Evaluación ecográfica del Ligamento Calcáneonavicular (Ligamento de Spring): correlación de hallazgos anatómicos y sonográficos

Programa Oficial de Doutoramento en Saúde e Motricidade Humana. 5002V01[Resumen] Introducción: El ligamento Spring (LS) representa una de las estructuras más importantes en la estabilidad del pie, principalmente en el mantenimiento del arco plantar (AP), evitando así el pie plano adquirido en el adulto (PPAA). Debido a su ubicación, origen e inserción, así como la disposición de sus haces, lo convierten en un elemento estabilizador que está minuciosamente preparado para mejorar la biomecánica del pie. El análisis de dicho ligamento mediante ecografía se presenta ventajoso por su rapidez, facilidad de uso en el ámbito clínico, inocuidad y efectividad. Objetivos: El propósito ha sido evaluar la confiabilidad intra e interobservador entre las imágenes de ultrasonido (US) y las mediciones del calibre para determinar las dimensiones del LS en cadáveres, para poder de esta manera contribuir en la calidad y especificidad diagnóstica de esta estructura. Material y Métodos: Se estudiaron LS de 62 pies humanos de cadáveres embalsamados con formaldehído. La confiabilidad intra e interobservador de la longitud, el ancho y el grosor de LS entre las medidas de US y el calibre se determinó en períodos de sesiones intra e intersesión por los coeficientes de correlación intraclase (ICC) y los coeficientes de correlación de Pearson (r). Resúmenes 18 Resultados: Diferenciando entre los resultados intersesión y los resultados entre examinadores encontramos que la evaluación de LS realizada por US y el calibre entre el primer y el segundo observador entre sesiones mostró una excelente confiabilidad entre examinadores (ICC (1-1) = 0.938-0.994; ICC (1-1) = 0.825-0.998) con una fuerte correlación ( r = 0.893-0.989; r = 0.725-0.998; P <0.001) para todas las medidas (ancho, longitud y grosor), respectivamente, y no hubo diferencias estadísticamente significativas entre los evaluadores (P> 0.05) para todas las dimensiones, aunque para las medidas de ancho por US sí que las hubo (P < 0,05). Al contrastar tanto el US como el calibre, la evaluación de LS entre las mediciones entre el US y el calibre entre sesiones para ambos observadores demostró una excelente confiabilidad entre evaluadores (ICC (1-1) = 0.911-0.966) con una fuerte correlación (r = 0.852-0.937; P <0.001) para todas las medidas, y no hubo diferencias estadísticamente significativas entre sesiones (P> 0.05) entre las medidas de US y el calibre. Conclusión: Tanto el US como el Calibre pueden ser recomendados para las mediciones de las diferentes dimensiones del LS debido a su excelente confiabilidad y fuerte correlación en cadáveres, aunque las mediciones de ancho deben ser tomadas con precaución ya que existen diferencias de repetibilidad en los US.[Resumo] Introducción: O ligamento Spring (LS) representa unha das estruturas máis importantes na estabilidade do pé, principalmente no mantemento do arco plantar (AP), evitando así o pé plano adquirido no adulto (PPAA). Debido á súa localización, orixe e inserción, así como a disposición dos seus feixes de fibras, convérteno nun elemento estabilizador que está minuciosamente preparado para mellorar a biomecánica do pé. A análise deste ligamento mediante a ecografía preséntase vantaxosa pola súa rapidez, facilidade de uso no ámbito clínico, inocuidade e efectividade. Obxectivos: o propósito foi avaliar a fiabilidade intra e interobservador entre as medidas de ultrasóns (US) e as medidas do calibre para determinar as dimensións do LS nos cadáveres, co fin de contribuír deste xeito á calidade e diagnóstico específico desta estrutura. Material e métodos: Estudáronse LS de 62 pés humanos de cadáveres embalsados con formaldehído. A fiabilidade intra e interobservador da lonxitude, ancho e grosor do LS entre as medidas US e calibre determinouse nas sesións intra e intersesión mediante coeficientes de correlación intraclase (ICC) e coeficientes de correlación Pearson (r). Resúmenes 20 Resultados: Diferenciando entre os resultados da intersección e os resultados entre os examinadores descubrimos que a avaliación do LS realizada polos US e do calibre entre o primeiro e o segundo observador entre as sesións mostraron unha excelente fiabilidade inter-examinadores (ICC (1-1) = 0.938-0.994 ; CCI (1-1) = 0,825-0,998) cunha forte correlación (r = 0,893-0,989; r = 0,725-0,998; P <0,001) para todas as medidas (ancho, lonxitude e grosor), respectivamente, e non houbo diferenzas estatísticamente significativas entre os avaliadores (P> 0,05) para tódalas dimensións, aínda que para as medicións de ancho dos US houbo (P <0,05). Ao contrastar tanto os US como o calibre, a avaliación do LS entre as medidas entre os US e calibre entre as sesións de ambos os observadores demostrou unha excelente fiabilidade entre os avaliadores (ICC (1-1) = 0.911-0.966) cunha forte correlación (r = 0,852-0,937; P <0,001) para tódalas medicións, e non houbo diferenzas estadísticamente significativas entre as sesións (P> 0,05) entre as medicións dos US e calibre. Conclusión: Os US e o calibre pódense recomendar para as medicións das diferentes dimensións do LS debido á súa excelente fiabilidade e forte correlación nos cadáveres, aínda que as medidas de ancho deben tomarse con precaución xa que hai diferenzas de repetibilidade nos US.[Abstract] Introduction: The spring ligament (SL) is one of the most important structures responsible for stabilizing the foot, mainly in the plantar arch (PA) maintaining. This ligament is not present or is lax in adults acquired flat foot deformity (AFFD). Due to its location, origin, and insertion in addition to the disposition of its beams, it is a stabilizing element that was meticulously designed to improve the biomechanics of the foot. Ultrasound analysis of this ligament is advantageous due to its speed, ease of use in the clinical field, safety, and efficacy. Objectives: The purpose has been to evaluate intra and inter- rater reliability between ultrasound imaging (US) and caliper measures, to determine Spring ligament (SL) dimensions in cadavers, in order to evaluate the structure’s quality and diagnostic specificity. Material and Methods: SLs were studied from 62 human feet from formaldehyde-embalmed cadavers. Intra and inter-observer reliability of SL length, width and thickness between US and caliper measurements was determined at intra and inter-session by intraclass correlation coefficients (ICC) and Pearson´s correlation coefficients (r). Resúmenes 22 Results: Differentiating between intersession results and results between examiners, we found that SL evaluation by US and caliper between inter-session first and second observer showed excellent inter-rater reliability (ICC(1-1)=0.938-0.994; ICC(1- 1)=0.825-0.998) with a strong correlation (r=0.893-0.989; r=0.725- 0.998; P<0.001) for all dimensions (width, length and thickness), respectively, and there were not inter-rater statistically significant differences (P>0.05) for all measurement even though there were for width measurements by US (P < 0.05). Comparing both US and caliper, SL evaluation between inter-session US and caliper measurements for both observers showed an excellent inter-rater reliability (ICC(1-1)=0.911-0.966) with a strong correlation (r=0.852-0.937; P < 0.001) for all dimensions, and there were not inter-session statistically significant differences (P>0.05) between US and caliper measurements. Conclusion: US and caliper could be recommended for all SL measurements evaluation due to their excellent reliability and strong correlation in cadavers, although width measurements should be taken with caution due to US repeatability difference

