Accuracy of Opportunistic Bone Mineral Density Assessment on Staging Computed Tomography for Gynaecological Cancers

Background and Objectives: Women with gynecological cancers constitute a high-risk cohort for loss of bone density. International guidance stipulates women undergoing cancer treatments associated with bone loss should have a quantitative assessment of bone density. Access to Dual-energy X-ray Absorptiometry (DXA) is limited. This study aimed to assess the accuracy of opportunistic bone density measurement on staging computed tomography (CT) scans for gynaecological malignancies, in comparison to the gold standard DXA. Materials and Methods: Women with a staging CT scan of the abdomen and pelvis for a new diagnosis of gynecological cancer were recruited. DXA was performed within 6 weeks of treatment for gynaecological cancer. Lumbar bone density was measured by CT attenuation values, in Hounsfield units (HU), of the anterior trabecular region. Correlations between CT and DXA parameters were analysed. Receiver Operating Characteristic(ROC) curves for diagnosis of low bone density and osteoporosis were analysed. Results: Final cohort included 48 of 50 women recruited. There was good diagnostic accuracy for abnormal bone density and osteoporosis, with areas under the ROC curve at L1 of 0.77 (p = 0.002) and 0.80 (p = 0.020) respectively. CT-HU of 170–190 yielded sensitivities of 87–90%, positive predictive values of 75–84% and negative predictive values of 71–75% for the diagnosis of low bone mineral density. CT-HU of 90–110 yielded specificities of 85–93% for the diagnosis of osteoporosis. Moderate correlations were found between CT-HU and both DXA T-scores and diagnostic categories. Conclusions: This is the first study to assess the opportunistic application of CT in the assessment of bone health in women with gynaecological cancer, a cohort at high-risk of osteoporosis. The correlation between bone density assessment in CT-HU and DXA, and strong AUC values for the diagnosis of low bone density (0.77) and osteoporosis (0.80) support this pragmatic solution in resolving the care-gap in cancer treatment-induced bone loss, often associated with poor access to DXA.

A sustainability assessment framework for population density in central Indian cities

PurposeThe urban population in Indian cities is increasing at an alarming speed. Accommodating such a huge population while sustaining the environment is a challenge in urban areas. Compact urban forms with high-density planning is claimed to be a sustainable solution in such situations. Thus, this approach needs to be tested for Indian urban areas.Design/methodology/approachThis paper formulates a neighbourhood sustainability assessment (NSA) framework for monitoring, assessing and managing the population density of urban neighbourhoods. The paper identifies context-specific built density indicators at the neighbourhood scale. It assesses the indicators in neighbourhoods with varying population density by physical and perceived measures. This helps in verifying the feasibility of density by physical density assessment and verifies the acceptability of density by perceived density assessment.FindingsWhen tested in the Indian context, the framework shows that although high-density neighbourhoods are sustainable, certain indicators may endorse differing densities. The result displays that high-density planning is sustainable compared to low- and medium-density neighbourhoods in the selected cities.Practical implicationsThe study demonstrates the application of formulated assessment system in three central Indian cities with useful results. Similar studies can be conducted to identify the gaps for improving sustainability and achieve a livable density pattern.Originality/valueAlthough sustainable development goals are part of new planning policies, there exist very few assessment systems to determine the sustainability of neighbourhoods, especially for density. The methodology will assist in developing sustainability assessment frameworks and encourage the practice of sustainability assessment in developing countries like India.

Edukasi Kesehatan Osteoporosis Dan Pemeriksaan Kepadatan Tulang Di Posbindu Soka Indah RW 05 Kelurahan Bencongan

