Quantitative Ultrasound of Phalanx in Primary and Secondary Osteoporosis: Mini-review and Practical Experience

2022 ◽  
pp. 875647932110702
Author(s):  
Minoo Najafi ◽  
Maryam Najafi ◽  
Mitra Mahdavi-Mazdeh ◽  
Sima Maziar ◽  
Abbas Ali Keshtkar ◽  
...  

Objective: Dual x-ray absorptiometry (DXA) is gold standard of bone densitometry, but quantitative ultrasound (QUS) of bone is less expensive and portable. This study was designed to assess its usefulness in secondary osteoporosis diagnosis. Materials and Methods: There were 200 secondary osteoporosis cases (rheumatoid arthritis, hemodialysis, kidney transplant patients, and levothyroxine users) and of those, their phalanx QUS results were compared with normal controls. Also, the QUS and DXA results were compared to find any correlation of these methods for diagnosing osteoporosis. Results: There was not significantly different results compared with normal controls, except for those of hemodialysis patients ( P = .00). Also, the comparison of QUS with DXA results showed no significant correlation except in hemodialysis patients, in both spinal and femoral regions ( P = .023 and .21, respectively), as well as the levothyroxine group’s spinal region ( P = .005). Conclusion: These results suggest that QUS of phalanx may be useful in screening secondary osteoporosis but for establishment of diagnosis, DXA measurements are still needed.

Author(s):  
Dilek Gogas Yavuz ◽  
Kadriye Aydin ◽  
tugce apaydin ◽  
Arzu Velioglu ◽  
Meral Mert ◽  
...  

Purpose: Kidney transplant recipients are prone to metabolic bone diseases and consequent fractures. This study aimed to evaluate the incidence of incipient vertebral fractures, osteopenia, osteoporosis, and the clinical factors associated with incipient vertebral fractures in a group of kidney transplant patients. Methods: Two hundred sixty-four patients (F/M:124/140, 45.3±13 years) who had undergone kidney transplantation between 2008 and 2018 and who were followed up at least one year in third care centers were included in this multicenter retrospective study. Bone mineral densitometry was performed using dual-energy X-ray absorptiometry. Vertebral fractures were assessed semi-quantitatively using conventional thoracolumbar lateral radiography in 202 of the patients. Results: Vertebral fractures were observed in 56.4% (n=114) of the study group. Severe vertebral fractures were observed in 30.7% (n=62) of the patients in vertebral X-ray evaluation. The frequency of osteoporosis was 20.0% (53 of 264 patients), and osteopenia was 35.6% (94 of 264 patients). BMD levels were in the normal range in 40.3% (n=46) of the subjects with vertebral fractures. It was in the osteoporotic range in 20.1% (n=23) and the osteopenic range in 40.3% (n=46). Serum calcium, parathormone vitamin, and creatinine levels were similar between the patients with and without vertebral fractures. Femoral neck BMD was negatively correlated with age (r: −0.21, p<0.001) and positively correlated with body mass index (r:0.29, p<0.001). Vertebral fractures were associated with age, duration of hemodialysis, BMI, femoral neck Z score (R2: 37.8%, p=0.027). Conclusion: BMD was in the normal or osteopenic range in 79.8% in our cohort of renal transplant patients with incipient vertebral fractures. As incipient vertebral fractures can be observed in patients with normal BMD levels in kidney transplant recipients, conventional X-ray screening for vertebral fractures may be beneficial for a proper therapy decision of metabolic bone disease in kidney transplant recipients.


Author(s):  
nurettin ay ◽  
Ramazan Danis ◽  
Jehat Kılıc ◽  
Derya Deniz Altıntaş

Objective: This study aims to investigate the mortality factors in hemodialysis patients and kidney transplant patients with COVID-19 patients. Method: The demographic, clinic, laboratory, and radiologic signs of the kidney transplant and hemodialysis patients diagnosed with COVID-19 between 11 March 2020-11 March 2021 were evaluated. Results: To this study, 72 hemodialysis (median age, 57.5 Q1-Q3:43-65; female:36/50%) and 58 kidney transplant (median age, 44.5 Q1-Q3:28.75-55.25; female:21/36.2%) were included. Fifteen HD patients (20.8%) died. To identify the independent predictors of in-hospital mortality, multivariable logistic regression analyses were performed using the variables in the univariate analyses including age, female gender, diabetes mellitus, ferritin, d-dimer, albumin, CRP, procalcitonin, dyspnea. Age (OR:1.12, 95% [CI]: 1.03-1.21, p=0.004), and dyspnea (OR: 9,7 95% CI 1.80-52.2, p=0.008) were found to be associated with in-hospital mortality. Nine (15.5%) of transplant patients died. The median time from the beginning of symptoms to the time of admission was 3 days (2-5). And this rate was 2 (2-3) and 5 (4-5.75) days, respectively, for patients followed up in our center and the external centers (p<0.001). Although an increase in CRP, ferritin, D-dimer levels, dyspnea, and bilateral involvement in CT images was statistically significant in the univariate analysis, no single factor was found to be related to mortality in multivariate analysis. Conclusion: Both HD and renal transplant patients should be followed closely. Early admission of HD and RT patients might be life-saving when suspected. Early inclusion of these patients into the vaccination program might reduce mortality. However, large-scale prospective randomized studies are needed.


2020 ◽  
Vol 13 (4) ◽  
pp. 184-190
Author(s):  
Muhammad Irfan ◽  
Abdul Rasheed Qureshi ◽  
Zeeshan Ashraf ◽  
Muhammad Amjad Ramzan ◽  
Tehmina Naeem ◽  
...  

ABSTRACT Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available  and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard.   Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology  OPD-Gulab Devi Teaching Hospital, Lahore from November 2016 to July 2018. Adult patients with clinical features suggesting pleural effusions were included while those where no suspicion of pleural effusion, patients < 14 years and pregnant ladies were excluded. Patients were subjected to chest x-ray PA and Lateral views and chest ultrasonography was done by a senior qualified radiologist in OPD. Ultrasound-guided pleural aspiration was done in OPD & fluid was sent for analysis. At least 10ml aspirated fluid was considered as diagnostic for pleural effusion. Patient files containing history, physical examination, x-ray reports, ultrasound reports, pleural aspiration notes and informed consent were retrieved, reviewed and findings were recorded in the preformed proforma. Results were tabulated and conclusion was drawn by statistical analysis. Results: Out of 4597 cases, 4498 pleural effusion were manifested on CXR and only 2547(56.62%) pleural effusions were proved by ultrasound while 2050 (45.57%) cases were reported as no Pleural effusion. Chest sonography demonstrated sensitivity, specificity, PPV, NPV and diagnostic accuracy 100 % each. Conclusions: Trans-thoracic ultrasonography revealed an excellent efficacy that is why it can be considered as non-invasive gold standard for the detection of pleural effusion.


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