Hasil untuk "Osteopathy"

Waleed Kishta, Karim Gaber, Zhi Li et al.

<b>Background/Objectives</b>: Charcot-Marie-Tooth (CMT) disease, the most common hereditary peripheral neuropathy, often causes cavovarus foot deformity in children. Surgical interventions to correct deformity or improve function can involve either primary fusion or reconstruction. However, the optimal surgical approach remains contested. This systematic review aims to present and evaluate existing data on both fusion and reconstruction surgical interventions in treating pediatric CMT cavus foot. <b>Methods</b>: A PRISMA-guided search of five electronic databases was conducted (from inception to 17 February 2025). Studies were eligible if they reported surgical outcomes for CMT pediatric patients (<inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mo>≤</mo></mrow></semantics></math></inline-formula>18 years) with cavovarus foot treated by primary fusion or reconstruction. Titles, abstracts and full texts were screened by four independent reviewers, and data were extracted on patient demographics, procedures, follow-up, functional scores, radiographic correction and complications. <b>Results</b>: Fourteen studies met inclusion criteria, encompassing 169 patients and 276 feet, with a mean age at surgery of ~13.5 years. Nine studies evaluated joint-sparing reconstruction, three assessed primary fusion, and two combined both reconstruction and fusion. Both interventions yielded improved outcomes post-operatively. Reconstruction generally produced high patient satisfaction and near-normal radiographic parameters but carried recurrence or reoperation rates of 10–40%. Fusion provided durable correction of rigid deformities but was associated with nonunion, adjacent joint arthritis and higher revision rates. <b>Conclusions</b>: Joint-sparing reconstruction is an effective first-line approach for flexible cavovarus deformities in pediatric CMT patients, while fusion should be reserved for severe, rigid or recurrent cases. A patient-specific staged approach is recommended, and higher-quality comparative studies are needed to refine surgical decision-making.

He Y, Chen Y

Yinxi He,1 Yanxia Chen2 1Department of Orthopaedic Trauma, The Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, 050000, People’s Republic of China; 2Department of Endocrinology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, People’s Republic of ChinaCorrespondence: Yanxia Chen, Department of Endocrinology, the Second Hospital of Hebei Medical University, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, People’s Republic of China, Email chenyx@hebmu.edu.cnAbstract: As a continuous process comprising bone resorption and formation, bone remodeling, plays an essential role in maintaining the balance of bone metabolism. One type of metabolic osteopathy is osteoporosis, which is defined by low bone mass and deteriorating bone microstructure. Osteoporosis patients are more likely to experience frequent osteoporotic fractures, which makes osteoporosis prevention and treatment crucial. A growing body of research has revealed that exosomes, which are homogenous vesicles released by most cell types, play a major role in mediating a number of pathophysiological processes, including osteoporosis. Exosomes may act as a mediator in cell-to-cell communication and offer a fresh perspective on information sharing. This review discusses the characteristics of exosomes and outlines the exosomes’ underlying mechanism that contributes to the onset of osteoporosis. Recent years have seen a rise in interest in the role of exosomes in osteoporosis, which has given rise to innovative therapeutic approaches for the disease prevention and management.Keywords: exosomes, extracellular vesicles, osteoporosis, osteoblast function, osteoclast function

Jonas Manschel, Jan Porthun, Ulrike Winkler et al.

BackgroundThere are no uniform regulations for the osteopathic profession in Europe. It is subject to country-specific regulations defining who shall be allowed to practice osteopathy and which qualification shall be required. In recent years, legal regulations have been established in several European countries for the profession of osteopathy; however, these are also still pending for Austria. Currently, physiotherapists and physicians with osteopathic training are practicing osteopathy in Austria. ObjectiveThis study aims to examine the characteristics, challenges, and opportunities of osteopaths in Austria. MethodsGuideline-based interviews with osteopaths (N=10) were conducted. The different research questions were examined using a qualitative content analysis. ResultsThe study provided a differentiated insight into the professional situation of osteopaths in Austria. The most important result was that all interviewees unanimously supported a legal regulation of their profession. However, owing to their different professional self-image—on the one hand, individuals working on a structural basis, and, on the other hand, individuals working on a cranial or biodynamic basis—they were able to imagine a uniform professional regulation only to a limited extent. Additional topics for the interviewed osteopaths in Austria were the quality assurance of training and the urgent need for scientific research. Furthermore, the study also dealt with the influence of the COVID-19 pandemic on daily practice and on education and training in osteopathy. ConclusionsThis study is a pioneering study with regard to systematic basic research on osteopathy in Austria. The obtained results and the newly acquired research questions not only have the potential to serve as a basis for further studies but also provide insight into the working and professional situation of osteopaths in Austria for universities, schools, professional associations, politics, and—last but not least—all interested parties. International Registered Report Identifier (IRRID)RR2-10.2196/15399

Luis G. Padilla-Rojas, MD, PhD, FIOTA, Johnatan Tamayo-Cosio, FTL, Darío E. Garín-Zertuche, MD, PhD, FIOTA et al.

Abstract. Trauma is a leading cause of mortality and morbidity worldwide with high rates of disability in survivors. With improvements in care, rehabilitation of the trauma patient is a cornerstone to reducing sequelae. A lack of well-established hospital rehabilitation units and standardized protocols for managing posttraumatic injuries is a common problem in Latin American countries. Future studies should seek to understand the barriers and gaps in care so that consensus and ultimately best practice guidelines can be developed and included in rehabilitation programs throughout trauma centers in Latin America.

Lindsay M Gorrell, Luana Nyirö, Mégane Pasquier et al.

Abstract Background Spinal manipulation (SM) is a recommended and effective treatment for musculoskeletal disorders. Biomechanical (kinetic) parameters (e.g. preload/peak force, rate of force application and thrust duration) can be measured during SM, quantifying the intervention. Understanding these force-time characteristics is the first step towards identifying possible active ingredient/s responsible for the clinical effectiveness of SM. Few studies have quantified SM force-time characteristics and with considerable heterogeneity evident, interpretation of findings is difficult. The aim of this study was to synthesise the literature describing force-time characteristics of manual SM. Methods This scoping literature review is reported following the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) statement. Databases were searched from inception to October 2022: MEDLINE (Ovid), Embase, CINAHL, ICL, PEDro and Cochrane Library. The following search terms and their derivatives were adapted for each platform: spine, spinal, manipulation, mobilization or mobilisation, musculoskeletal, chiropractic, osteopathy, physiotherapy, naprapathy, force, motor skill, biomechanics, dosage, dose-response, education, performance, psychomotor, back, neck, spine, thoracic, lumbar, pelvic, cervical and sacral. Data were extracted and reported descriptively for the following domains: general study characteristics, number of and characteristics of individuals who delivered/received SM, region treated, equipment used and force-time characteristics of SM. Results Of 7,607 records identified, 66 (0.9%) fulfilled the eligibility criteria and were included in the analysis. Of these, SM was delivered to the cervical spine in 12 (18.2%), the thoracic spine in 40 (60.6%) and the lumbopelvic spine in 19 (28.8%) studies. In 6 (9.1%) studies, the spinal region was not specified. For SM applied to all spinal regions, force-time characteristics were: preload force (range: 0-671N); peak force (17-1213N); rate of force application (202-8700N/s); time to peak thrust force (12-938ms); and thrust duration (36-2876ms). Conclusions Considerable variability in the reported kinetic force-time characteristics of SM exists. Some of this variability is likely due to differences in SM delivery (e.g. different clinicians) and the measurement equipment used to quantify force-time characteristics. However, improved reporting in certain key areas could facilitate more sophisticated syntheses of force-time characteristics data in the future. Such syntheses could provide the foundation upon which dose-response estimates regarding the clinical effectiveness of SM are made.

Xuhua Sun, Chenxing Zhou, Liyi Chen et al.

Introduction To explore the epidemiological characteristics of ankylosing spondylitis (AS) in Guangxi Province of China through a large sample survey of more than 50 million aboriginal aboriginal population. Material and methods A systematic search was conducted using the International Classification of Diseases 10 (ICD-10) codes M45.x00(AS), M45.x03+(AS with iridocyclitis), and M40.101(AS with kyphosis) to search the database in the National Health Statistics Network Direct Reporting System (NHSNDRS). 14004 patients were eventually included in the study. The parameters analyzed included the number of patients, gender, marriage, blood type, occupation, age at diagnosis, and location of household registration data each year, and statistical analysis was performed. Results AS incidence rates increased from 1.30 (95% CI: 1.20–1.40) per 100,000 person-years in 2014 to 5.71 (95% CI: 5.50–5.92) in 2020 in Guangxi Province, and decreased slightly in 2021. Males have a higher incidence than females; the ratio was 5.61 : 1. The mean age of diagnosis in male patients was 45.4 (95% CI: 45.1–45.7) years, in females 47.6 (95% CI: 46.8–48.4) years. The most frequent blood type was O, and the most frequent occupation was farmer. The AS incidence rate was disparate in different cities. Liuzhou city had the highest eight-year average AS incidence rates from 2014 to 2021, and Chongzuo city had the lowest (p 0.05). Conclusions The AS person-years incidence rate was increasing in Guangxi province of China from 2014 to 2020, which had obvious gender and regional differences, showing the characteristics of local area aggregation.

Brownie S, Tokolahi E, Broman P et al.

Sharon Brownie,1– 3 Ema Tokolahi,4 Patrick Broman,3 Marrin Haggie,3 Patrea Andersen3,5,6 1School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia; 2School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia; 3Centre for Health and Social Practice, Wintec Te P&umacr;kenga, Hamilton, New Zealand; 4School of Occupational Therapy, Otago Polytechnic Te P&umacr;kenga, Dunedin, New Zealand; 5School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia; 6School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, AustraliaCorrespondence: Sharon Brownie, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia, 3122, Email sbrownie@swin.edu.auBackground: While interprofessional (IP) competency and Interprofessional Education (IPE) has received increasing attention in health, agreement on specific competencies and teaching approaches is frequently limited by profession-specific understandings. As part of a quality improvement initiative focused on improving delivery of IPE offerings, this enquiry maps current regulatory and curricula requirements for IP practice to health professional students from 12 professions trained across Aotearoa New Zealand’s national vocational education provider.Methods: Requirements for IP competency in national accreditation documents and in an operative teaching curricula were mapped for 12 professions, namely, clinical exercise physiology, counselling, massage, medical radiology, midwifery, nursing, occupational therapy, osteopathy, paramedicine, physiotherapy, social work, and sport and exercise science. A desk audit was conducted to identify the presence of core IP competencies for each profession. This involved a four-step process 1) Examination of regulatory standards for each profession to confirm IP requirements for each profession; 2) Examination of an operative curricula from each profession to identify the presence and translation of IP regulatory requirements to each of the profession-specific programs of study; 3) Mapping to identify within domains the core (common) IP competencies across the professions, and 4) Consideration of the similarities and differences between accreditation documents and curricula.Results: Of 12 professions, 10 clearly identified IP competency as an expectation. Clinical Exercise Physiology and Counselling were exceptions with explicit requirement for IP competency not evident. Coordination and collaboration were the most identified competency domains in accreditation documents and curricula. In descending order of prevalence, communication, shared values, reflexivity, role-understanding, and teamwork were also identified requirements amongst the 10 professions with IP competency requirements.Conclusion: The IP competencies identified as common across professions can be used to inform development of teaching and assessment. Greater alignment between teaching curricula and required competency standards in this area is recommended.Keywords: interdisciplinary education, interdisciplinary communication, interprofessional relations, collaboration, competency

Muñoz-Torres M, Carazo-Gallego A, Jiménez-López JC et al.

Objetivo: La diabetes mellitus tipo 2 (DM2) y la osteoporosis son enfermedades asociadas con un entorno pro-inflamatorio, cuya prevención mediante nuevas estrategias terapéuticas podría evitar su desarrollo. Sin embargo, existe un escaso número de estudios que evalúen el perfil inflamatorio de la osteoporosis en pacientes con DM2. El objetivo de este estudio se centró en evaluar la respuesta inflamatoria inmunitaria mediante concentraciones séricas de nueve citocinas, dos de ellas de carácter anti-inflamatorio (IL-10, IL-5) y seis pro-inflamatorias (IL-2, IL-6, IL-12 (p70), IL-17A, TNFα e IFNɣ) en 163 individuos con DM2 y 47 controles. Una subpoblación, formada por 43 pacientes DM2 sin osteoporosis, y 33 con osteoporosis, fue analizada en más profundidad a nivel de parámetros óseos. Además, hemos evaluado las hormonas calciotropas, los marcadores de remodelado óseo, densidad mineral ósea y fracturas vertebrales en la población, y hemos analizado la relación de las citocinas ensayadas con la DM2, la osteoporosis y las fracturas vertebrales prevalentes. Los pacientes con DM2 tenían concentraciones séricas significativamente más altas de IL-10 en comparación con el grupo control (0,5±1 vs. 0,14±0,3 pg/ml; p=0,016) y los niveles de IL-12 p70 se mostraron más bajos en pacientes con DM2 respecto a los controles (2,9±1,6 vs. 3,9±3,1 pg/ml; p=0,027). En el grupo de pacientes con DM2 y osteoporosis, los niveles de la citocina IL-6 resultaron elevados respecto al grupo de DM2 sin osteoporosis (10,9±14,6 vs. 4,5±7,0; p=0,017). También se observó una asociación de IL-5, siendo sus niveles más bajos en el grupo DM2 con osteoporosis (1,7±0,2 vs. 3,8±0,6; p=0,032). Además, la IL-5 mostró una correlación directa con los niveles del biomarcador de formación ósea fosfatasa alcalina ósea (r=0,277, p=0,004) en la subpoblación de pacientes con DM2. El resto de citocinas no mostraron diferencias significativas. En conclusión, nuestros hallazgos demuestran que en nuestra población de estudio, los pacientes con DM2 respecto a sujetos sanos presentan un perfil inflamatorio opuesto a lo que se espera en situación de hiperglicemia, probablemente como respuesta compensatoria a la inflamación originada. El perfil de citocinas se modifica en la subpoblación de los pacientes diabéticos, dependiendo de la presencia de osteoporosis. En este caso, el perfil inflamatorio en presencia de osteoporosis es coherente con la respuesta esperada.

Zhaoping Gan, Liyi Chen, Meiqing Wu et al.

Abstract The purpose was to predict the risk of acute kidney injury (AKI) within 100 days after hematopoietic stem cell transplantation (HSCT) in patients with hematologic disease by using a new predictive nomogram. Collect clinical data of patients with hematologic disease undergoing HSCT in our hospital from August 2012 to March 2018. Parameters with non-zero coefficients were selected by the Least Absolute Selection Operator (LASSO). Then these parameters were selected to build a new predictive nomogram model. Receiver operating characteristic (ROC) curve, calibration curve, C-index, and decision curve analysis (DCA) were used for the validation of the evaluation model. Finally, the nomogram was further evaluated by internal verification. According to 2012 Kidney Disease Improving Global Guidelines (KDIGO) diagnostic criteria, among 144 patients, the occurrence of AKI within 100 days after HSCT The rate was 29.2% (42/144). The C-index of the nomogram was 0.842. The C-value calculated by the internal verification was 0.809. The AUC was 0.842, and The DCA range of the predicted nomogram was from 0.01 to 0.71. This article established a high-precision nomogram for the first time for predicting the risk of AKI within 100 days after HSCT in patients with hematologic diseases. The nomogram had good clinical validity and reliability. For clinicians, it was very important to prevent AKI after HSCT.

Kesava Kovanur Sampath, Ben Darlow, Steve Tumilty et al.

Abstract Background Clinical practice guidelines commonly recommend adopting a biopsychosocial (BPS) framework by practitioners managing musculoskeletal pain. However, it remains unclear how osteopaths implement a BPS framework in the management of musculoskeletal pain. Hence, the objective of this review was to systematically appraise the literature on the current practices, barriers and facilitators experienced by osteopaths in implementing a BPS framework of care when managing people with musculoskeletal pain. Methods The following electronic databases from January 2005 to August 2020 were searched: PubMed, CINAHL, Science Direct, Google Scholar, ProQuest Central and SCOPUS. Two independent reviewers reviewed the articles retrieved from the databases to assess for eligibility. Any studies (quantitative, qualitative and mixed methods) that investigated the use or application of the BPS approach in osteopathic practice were included in the review. The critical appraisal skills program (CASP) checklist was used to appraise the qualitative studies and the Mixed Methods Appraisal Tool (MMAT) was used to appraise quantitative or mixed methods studies. Advanced convergent meta-integration was used to synthesise data from quantitative, qualitative and mixed methods studies. Results A total of 6 studies (two quantitative, three qualitative and one mixed methods) were included in the final review. While two key concepts (current practice and embracing a BPS approach) were generated using advanced meta-integration synthesis, two concepts (barriers and enablers) were informed from qualitative only data. Discussion Our review finding showed that current osteopathic practice occurs within in the biomedical model of care. Although, osteopaths are aware of the theoretical underpinnings of the BPS model and identified the need to embrace it, various barriers exist that may prevent osteopaths from implementing the BPS model in clinical practice. Ongoing education and/or workshops may be necessary to enable osteopaths to implement a BPS approach.

Olga O. Golounina, Gyuzel E. Runova, Valentin V. Fadeyev

Osteoporosis is the most common cause of low bone mineral density (BMD) and low-traumatic fractures in adults. However, differential diagnosis should also consider other causes of decreased BMD, including osteomalacia, as treatment for these conditions vary significantly. Osteomalacia is a systemic disorder characterized by decrease in bone strength due to of excessive accumulation of non-mineralized osteoid and uncoupling between bone matrix formation and mineralization. Osteomalacia in adults mostly develops due to severe vitamin D deficiency of any etiology, less often along with kidney pathology, mesenchymal tumors secreting fibroblast growth factor 23 or hereditary metabolic bone diseases. Clinical symptoms of osteomalacia are nonspecific and mostly manifest by generalized diffuse bone pain, muscle weakness, skeletal deformities and often go unnoticed at initial stage of the disease. Histomorphometric examination is the most accurate method of the diagnosis, which allows assessment of bone formation rate and calcification. The utmost priority of the treatment of osteomalacia of any etiology is the elimination of vitamin D deficiency, hypocalcemia, hypophosphatemia and prevention of bone deformities progression and muscle hypotension.

Katie Chaucer, Monika DeTurk

Photo by Markus Spiske on Unsplash INTRODUCTION Racism makes people sick. As the United States navigates a social awakening, primary care providers (PCPs) need to join the movement by addressing the impact of racism on our society. As community leaders, all PCPs, including medical doctors, doctors of osteopathy, physician assistants, and advanced practice nurses, are morally called to combat systemic racism. PCPs need to consider how traditional treatment modalities, such as drug prescription and lifestyle modifications, may perpetuate systemic racism and inflict further injustice upon the health of Black Americans. Furthermore, as physical healers, PCPs are professionally bound to address systemic racism as its detrimental physical effects ravage those marginalized by our racialized society. ANALYSIS The effects of allostatic overload demonstrate that racism causes physical illness. Allostatic overload refers to the physical effects of chronically adapting to negative experiences over one’s lifetime.[1] It predisposes people to chronic disease, predicts an increase in all-cause mortality, and is highly correlated with racial discrimination.[2] After controlling for socioeconomic status and other adverse health behaviors, researchers have shown that Black participants have consistently higher allostatic load scores than white participants.[3]  The outcomes of the COVID-19 pandemic have dramatically affected communities of color, demonstrating the relationship between the physical effects of allostatic load and racism. During this pandemic, Black Americans are dying at three times the rate of white Americans.[4] If we are truly committed to providing care that lives up to high ethical standards, we should start by investigating structures of inequity within our practices to improve the health of patients of color. Below, we propose a three-tier intervention strategy, employing interventions in practice, patient, and personal levels of care. At the practice level, PCPs could use their voices to advocate for patients on a macro scale. For example, they could support initiatives that provide patients with bus fare or child care, prioritize the accessibility of clinic interpreters, or create more flexible clinic hours.[5] In addition, PCPs should consider using third-party organizations, such as Health Leads, that would connect their patients with social solutions like housing, transportation, and healthy foods.[6] We also suggest that a clinician pair with a member of the community to create a one-page clinician reference of local resources. This type of intervention is shown to increase referrals to support services, improve patient employment, and raise the number of children accessing childcare, while reducing the use of homeless shelters.[7] PCPs may become advocates of social change in two unique ways: by dismantling societal systems that perpetuate inequity and by addressing patients’ manifestations of these systems. Both stem from PCPs’ ethical and fiduciary role; they both require moral agency or the ability to act in the face of deeply rooted systemic obstacles. To address the public health emergency of racism and advocate for their population’s health, PCPs should address the social structures that have an undeniable effect on health. This kind of comprehensive care will often extend past the traditional prescriptive relationship. Social workers are not exclusively responsible for performing assessments of societal effects on healthcare. It is crucial that PCPs perform initial assessments to identify inequities to meet ethical expectations and fulfill their fiduciary role. On a patient level, PCPs should routinely assess patients’ social determinants of health (SDOH) by discussing their living environment, financial circumstances, education, support systems, and experiences with racial segregation.[8] It is important to investigate social challenges in a sensitive and empathetic way by using validated and reliable assessment questions, such as “do you ever have difficulty making ends meet at the end of the month?”[9] Sensitively documenting the results of these screenings of  the medical record allows for a seamless multidisciplinary approach and assessment over time.  By starting these difficult conversations, PCPs display beneficence toward their patients and a fidelity to their profession. In accordance with the professional commitments of providers, PCPs engage in these conversations to assess and improve patients’ circumstances and to promote their integrated wellness. However, conflict can arise between provider intentions of beneficence and patient autonomy or privacy. Patients may choose not to disclose situations they perceive as embarrassing, ranging from food insecurity to unhealthy housing conditions or debt. In such situations, it is important for PCPs to respect the patient’s desire for confidentiality and personal decision making. It should be the patient’s choice and not the provider’s choice to avoid the conversation. PCPs have demonstrated their ability to investigate other sensitive patient issues such as suicidal ideation, teenage sexual activity, and substance use concerns. PCPs should not avoid the topic of racial inequity due to their own unease surrounding this topic. Regardless of an individual patient’s response to a SDOH assessment, PCPs who routinely screen all of their patients communicate that they truly care about the betterment of their patients, are a trusted resource, and are readily available for future assistance. On a personal level, all PCPs should understand their implicit bias by taking a confidential racial implicit bias assessment. This commitment to self-assessment requires introspection and confrontation of automatic, pervasive cultural assumptions. It is essential that all PCPs take time to identify their subconscious biases because without knowledge of the problem, no solution would be offered. PCPs should also consider supporting the social movements and political parties that align with racial justice initiatives. As we begin to envision new policies under a new presidential administration, focus should be placed upon expanding coverage and quality of healthcare for people of color. While this process of introspection may be jarring and unfamiliar, all PCPs have a professional responsibility to be aware of deeply rooted assumptions that inform biased assessments or behaviors. Eradicating bias is necessary. Otherwise, unchecked biases can lead to unintended harm in the form of both subtle micro-aggressions, which erode the trust between PCP and patient, and overt differences in patient care. The effect of provider racial bias has been shown to delay referrals to specialists, to create disparity in assessment and treatment of pain, to defer routine cancer screenings, and even to reduce the rate of cardiac catheterization for Black patients experiencing chest pain.[10] The deleterious effect of bias reaches nearly every corner of healthcare. Non-maleficence should serve as the natural ethical motivation for PCPs to check their implicit bias on a regular basis. Providers acting on implicit or explicit bias harm those  they are responsible for protecting. Once aware of the existence and impact of bias, introspective PCPs will recognize the moral impetus to make changes. CONCLUSION Both the Hippocratic Oath and the American Nurses Association’s Code of Ethics and Interpretive Statements imply that PCPs are united in their professional and ethical obligations to serve the whole patient. One manifestation of these obligations is taking actionable steps to reduce racism. The task of addressing the SDOH can be daunting in scope; however, to identify the effects of systematic racism or social injustice at the practice, patient, and personal levels is a concrete action. Connecting marginalized patient populations to local resources can make small differences that produce significant change. PCPs are important leaders in making systemic changes due to the unique role they play in communities. It is vital that they work toward identifying and dismantling structures of racial oppression in our society as we seek to improve the health of our nation. “Not everything that is faced can be changed, but nothing can be changed until it is faced.” - James Baldwin [1] Finlayson, Judith.”You are what Your Grandparents Ate: What you need to know about Nutrition, Experience, Epigenetics & the Origins of Chronic Disease.” Toronto, Robert Rose Inc. 2019. [2] Tomfohr, Lianne M., Meredith A. Pung, and Joel E. Dimsdale. "Mediators of the relationship between race and allostatic load in African and White Americans." Health Psychology 35.4 (2016): 322. [3] Duru, O. Kenrik, et al. "Allostatic load burden and racial disparities in mortality." Journal of the National Medical Association 104.1-2 (2012): 89-95. [4] Pilkington, Ed. “Black Americans dying of Covid-19 at three times the rate of white people.” May 20, 2020, The Guardian, https://www.theguardian.com/world/2020/may/20/black-americans-death-rate-covid-19-coronavirus, Accessed on 6/24/2020.  [5] Andermann, Anne. "Taking action on the social determinants of health in clinical practice: a framework for health professionals." Cmaj 188.17-18 (2016): E474-E483. [6] Health Leads. “Health Leads.” 2020, healthleadsusa.org/ Accessed on 6/24/2020. [7] Garg, Arvin, et al. "Addressing social determinants of health at well child care visits: a cluster RCT." Pediatrics 135.2 (2015): e296-e304. [8] Artiga, Samantha and Orgera, Kendall.  “Key Facts on Health and Health Care by Race and Ethnicity.” Kaiser Family Foundation, November 12, 2019, https://www.kff.org/report-section/key-facts-on-health-and-health-care-by-race-and-ethnicity-health-status/ , Accessed 6/24/2020. [9] Brcic, V., Eberdt, C., & Kaczorowski, J. (2011). Development of a tool to identify poverty in a family practice setting: a pilot study. International journal of family medicine, 2011. [10] IOM. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (with CD). National Academies Press, 2003, p. 12875. DOI.org (Crossref), doi:10.17226/12875.

Diliara Sh. Umiarova, Tatiana A. Grebennikova, Tatiana S. Zenkova et al.

MELAS syndrome belongs to the group of progressive mitochondrial diseases associated with point mutations in mitochondrial DNA, and includes mitochondrial encephalomyopathy, lactic acidosis, stroke-like episodes, which can combined with endocrine disorders (thyroid, parathyroid and pancreas). The frequency of hypoparathyroidism in the framework of the syndrome is less than 0.5%. Verification of the MELAS syndrome is associated with certain difficulties due to low incidence of the disease and variety of clinical manifestations and requires continuity in the work of doctors of various specialties: neurologists, endocrinologists and audiologists. Confirmation of the diagnosis is carried out by molecular genetic test of mitochondrial DNA in lymphocytes, in some cases muscle tissue biopsy analysis. In the article, we present a rare diagnosis case young patient with MELAS syndrome based on the presence of unclear hypoparathyroidism in combination with neurological symptoms, diabetes mellitus, lactic acidosis and hearing loss. MELAS syndrome was confirmed by a genetic blood test. In the debut of hypoparathyroidism, diabetes mellitus, hypothyroidism of the MELAS syndrome were easily compensated on replacement therapy.

Oksana A. Nikitinskaya, Natalya V. Toroptsova

Background: There are two approaches to identify candidates for the prescription of osteoporosis treatment: identification of patients with low bone mineral density using DEXA of the axial skeleton and calculation of the 10-year probability of major osteoporotic fractures using FRAX. Aims: to assess the diagnostic accuracy of different FRAX thresholds in the Russian population. Materials and methods: the value of individual 10-year probability of osteoporotic fracture by FRAX at the time of inclusion in the study was retrospectively estimated in 224 postmenopausal women, whom the major osteoporotic fractures were recorded over 10 years of prospective observation. The diagnostic accuracy of different thresholds were compared: "European" and Russian age-dependent thresholds, fixed 20% threshold, the average FRAX of patients who had a major osteoporotic fracture during follow-up (16%), FRAX value corresponding to the "cut-off point" (12,5%). Results: The Russian FRAX model showed the acceptable diagnostic accuracy of the method (AUC=0.6650.036; 95% CI 0.595; 0.736). The "European" threshold of therapeutic intervention demonstrated 72% sensitivity and 38% specificity, 20% threshold 27% and 87%, the Russian threshold 41% and 77%, 12.5% threshold 68% and 58%, 16% threshold 57% and 73%, respectively. The diagnostic precision of the specified thresholds was 54%, 58%, 60%, 63% and 65%, respectively. Conclusions: the Russian age-dependent threshold remains the optimal way to decide whether to initiate anti-osteoporotic therapy based on an assessment of the 10-year probability of fracture by the Russian model for FRAX.

Hana Ciferská, Pavel Horák, