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BACKGROUNDOsteoporosis, a multifactorial disease linked to senility, contributes to femur fractures caused by falls as a result of bone fragility, with a high incidence of mortality. This study analyzed 10 years of hospitalizations for femur fractures in elderly patients, with a special view of 2020 and 2021, a critical period of the COVID-19 pandemic. METHODSTime series ecological study, using the Health Information System (TABNET), made available by the Department of Informatics of the Unified Health System (DATASUS), in June 2022. In hospital morbidity, the number of hospitalizations and mortality rate were evaluated, with filters for the Chapter ICD-10: XIX, including the falls, and ICD-10 Morb List: femur fracture, aged 60 or more, during January 2012 to December 2021 in Brazil. RESULTSFrom 2012 to 2021, there were a total of 533,938 hospital admissions for femur fractures among the population over 60 years old and an average mortality rate of 5.16% per year. The data showed an increasing pattern on the number of admissions each year, with an annual average increase of 6.39%. In 2020, the first year of the COVID-19 pandemic, the hospitalizations records were slightly smaller when compared to 2019 (-0.05%). However, in 2021 there was an increase of 8.69% (5,470 cases) when compared to 2020, a number 2.3% higher than the annual average for the decade analyzed. Yet, the mortality rate during the pandemic was maintained in both years (5.25%), standing slightly above the historical average (5.16%), but below the maximum observed during the decade (5.29% in 2017). CONCLUSIONThe reduction of bone density, resulting from physiological alterations of aging, is associated with a higher risk of falls and fractures. Falls in the elderly are a public health issue with significant physical, psychological and social consequences. Although the method does not allow inferences, it is postulated that the lower number of hospitalizations in 2020 is due to the changes in the healthcare system to deal with the emerging disease. With the prolonged period of confinement, differences in physical abilities, worsening of balance and worsening of muscle condition, begin to be observed. This physical deconditioning increases the risk of a fall, resulting in the data for 2021.

BACKGROUNDGranulomatosis with polyangiitis (GPA) is a rare disease, with the largest population affected being individuals over 40 years old. It is a systemic syndrome marked by necrotizing granulomatous inflammation and primary airway vasculitis, together with glomerulonephritis, associated with antineutrophil cytoplasmic antibodies. The clinical picture includes upper airway involvement in 95% of cases. Other common findings also include arthralgias, fever, cough and skin lesions. Gingival involvement, as related in this case, is rarely described. CASE REPORTA 42-year-old female was diagnosed with granulomatosis associated with polyangiitis 7 years ago, with sudden onset of hearing loss, retro-orbital pseudotumor, recurrent sinusitis and positive c-ANCA. She received treatment with pulse therapy using methylprednisolone and subsequently rituximab, which originated a favorable response. The disease remained inactive until January 2022, when it started with exuberant polyarthritis, sinusitis and rhinitis, in addition to a perforated lesion in the nasal septum. Concomitantly, she presented gingival lesions compatible with strawberry gingivitis (Fig. 1). The patient underwent a new treatment with rituximab, evolving with a good response to the symptoms. Figure 1. Oral lesions, characterized as strawberry gingivitis. CONCLUSIONThe diagnosis of GPS remains challenging especially in early cases or with atypical manifestations. Gingival involvement with hyperplasia or strawberry gingivitis is rarely described in the course of the disease and, in some cases, may precede the involvement of other organs. Thus, early recognition of these manifestations can be extremely useful in clarifying the diagnosis and instituting appropriate treatment.