Densitometria ossea: una breve guida per il nefrologo:

DXA: a beginner's guideStudies in patients with chronic kidney disease have definitively shown that "dual-energy X-ray absorptiometry" (DXA) may be helpful in assessing fracture risk. Moreover, it is essential to diagnose osteoporosis and evaluate response to treatment. In order to obtain the best utility from DXA, nephrologists need to know the fundamentals of this technique, its indications in clinical practice, and the potential pitfalls in the interpretation of its results. This review will provide an overview of the fundamentals, methodology, and current clinical applications of DXA with special focus on the nephrologist's perspective

Older people with hip fracture and IADL disability require earlier surgery

Background: Hip fractures represent a major challenge for physicians as well as society as a whole. Both poor functional status and delay to surgery are well known risk factors for negative outcomes. We hypothesized that the timing of the operation is more important for frail older people than older people without functional limitations before fracture. Methods: We performed a prospective multicenter cohort study on 806 consecutive patients, 75 years of age or older, admitted with a fragility hip fracture to three hospitals in the Emilia-Romagna Region (Italy). All three hospitals had a comanaged care model, and the patients were under the shared responsibility of an orthopedic surgeon and a geriatrician. Results: Functional status assessed as instrumental activities of daily living was an important predictor of survival after 1 year from fracture. After adjusting for confounders, the hazard ratios per 1 point score of increase from 0 to 8 was 1.30 (95% confidence interval 1.19-1.42, p =. 000). Time to surgery increased 1-year mortality in patients with a low instrumental activities of daily living score (hazard ratios per day of surgical delay 1.14, 95% confidence interval 1.06-1.22, p <. 001) and intermediate instrumental activities of daily living score (hazard ratios 1.21, 95% confidence interval 1.09-1.34, p <. 001) but was an insignificant risk factor in functionally independent patients (hazard ratios 1.05 95% confidence interval 0.79-1.41, p =. 706). Conclusions: Surgery delay is an independent factor for mortality in older patients after hip fracture but only for the frail older people with prefracture functional impairment. If our results are confirmed, a more intensive approach should be adopted for older people with hip fractures who have disabilities. © 2012 The Author

TEX (TEst stand for X-band) at LNF

TEX facility if commissioned for high power testing to characterize accelerating structures and validate them for the operation on future particle accelerators for medical, industrial and research applications. At this aim, TEX is directly involved in the LNF leading project EuPRAXIA@SPARC_Lab. The brief description of the facility and its status and prospective will be provided.Comment: Talk presented at the International Workshop on Future Linear Colliders (LCWS 2023), 15-19 May 2023. C23-05-15.

The Inconsistent Data On The Effect Of Vitamin D On Muscle Function

n/

REHABILITATION AFTER HIP FRACTURE IN PATIENTS WITH DEMENTIA

n/

Challenges in the differential diagnosis of hypercalcemia: A case of hypercalcemia with normal PTH level

The hypercalcemias are a common and heterogeneous group of disorders, ranging from the occasional detection of a high level of serum calcium to a life-treating condition. In a patient presenting with hypercalcemia, a differential diagnosis can be established easily by measuring serum calcium and parathyroid hormone (PTH) concentrations. We describe the case of an 83-year-old man presenting with a severe symptomatic hypercalcemia with high-normal PTH level due to the coexistence of primary hyperparathyroidism and malignancy-associated hypercalcemia. The presence of two conditions producing hypercalcemia was revealed only during in-hospital stay and after the administration of an intravenous bisphosphonate, when the PTH concentration increased rapidly after bisphosphonate treatment with a decrease in serum calcium. The occurrence of two conditions producing hypercalcemia is a rare event in the literature, and should be considered in the presence of an abnormally high serum calcium level associated with normal or high-normal PTH, in order to establish a correct diagnosis and appropriate interventions

GIOG. The Management of Hip Fracture in the Older Population. Joint Position Statement by Gruppo Italiano Ortogeriatria (GIOG)

This document is a Joint Position Statement by Gruppo Italiano di OrtoGeriatria (GIOG) supported by Societ\ue0 Italiana di Gerontologia e Geriatria (SIGG), and Associazione Italiana Psicogeriatria (AIP) on management of hip fracture older patients. Orthogeriatric care is at present the best model of care to improve results in older patients after hip fracture. The implementation of orthogeriatric model of care, based on the collaboration between orthopaedic surgeons and geriatricians, must take into account the local availability of resources and facilities and should be integrated into the local context. At the same time the programme must be based on the best available evidences and planned following accepted quality standards that ensure the efficacy of the intervention. The position paper focused on eight quality standards for the management of hip fracture older patients in orthogeriatric model of care. The GIOG promotes the development of a clinic database with the aim of obtaining a qualitative improvement in the management of hip fracture

Time to surgery and rehabilitation resources affect outcomes in orthogeriatric units

Objective: To compare the pathways of care and clinical results for patients admitted for hip fracture (HF) in 3 orthogeriatric co-managed care centers in order to estimate the effect of system factors on mortality and functional outcome. Design: Prospective inception multicenter cohort study. Setting: Three tertiary Hospitals. Participants: 806 patients consecutively admitted with HF. Measurements: 1-Year mortality, the loss of 1 or more functional abilities in activities of daily living (ADLs), and the recovery/maintenance of independent ambulation at 6 months from the fracture. Results: On the whole sample, 71.1% of patients survived 1 year from the fracture. In one hospital the risk of 1-year mortality was significantly higher even after adjusting for age, sex, comorbidity, prefracture functional status and cognitive impairment (odd ratio (OR) 1.56, 95% confidence interval (CI) 1.15-2.18, p= 0.01). This was principally explained by a longer time to surgery (5.2 days ± 3.2 vs 2.7 ± 2.3 and 2.7 ± 2.2, p< 0.001). The three hospitals also differed in the rate of subjects losing the ability in ADLs after 6 months from the fracture (54.2%, 61%, 43.5%, p= 0.016), while no statistical differences were found in the recovery of independent ambulation. On the basis of multivariate models, a lower access to post-acute rehabilitation could account for lower outcome in functional status. Conclusions: This study suggests that system factors such as time to surgery and rehabilitation resources can affect functional recovery and 1-year mortality in orthogeriatric units and they could explain different outcomes when comparing care models. © 2011 Elsevier Ireland Ltd