Estimación de densidad mineral ósea mediante estudio de tomografía computarizada con protocolo GSI. Correlación densitométrica.

The idea of this research work has focused on proposing a solution to a problem that day by day increases its prevalence and affects both men and women without distinction of age. The risk of suffering a fracture is the main clinical result of osteoporosis. Vertebral fractures represent the hallmark of them, with a prevalence calculated between 35 and 50% in women over 50 years of age, so it is essential to identify an osteoporotic vertebral fracture, in order to offer immediate treatment and avoid complications that they range from incapacitating pain to death caused by spinal cord compression. 100% of the patients who presented with vertebral fracture (VF) to the emergency department of the Hospital Clínico Universitario de Valladolid, who reported low back pain or low back trauma, were studied from August 2020 to August 2021 with subsequent follow-up of one year after definitive treatment, either conservative or surgical, and using a validated frailty assessment tool, where 11 clinical parameters are explored. A test that is routinely performed on patients who suffer OVF was used, such as the CT scan using its GSI tool and that match the results obtained in the different tests that serve as a diagnostic complement in the identification and planning and treatment of OVF. We use pathomorphological criteria to define VF, allowing categorical establishment according to the mechanism of the lesion, in order to identify the degree of instability and assess the prognosis for cure and possible treatment. Through Binary Logistic Regression, it was possible to find a test that would allow the diagnosis of osteoporosis as DXA does. Using the C statistic (ROC curve) the theoretical cut-off point of the new TACGSI2Bwater Test was established. Sensitivity, specificity, and positive predictive values were calculated to estimate osteoporotic patients. With this test it was determined that the presence of water in the measured vertebra classifies patients with 75% certainty. It can be used as a diagnostic tool for this pathology in the future.La idea de este trabajo de investigación se ha centrado en plantear una solución a un problema que día a día aumenta su prevalencia y afecta tanto a hombres como a mujeres sin distinción etaria. El riesgo de sufrir una fractura, es el principal resultado clínico de la osteoporosis. Las fracturas vertebrales representan el sello distintivo de ellas, con una prevalencia calculada entre el 35 y el 50% en mujeres mayores de 50 años, por lo que se hace fundamental identificar una fractura vertebral osteoporótica, para así ofrecer un tratamiento inmediato y evitar complicaciones que van desde el dolor incapacitante, hasta la muerte producida por compresión medular. Se estudiaron el 100% de los pacientes que acudieron con Fractura vertebral (FV) al servicio de urgencias del Hospital Clínico Universitario de Valladolid, que refirieron dolor lumbar o traumatismo lumbar, desde agosto del 2020 a agosto del 2021 con posterior seguimiento de un año tras el tratamiento definitivo, ya sea conservador o quirúrgico, y utilizando una herramienta validada de evaluación de la fragilidad, donde se exploran 11 parámetros clínicos. Se utilizó una prueba que se realiza de manera rutinaria a pacientes que sufren una FVO como es el TAC utilizando su herramienta GSI y que igualen los resultados obtenidos en las diferentes pruebas que sirven como complemento diagnóstico en la identificación y planificación y tratamiento de la FVO. Utilizamos criterios patomorfológicos para definir las FV, permitiendo establecer categóricamente según el mecanismo de la lesión, para así identificar el grado de inestabilidad y valorar el pronóstico de curación y posible tratamiento. A través de Regresión Logística Binaria se logró encontrar una prueba que permitiera diagnosticar osteoporosis tal como lo hace DXA. Mediante el estadístico C (curva ROC) se estableció el punto de corte teórico de la nueva Prueba TACGSI2Bwater. Se calculó la sensibilidad, la especificidad y los valores predictivos positivos para estimar pacientes osteoporóticos. Con esta prueba se determinó que la presencia de agua en la vértebra medida, clasifica a los pacientes con un 75% de certeza. Pudiendo ser utilizada como herramienta diagnóstica de dicha patología en el futuro.Escuela de DoctoradoDoctorado en Investigación en Ciencias de la Salu

IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit. Lessons from an international multicentre study of 7,090 patients conducted in 14 nations during the COVID-19 pandemic

AIMS: This international study aimed to assess: 1) the prevalence of preoperative and postoperative COVID-19 among patients with hip fracture, 2) the effect on 30-day mortality, and 3) clinical factors associated with the infection and with mortality in COVID-19-positive patients. METHODS: A multicentre collaboration among 112 centres in 14 countries collected data on all patients presenting with a hip fracture between 1(st) March-31(st) May 2020. Demographics, residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, management, ASA grade, length of stay, COVID-19 and 30-day mortality status were recorded. RESULTS: A total of 7090 patients were included, with a mean age of 82.2 (range 50-104) years and 4959 (70%) being female. Of 651 (9.2%) patients diagnosed with COVID-19, 225 (34.6%) were positive at presentation and 426 (65.4%) became positive postoperatively. Positive COVID-19 status was independently associated with male sex (odds ratio (OR) 1.38, p=0.001), residential care (OR 2.15, p<0.001), inpatient fall (OR 2.23, p=0.003), cancer (OR 0.63, p=0.009), ASA grade 4-5 (OR 1.59, p=0.008; OR 8.28, p<0.001), and longer admission (OR 1.06 for each increasing day, p<0.001). Patients with COVID-19 at any time had a significantly lower chance of 30-day survival versus those without COVID-19 (72.7% versus 92.6%, p<0.001). COVID-19 was independently associated with an increased 30-day mortality risk (hazard ratio (HR) 2.83, p<0.001). Increasing age (HR 1.03, p=0.028), male sex (HR 2.35, p<0.001), renal disease (HR 1.53, p=0.017), and pulmonary disease (HR 1.45, p=0.039) were independently associated with a higher 30-day mortality risk in patients with COVID-19 when adjusting for confounders. CONCLUSION: The prevalence of COVID-19 in hip fracture patients during the first wave of the pandemic was 9%, and was independently associated with a three-fold increased 30-day mortality risk. Among COVID-19-positive patients, those who were older, male, with renal or pulmonary disease had a significantly higher mortality risk

Trabajo fin de Grado

Doble Grado en Psicología y Criminología, Grado en Psicologí

Trabajo fin de Grado

Doble Grado en Psicología y Criminología, Grado en Psicologí

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Diagnosis of segmental caudal vena cava aplasia using Computed Tomography.

Segmental caudal vena cava (CVC) aplasia, also termed azygos continuation of the CVC, is a very rare congenital vascular anomaly in dogs and is similar to the segmental aplasia of the same blood vessel in humans. Four dogs between 4 and 18 months of age were diagnosed by computed tomography (CT) at the Veterinary Hospital of the ULPGC. In addition, a normal patient (N) is described first for knowledge and understanding of the normal anatomy and pathophysiology of these abnormalities. A three-phase angiographic study (arterial, portal and delayed) with manual administration of contrast and multiplanar reconstructions are performed, from the cranial aspect of the cardiac silhouette to the region of the bifurcation of the iliac veins and arteries. The images show an interruption of the caudal vena cava between the kidneys and the hepatic structure, with marked distension of the right azygos vein with continuity to the right abdominal region presenting a mild-severe aneurysm. In this study, the following diameters were measured: the azygos vein (0.9 – 1.6 cm, being equal or wider than the aorta), the dilatation produced cranial to kidneys (between 1.75 and 5.4 cm) and the portal vein (1 cm being normal or becoming less than 3 mm). Therefore, two animals were found with portal vein hypoplasia/atresia and one with a thrombus, but in no case were there porto-azygos shunts. Due to the complex vascular anatomy of these patients, it is essential to measure the diameter and insertion site of the portal vein to understand the clinical signs and to evaluate prognosis and surgical interventions if necessary. The results demonstrate that CT is the gold standard test for diagnosing vascular malformations

Didactics strategic for learning teaching strenghtening in Phisical Education through interdisciplinary

The research favors the relationship between two subjects complementing the existent handbook with an oriented guide with matches Physics and Physical Educations disciplines from the Physics lesson, with another one that improves it allowing that relationship from the Physical Education lesson. The analysis of the moments in which the Physics and Physical Education new contents are introduced permitted to elaborate a teaching aid, which complements the existed one to be used by both disciplines´ teachers during the lessons and when the students do the homework, as well as, an oriented guide for the teacher, which helps him/her to understand and use concepts, principles and laws that students receive in Physics lessons beneficiating theoretical knowledge transmission in the Physical Education lesson

Estrategia didáctica para el fortalecimiento de la enseñanza aprendizaje en educación física mediante la interdisciplinariedad

The research favors the relationship between two subjects complementing the existent handbook with an oriented guide with matches Physics and Physical Educations disciplines from the Physics lesson, with another one that improves it allowing that relationship from the Physical Education lesson. The analysis of the moments in which the Physics and Physical Education new contents are introduced permitted to elaborate a teaching aid, which complements the existed one to be used by both disciplines´ teachers during the lessons and when the students do the homework, as well as, an oriented guide for the teacher, which helps him/her to understand and use concepts, principles and laws that students receive in Physics lessons beneficiating theoretical knowledge transmission in the Physical Education lesson.La investigación posibilita la relación de dos asignaturas al complementar un manual existente con guía orientadora que relaciona las disciplinas de Física y Educación Física desde la clase de física, con otro que lo perfecciona al posibilitar esa relación desde la clase de educación física. El estudio de los momentos en que se introducen nuevos contenidos en Física y los que en ese momento reciben los estudiantes en Educación Física facilitó elaborar un medio de enseñanza que complementa el existente para ser utilizado por los profesores de las dos asignaturas en sus clases o en el estudio independiente, así como una guía orientadora al profesor que le permite comprender y utilizar en sus clases conceptos principios y leyes que reciben los estudiantes en Física, beneficiando con ello la trasmisión de conocimientos teóricos en la clase de Educación Física