in marker values between the first and second evaluation moments showed that a 5% increase in creatinine values increased, on average, the risk of death by about 2.3 times and a 5% increase in cystatin C values, increased, on average, the risk of death by about 2 times. Conclusion: The decline in renal function has a significant prognostic impact in patients with COVID-19. Therefore, an early detection of renal dysfunction in these patients is essential.
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