Intra and Inter-rater Reliability between Ultrasound Imaging and Caliper Measures to determine Spring Ligament Dimensions in Cadavers

The purpose was to evaluate intra and inter-rater reliability, repeatability and absolute accuracy between ultrasound imaging (US) and caliper measures to determine Spring ligament (SL) dimensions in cadavers. SLs were identified from 62 human feet from formaldehyde-embalmed cadavers. Intra and inter-observer reliability, repeatability and absolute accuracy of SL width, thickness and length between US and caliper measurements were determined at intra and inter-session by intraclass correlation coefficients, Pearson´s correlation coefficients, Student t tests, standard errors of measurement, minimum detectable changes, values of normality, 95% limits of agreement, and Bland-Altman plots. Excellent inter-session and inter-rater reliability, adequate absolute accuracy, almost perfect agreement and strong correlations were shown for caliper, US and their comparison for all SL dimensions. US measurements presented higher absolute accuracy than caliper measures for SL length and thickness dimensions, while caliper displayed greater absolute accuracy for SL width dimensions. Good repeatability (P > 0.05) was shown for all SL dimensions by US, caliper and their comparison, except for SL width dimension measured with US (P = 0.019). Both US and caliper could be recommended for all SL dimensions evaluation due to their excellent reliability and absolute accuracy in cadavers, although width dimensions should be considered with caution due to US repeatability differences

