The presentation of spontaneous splenic rupture in a COVID-19 patient: a case report.

BACKGROUND: Splenic rupture is an emergency condition and a vast number of cases are secondary to trauma. Several underlying pathologies have also been associated with splenic rupture, such as hematological diseases, malignancies, and infectious and inflammatory diseases. CASE PRESENTATION: The patient was a 52-year-old man who referred to the Poursina Hospital in Rasht while complaining of abdominal pain from the day before hospitalization. The patient reported a history of lethargy, fever, and nausea. In the examinations performed, there was a brief tenderness in the patient's epigastrium. The patient was monitored and about 12 h after hospitalization, ill appearance, respiratory (respiratory distress) symptoms, and high fever were reported for the patient. According to the examination, the patient was immediately transferred to the operating room and underwent laparotomy. During the operation, contrary to our expectations, a lot of blood (about 1000 cc) was observed in the patient's abdomen. After blood suctioning, the left upper quadrant (LUQ) was bleeding and the rupture of the spleen could also be observed. Therefore, a splenectomy was performed. In the examinations performed for the patient, the patient's rtPCR test confirmed COVID-19. CONCLUSION: The evaluation of the spontaneous splenic rupture (SSR) in our case shows that this type of risk should also be considered in patients with COVID-19 who refer to medical centers with abdominal pain, and if more cases are reported, the correctness of this process can be commented on.

Changes in the serum level of vitamin d during healing of tibial and femoral shaft fractures.

BACKGROUND: Several systemic factors and hormones are thought to regulate the fracture healing process. Vitamin D has emerged as a compound or hormone that actively participates in the regulation of calcium homeostasis and bone metabolism. OBJECTIVES: The aim of this study is to determine the serum changes in the level of vitamin D during the acute healing period of tibial and femoral shaft fractures. PATIENTS AND METHODS: This cross-sectional study included of 73 patients with tibial and femoral shaft fractures referred to the Poursina Hospital between February 2011 and February 2012. Changes in the serum levels of vitamin D were assessed three times in a period of three weeks (at the first visit, end of first week, and end of the third week). Variables such as age, gender, fractured bone, concomitant fracture of tibia and fibula, type of fracture, time of measurement and serum levels of 25-hydroxyvitamin D were assessed. All statistical analyses were performed using the SPSS software. RESULTS: Forty tibial fractures and 33 femoral fractures were recorded. Mean vitamin D levels at the time of admission, after one week and at the end of the third week for the 73 participants included in the study were 39.23, 31.49, and 28.57 ng/mL, respectively. The overall reduction of vitamin D level was significantly more evident in the first week versus the following (P < 0.0001). CONCLUSIONS: Serum levels of vitamin D in patients with tibial or femoral fractures were reduced during the curative period of the fracture. This can be related the role of vitamin D in the formation and mineralization of the callus. Patients with tibial or femoral shaft fractures may benefit from the administration of vitamin D supplements during the fracture healing process.