ABSTRAK Osteoporosis adalah keadaan dimana menurunnya kepadatan tulang yang menyebabkan pasien mengalami kejadian fraktur. Osteoporosis seringkali dikaitkan dengan kejadian yang umum terjadi pada lanjut usia, akan tetapi menurut osteoporosis dapat juga mengenai usia muda. Wanita dikatakan memiliki faktor resiko paling tinggi terjadinya osteoporosis dibandingkan pria. Hal ini bisa disebabkan karena wanita memiliki ukuran tubuh yang lebih kecil dari pria, kurangnya paparan matahari dan kurangnya konsumsi makanan yang mengandung kalsium. Di posbindu Soka Indah RW 05 Bencongan Indah memiliki 40 lansia dengan usia antara 46 sampai dengan >60 tahun. Data yang didapatkan dari kader posbindu ada satu lansia wanita yang sudah terdiagnosa osteoporosis, dan dua lansia usia antara 50-60 tahun yang mengeluh kakinya sakit. Edukasi tentang osteoporosis belum pernah dilakukan di posbindu bencongan RW 05. Sebagai upaya untuk meningkatkan pengetahuan lansia tentang osteoporosis maka edukasi Kesehatan serta pemeriksaan kepadatan tulang pada seluruh lansia di Posbindu Bencongan RW 05 dilakukan. Hasil yang didapatkan dari kegiatan ini adalah terjadinya peningkatan pemahaman lansia terkait osteoporosis dengan rata-rata nilai 10 poin meningkat dari pre-test. Selanjutnya hasil kepadatan tulang didapatkan hasil sebanyak tiga lansia memiliki kepadatan tulang yang normal, 11 orang mengalami osteopenia dan 14 orang lainnya terskrining osteoporosis. Kata kunci: Edukasi, Kepadatan tulang, Osteoporosis ABSTRACT Osteoporosis is a condition where bone density is decreased which can be caused the fracture. Osteoporosis is often associated with an incident that generally occurs in elderly people, but based on health ministry, osteoporosis can also occur in young people. Women are told to have a high risk of osteoporosis compared to men. This is because we have a small body size than men, minimum sun exposure, insufficient intake of foods that contain calcium. In Posbindu Soka Indah Bencongan has 40 elderly people with 46 – above 60 years old range. Data taken from cadres, there was one of them who was diagnosed with osteoporosis, and two of the elders in their 50-60 years old were complaining of sore legs. Health education about osteoporosis has never been given in the posbindu bencongan. Therefore, as an effort in order to increase the elderly’s knowledge in osteoporosis, health education and also bone density assessment in posbindu were done. The result showed there was an increased point in the post=test result of 10 points which means the elderly’s knowledge was an increase. Furthermore, the bone density result was three people had a normal bone density, while 11 people had low bone density and 14 people were screened to have osteoporosis. Keywords: Bone density, Education, osteoporosis

Density assessment and reporting for Phlebotomus perniciosus and other sand fly species in periurban residential estates in Spain

Green periurban residential areas in Mediterranean countries have flourished in the last decades and become foci for leishmaniasis. To remedy the absence of information on vector ecology in these environments, we examined phlebotomine sand fly distribution in 29 sites in Murcia City over a 3-year period, including the plots of 20 detached houses and nine non-urbanized sites nearby. We collected 5,066 specimens from five species using “sticky” interception and light attraction traps. The relative frequency of the main Leishmania infantum vector Phlebotomus perniciosus in these traps was 32% and 63%, respectively. Sand fly density was widely variable spatially and temporally and greatest in non-urbanized sites, particularly in caves and abandoned buildings close to domestic animal holdings. Phlebotomus perniciosus density in house plots was positively correlated with those in non-urbanized sites, greatest in larger properties with extensive vegetation and non-permanently lived, but not associated to dog presence or a history of canine leishmaniasis. Within house plots, sand fly density was highest in traps closest to walls. Furthermore, the study provides a guideline for insect density assessment and reporting and is envisioned as a building block towards the development of a pan-European database for robust investigation of environmental determinants of sand fly distribution.

Bone and Mineral Disease in Kidney Transplant Recipients

After kidney transplantation mineral and bone disorders are associated with higher risk of fractures and consequent morbidity and mortality. Disorders of calcium and phosphorus, vitamin D deficiency and hyperparathyroidism are also common. The epidemiology of bone disease has evolved over the past several decades due to changes in immunosuppressive regimens, mainly glucocorticoid minimization or avoidance. The assessment of bone disease in kidney transplant recipients relies on risk factor recognition and bone mineral density assessment. Several drugs have been trialed for the treatment of post-transplant mineral and bone disorders. This review will focus on the epidemiology, impact and treatment of metabolic and skeletal derangements in the transplant recipient.