RESUMO
Osteonecrosis is a pathologic process that involves focal bone infarction and death of bone tissue caused by trauma, infections, autoimmune conditions, and chronic steroid use; however, most cases go undiagnosed. The link between bilateral osteonecrosis and coronavirus disease 2019 (COVID-19) infections has not been fully investigated. This is the case of a 42-year-old Caucasian woman who presented to the emergency department for bilateral hip pain, which started three months prior. Initially, the pain was mild; however, her symptoms worsened, causing her to have difficulty ambulating. Co-incidentally she tested positive for COVID-19 10 days after the onset of pain. She denied any lower-extremity numbness, weakness, and loss of bowel or bladder function. X-ray of the hips showed significant sclerosis of bilateral femoral heads and acetabula, indicating avascular necrosis. She was given ketorolac injection intramuscularly for analgesia and remained in stable condition. Upon discharge, she was given a referral to orthopedic surgery for bilateral total hip arthroplasty. Atraumatic osteonecrosis of the femoral head can be caused by multiple etiologies, including exposure to medications, post-transplantation procedures, trauma, and hypercoagulable states. This condition is likely due to poor angiogenesis after an infarct, causing a domino effect of bone demineralization, trabecular thinning, and cortical collapse. A literature search demonstrated prior cases of unilateral femoral head necrosis associated with COVID-19 infection and steroid use. There have been no cases of bilateral osteonecrosis of the femoral head reported without long-term steroid use. Considering the disease severity in both hips and limited steroid use (only five days of prednisone), other common etiologies were sought and were ruled out. In our patient, the only event that was related to her initial onset of hip pain was a COVID-19 infection. We suggest a relationship between COVID-19 infection and avascular necrosis given the rapid progression of the disease. We acknowledge that this presentation of bilateral osteonecrosis is rare and warrants further investigation. More research should be performed to establish a tenable relationship between COVID-19 infection and osteonecrosis, with and without the use of steroids.
RESUMO
BACKGROUND: Food and beverage marketing has been associated with childhood obesity. We quantified the number and type of food or beverage brands promoted by music celebrities, assessed the nutritional quality of the products, and examined Teen Choice Award data to assess the celebrities' popularity among adolescents. METHODS: This was a descriptive study. A list of music celebrities associated with the 2013 and 2014 Billboard Hot 100 Chart, which ranks songs according to sales and radio impressions, was compiled. Data on celebrity endorsements were gathered from official company Web sites, YouTube commercials, an advertising database, and media reports. Nutritional quality of foods was assessed according to the Nutrient Profile Index, whereas nonalcoholic beverages were evaluated based on calories from added sugar. Teen Choice Award nominations were used to measure the celebrities' popularity among adolescents. RESULTS: Of the 590 endorsements made by the 163 celebrities in the sample, consumer goods (eg, fragrances, makeup) represented the largest endorsement category (26%), followed by food and beverage (18%) and retail (11%). Sixty-five celebrities were collectively associated with 57 different food and beverage brands owned by 38 parent companies. Of these 65 celebrities, 53 (81.5%) had ≥1 Teen Choice Award nomination. Forty-nine (71%) of the 69 nonalcoholic beverage references promoted sugar-sweetened beverages. Twenty-one (80.8%) of the 26 endorsed foods were energy dense and nutrient poor. Baauer, will.i.am, Justin Timberlake, Maroon 5, and Britney Spears had the most food and beverage endorsements. CONCLUSIONS: This study demonstrates that music celebrities who are popular among adolescents endorse energy-dense, nutrient-poor products.