Association between anterior talofibular ligament injury and ankle tendon, ligament, and joint conditions revealed by magnetic resonance imaging

[Abstract] Background: The lateral ankle ligament complex is the most frequently injured ligament secondary to strong ankle inversion movement during lateral ankle sprains (LAS). Among these injuries, anterior talofibular ligament (ATFL) injury is the most frequent condition (present in 66-85% of such injuries). The purpose of this research was to use magnetic resonance imaging (MRI) to determine the association between ankle tendon, ligament, and joint conditions and ATFL injuries. Methods: A case-control MRI study was carried out to compare the presence of ankle muscle, tendon, ligament, and joint conditions in patients with injured ATFLs (case group; n=25) and non-injured ATFLs (control group; n=25). Results: Achilles tendinopathy was present in 1/25 (4%) patients with injured ATFLs and 7/25 (28%) non-injured ATFL subjects (P=0.048). Injured calcaneofibular ligaments (CFLs) were present in 19/25 (76%) patients with injured ATFLs and 1/25 (4%) non-injured ATFL subjects (P<0.001). Finally, injured tibiotalar joints were present in 16/25 (64%) patients with injured ATFLs and 5/25 (20%) non-injured ATFL subjects (P=0.002). Other musculoskeletal structure injuries occurred at similar rates between patients with injured ATFLs and those with non-injured ATLFs (P≥0.05). Conclusions: Patients with ATFL injuries showed a greater presence of CFL and tibiotalar joint injuries than subjects with non-injured ATFLs

Epidemiological pattern, incidence, and outcomes of COVID-19 in liver transplant patients.

The incidence and outcomes of coronavirus disease 2019 (COVID-19) in immunocompromised patients are a matter of debate. We performed a prospective nationwide study including a consecutive cohort of liver transplant patients with COVID-19 recruited during the Spanish outbreak from 28 February to 7 April, 2020. The primary outcome was severe COVID-19, defined as the need for mechanical ventilation, intensive care, and/or death. Age- and gender-standardised incidence and mortality ratios (SIR and SMR) were calculated using data from the Ministry of Health and the Spanish liver transplant registry. Independent predictors of severe COVID-19 among hospitalised patients were analysed using multivariate Cox regression. A total of 111 liver transplant patients were diagnosed with COVID-19 (SIR = 191.2 [95% CI 190.3-192.2]). The epidemiological curve and geographic distribution overlapped widely between the liver transplant and general populations. After a median follow-up of 23 days, 96 patients (86.5%) were admitted to hospital and 22 patients (19.8%) required respiratory support. A total of 12 patients were admitted to the ICU (10.8%). The mortality rate was 18%, which was lower than in the matched general population (SMR = 95.5 [95% CI 94.2-96.8]). Overall, 35 patients (31.5%) met criteria of severe COVID-19. Baseline immunosuppression containing mycophenolate was an independent predictor of severe COVID-19 (relative risk = 3.94; 95% CI 1.59-9.74; p = 0.003), particularly at doses higher than 1,000 mg/day (p = 0.003). This deleterious effect was not observed with calcineurin inhibitors or everolimus and complete immunosuppression withdrawal showed no benefit. Being chronically immunosuppressed, liver transplant patients have an increased risk of acquiring COVID-19 but their mortality rates are lower than the matched general population. Upon hospital admission, mycophenolate dose reduction or withdrawal could help in preventing severe COVID-19. However, complete immunosuppression withdrawal should be discouraged. In liver transplant patients, chronic immunosuppression increases the risk of acquiring COVID-19 but it could reduce disease severity. Complete immunosuppression withdrawal may not be justified. However, mycophenolate withdrawal or temporary conversion to calcineurin inhibitors or everolimus until disease resolution could be beneficial in hospitalised patients