Avascular necrosis (AVN) also referred to as osteonecrosis (ON) refers to inadequate perfusion to bone tissue resulting in death or necrosis of the bone. Although many known risk factors and etiologies exist, 20%-40% of AVN cases are idiopathic (1). There have been reported cases of osteonecrosis secondary to Covid-19 infection. However, these cases are typically attributed to the steroids used in the treatment plan of the viral infection. Here, we describe a case of idiopathic osteonecrosis attributed to a Covid-19 infection where the patient was not treated with steroids. We discuss a possible relationship between AVN and the cardiovascular system that may reflect an underlying cause contributing to avascular necrosis and Covid-19.
Cough is a common symptom of many underlying pathologies; sometimes, the etiology is well understood and, therefore, treatment can be applied accordingly. However, when the underlying etiology of the cough is not well understood, a nonconventional approach can sometimes be promising. In this article, a cough of unknown etiology resistant to conventional treatments seems to be suppressed with the use of acupuncture techniques.
Non-selective beta-adrenergic antagonists are used systemically to treat hypertension and tachycardia and are used ophthalmologically for glaucoma. Generally, ophthalmological medications don't have systemic effects, as they are applied specifically to a local area. In this case, however, it appears that timolol, a beta-blocker, had systemic effects on heart rate. This is something that prescribing physicians must be wary of when evaluating patients with glaucoma who have cardiovascular comorbidities. Additionally, patients should be informed of the importance of occluding the puncta when receiving eye treatments to lessen the risk of systemic effects.
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