Revisión de la evidencia científica sobre uso clínico del Trabecular Bone Score (TBS). Posiciones oficiales de la SEIOMM (2018)

La incorporación de nuevas aplicaciones tecnológicas en el campo médico conlleva un prolongado periodo de valoración de la evidencia científica que se va generando en el proceso de validación clínica. En los últimos 5 años se han generado múltiples publicaciones, comunicaciones en congresos y reuniones de sociedades científicas. La aplicación del Trabecular Bone Score (TBS) ha recibido también la atención de la Sociedad Internacional de Densitometría Clínica (The International Society for Clinical Densitometry -ISCD-) que la ha incorporado a sus posiciones oficiales

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Capacidad de dosificación de vehículos semisólidos en cápsulas duras conteniendo piroxicam 20 mg

The aim of the article is to familiarize the pharmaceutical compounding phamacist with liquid and semisolids contents in the form of capsules. This type of formulations require simple tools. For that, Piroxicam has been chosen as a prototype active ingredient also they have been choosen vehicles with different physico-chemical properties, such as hydrophilic and lipophilic liquids that had to be thicker and another semisolid previously melt. They had been developed methods for the determination of the solubility, viscosity and dosage ability of the formulations. In addition the stability to diverse conditions has been evaluated. The best results have been found with Gelucire® 44/14, semisolid excipient with emulsifying characteristics. It is possible to find better profiles for the other tried formulations alive when the phenomenon of precipitation and retardation could be avoid in the stomach. Additionally, simplicity in their formulation, suitable manufacture and stability turn to this alternative interesting for it application in the oficinal Pharmacy

La verdadera historia de la Aspirina

From the thirties of last century, the Aspirin has been wrongly considered as a Felix Hoffmann discovering. Nevertheless, recent research has put in evidence that the true inventor of this drug has been Arthur Eichengrün. In this paper, a short history of the drug is described, as well as the political interferences on it

Can 3D measurements obtained by lumbar DXA predict fractures in the dorsal vertebrae?

Objetivo: Valorar la asociación de las mediciónes tridimensionales (3D) derivadas de la absorciometría de rayos X de energía dual (DXA) lumbar con las fracturas osteoporóticas en las vértebras dorsales. Material y métodos: Analizamos retrospectivamente 32 mujeres postmenopáusicas: 16 con fracturas incidentes en las vértebras dorsales y 16 controles sin ningún tipo de fractura. Las DXA lumbares se adquirieron en la visita inicial (es decir, antes del evento de fractura) y se midió la densidad mineral ósea de área (DMOa) en las vértebras L1 a L4. Las mediciónes 3D derivadas de la DXA se evaluaron utilizando un software de modelado 3D (3DSHAPER). La densidad mineral ósea volumétrica (DMOv) se calculó en el hueso trabecular, cortical e integral. También se midió el grosor cortical y la DMO superficial (DMOs) cortical. Las diferencias en las mediciónes derivadas de la DXA entre los grupos de fracturados y controles se evaluaron utilizando una prueba t de Student no pareada. También se calculó la razón de probabilidades (OR) y el área bajo la curva característica operativa del receptor (AUC). Resultados: En el presente estudio casocontrol ajustado por edad no se encontraron diferencias significativas entre los grupos de fracturados y controles en términos de peso (ρ=0,44), altura (ρ=0,25) y DMOa (ρ=0,11). Sin embargo, sí se encontraron diferencias significativas (ρ<0,05) en la DMOv integral y trabecular y en la DMOs cortical. La DMOv trabecular en el cuerpo vertebral fue la medida que mejor discriminó entre ambos grupos, con un AUC de 0,733, respecto a 0,682 para la DMOa. Conclusión: Este estudio muestra la capacidad de los modelos 3D derivados de la DXA lumbar para discriminar entre sujetos con fracturas incidentes en las vértebras dorsales y controles. Es necesario analizar cohortes mayores para determinar si estas mediciónes podrían mejorar la predicción del riesgo de fractura en la práctica clínica.Objective: To assess the relation between threedimensional (3D) measurements obtained by lumbar dual energy Xray absorptiometry (DXA) and osteoporotic fractures in dorsal vertebrae. Material and methods: We analysed retrospectively 32 postmenopausal women, allocated to two groups: 16 women in the experimental group, who presented incident fractures of the dorsal vertebrae, and 16 women in the control group, who did not show any type of fracture. Measurements of the (aBMD) of vertebrae L1 through L4 were taken at the initial visit (i.e., prior to the fracture event) by lumbar dualenergy xray absorptiometries (DXA). 3D measurements obtained by DXA were evaluated using 3D modelling software (3DSHAPER). Volumetric bone mineral density (vBMD) was calculated in the trabecular, cortical and integral bone. Cortical thickness and cortical surface BMD (sBMD) were also measured. Differences in measurements derived from the DXA between the experimental and control groups were assessed using an unpaired Student ttest. The odds ratio (OR) and the area under the receiver operating characteristic curve (AUC) were also determined. Results: In the present ageadjusted casecontrol study, no significant differences were found between the experimental and control groups in terms of weight (ρ=0.44), height (ρ=0.25) and aBMD (ρ=0.11). However, significant differences (ρ<0.05) were found in the integral and trabecular vBMD and in the cortical sBMD. Trabecular vBMD in the vertebral body was the measure that best discriminated between both groups, with an AUC of 0.733, compared to 0.682 of the aBMD. Conclusion: This study shows the ability of 3D models resultant from lumbar DXAs to discern between subjects with incident fractures in the dorsal vertebrae and control subjects. It is necessary to analyse larger cohorts to establish if these measurements could improve the prediction of fracture risk in clinical practice.The research that led to these results also received funding from the State Program for Research, Development and Innovation Oriented to the Challenges of Society, Ministry of Economy and Competitiveness (Reference: RTC-2014-2740-1) and from the Eurostars program (project ID: 9 140), financed by the Centre for Industrial and Technological Development, Ministry of Economy and Competitiveness. Furthermore, the author Mirella López Picazo received a FEIOMM grant to present the results of this work at the ASBMR 2018

Technical note: cortical thickness and density estimation from clinical CT using a prior thickness-density relationship

\u3cp\u3ePurpose: Cortical thickness and density are critical components in determining the strength of bony structures. Computed tomography (CT) is one possible modality for analyzing the cortex in 3D. In this paper, a model-based approach for measuring the cortical bone thickness and density from clinical CT images is proposed. Methods: Density variations across the cortex were modeled as a function of the cortical thickness and density, location of the cortex, density of surrounding tissues, and imaging blur. High resolution micro-CT data of cadaver proximal femurs were analyzed to determine a relationship between cortical thickness and density. This thickness-density relationship was used as prior information to be incorporated in the model to obtain accurate measurements of cortical thickness and density from clinical CT volumes. The method was validated using micro-CT scans of 23 cadaver proximal femurs. Simulated clinical CT images with different voxel sizes were generated from the micro-CT data. Cortical thickness and density were estimated from the simulated images using the proposed method and compared with measurements obtained using the micro-CT images to evaluate the effect of voxel size on the accuracy of the method. Then, 19 of the 23 specimens were imaged using a clinical CT scanner. Cortical thickness and density were estimated from the clinical CT images using the proposed method and compared with the micro-CT measurements. Finally, a case-control study including 20 patients with osteoporosis and 20 age-matched controls with normal bone density was performed to evaluate the proposed method in a clinical context. Results: Cortical thickness (density) estimation errors were 0.07 ± 0.19 mm (-18 ± 92 mg/cm\u3csup\u3e3\u3c/sup\u3e) using the simulated clinical CT volumes with the smallest voxel size (0.33 × 0.33 × 0.5 mm\u3csup\u3e3\u3c/sup\u3e), and 0.10 ± 0.24 mm (-10 ± 115 mg/cm\u3csup\u3e3\u3c/sup\u3e) using the volumes with the largest voxel size (1.0 × 1.0 × 3.0 mm\u3csup\u3e3\u3c/sup\u3e). A trend for the cortical thickness and density estimation errors to increase with voxel size was observed and was more pronounced for thin cortices. Using clinical CT data for 19 of the 23 samples, mean errors of 0.18 ± 0.24 mm for the cortical thickness and 15 ± 106 mg/cm\u3csup\u3e3\u3c/sup\u3e for the density were found. The case-control study showed that osteoporotic patients had a thinner cortex and a lower cortical density, with average differences of -0.8 mm and -58.6 mg/cm\u3csup\u3e3\u3c/sup\u3e at the proximal femur in comparison with age-matched controls (p-value &lt;0.001). Conclusions: This method might be a promising approach for the quantification of cortical bone thickness and density using clinical routine imaging techniques. Future work will concentrate on investigating how this approach can improve the estimation of mechanical strength of bony structures, the prevention of fracture, and the management of osteoporosis.\u3c/p\u3

3D reconstruction of both shape and bone mineral density distribution of the femur from DXA images

Comunicació presentada a: IEEE International Symposium on Biomedical Imaging: From Nano to Macro celebrat del 14 al 17 d'abril de 2010 a Rotterdam, Països Baixos.This work has been supported by a grant from the Instituto de Sa–lud Carlos III and by a grant from the “Deutsche Forschungsge–meinschaft” (LO 730 / 3–1). The authors acknowledge Benedikt Schuler (Institute for Biomedical Image Analysis, UMIT, Hall in Tirol, Austria) and Dr. E. M. Lochmüller (Universitäts–Frauenklinik der LMU, München Germany) for the data collection