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

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

Restoration in Vertebral Compression Fractures (VCF): Effectiveness Evaluation Based on 3D Technology

There are few studies about anatomical reduction of the fractured vertebral body before stabilization for treatment of vertebral compression fracture (VCF). Although restoration on vertebral height has been useful, the reduction of fractured endplates is limited. The vertebra is part of a joint, and vertebral endplates must be treated like other weight-bearing joint to avoid complications. The aim of this study was to evaluate the feasibility of anatomic reduction of vertebral compression fracture, in different bone conditions, fracture types, and ages (VCF). Under methodological point of view, we followed different steps: first was the placement of two expandable titanium implants just below the fracture. Later, to push the fractured endplates into a more anatomical position, the implants were expanded. Finally, with the implants perfectly positioned, PMMA cement was injected to avoid any loss of correction. To evaluate the effectiveness of this procedure in anatomical fracture reduction, a method based on 3D CT reconstructions was developed. In this paper, we have developed the procedure in three case studies. In all of them, we were able to demonstrate the efficacy of this procedure to reduce the VCF. The percentage of correction of the kyphotic angle varied range between 49% and 62% with respect to the value after the fracture preoperative value. This was accompanied by a reduction of the pain level on the VAS scale around 50%. In conclusion, this novel approach to the vertebral fracture treatment (VCF) associated with 3D assessment have demonstrated the possibility of reducing the vertebral kyphosis angle and the vertebral endplate fractures. However, given the few cases presented, more studies are necessaries to confirm these results

C1-C2 Rotatory Subluxation in Adults “A Narrative Review”

The atlantoaxial joint C2 (axis) with the anterior arch of C1 (atlas) allows 50% of cervical lateral rotation. It is responsible for precise and important movements that allow us to perform precise actions, both in normal and working life. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed and the outcome is worse. An early diagnosis and treatment are essential to ensure satisfactory neurological and functional outcomes. The aim of this review is to analyze C1-C2 rotatory subluxation in adults, given its rarity. The time between injury and reduction is key, as it is directly related to prognosis and the severity of the treatment options. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed as a lot of cases are not related to a clear trauma, with a poor prognosis just because of the late diagnosis and the outcome is worse. The correct approach and treatment of atlantoaxial dislocation requires a careful study of the radiological findings to decide the direction and plane of the dislocation, and the search for associated skeletal anomalies

Nirmatrelvir/ritonavir in COVID-19 patients with haematological malignancies: a report from the EPICOVIDEHA registry

International audienceBackground: Nirmatrelvir/ritonavir treatment decreases the hospitalisation rate in immunocompetent patients with COVID-19, but data on efficacy in patients with haematological malignancy are scarce. Here, we describe the outcome of nirmatrelvir/ritonavir treatment in a large cohort of the latter patients. Methods: This is a retrospective cohort study from the multicentre EPICOVIDEHA registry (NCT04733729) on patients with haematological malignancy, who were diagnosed with COVID-19 between January and September 2022. Patients receiving nirmatrelvir/ritonavir were compared to those who did not. A logistic regression was run to determine factors associated with nirmatrelvir/ritonavir administration in our sample. Mortality between treatment groups was assessed with Kaplan–Meier survival plots after matching all the patients with a propensity score. Additionally, a Cox regression was modelled to detect factors associated with mortality in patients receiving nirmatrelvir/ritonavir. Findings: A total of 1859 patients were analysed, 117 (6%) were treated with nirmatrelvir/ritonavir, 1742 (94%) were treated otherwise. Of 117 patients receiving nirmatrelvir/ritonavir, 80% had received ≥1 anti-SARS-CoV-2 vaccine dose before COVID-19 onset, 13% of which received a 2nd vaccine booster. 5% were admitted to ICU. Nirmatrelvir/ritonavir treatment was associated with the presence of extrapulmonary symptoms at COVID-19 onset, for example anosmia, fever, rhinitis, or sinusitis (aOR 2.509, 95%CI 1.448–4.347) and 2nd vaccine booster (aOR 3.624, 95%CI 1.619–8.109). Chronic pulmonary disease (aOR 0.261, 95%CI 0.093–0.732) and obesity (aOR 0.105, 95%CI 0.014–0.776) were not associated with nirmatrelvir/ritonavir use. After propensity score matching, day-30 mortality rate in patients treated with nirmatrelvir/ritonavir was 2%, significantly lower than in patients with SARS-CoV-2 directed treatment other than nirmatrelvir/ritonavir (11%, p = 0.036). No factor was observed explaining the mortality difference in patients after nirmatrelvir/ritonavir administration. Interpretation: Haematological malignancy patients were more likely to receive nirmatrelvir/ritonavir when reporting extrapulmonary symptoms or 2nd vaccine booster at COVID-19 onset, as opposed to chronic pulmonary disease and obesity. The mortality rate in patients treated with nirmatrelvir/ritonavir was lower than in patients with targeted drugs other than nirmatrelvir/ritonavir. Funding: EPICOVIDEHA has received funds from Optics COMMIT (COVID-19 Unmet Medical Needs and Associated Research Extension) COVID-19 RFP program by GILEAD Science, United States (Project 2020-8223)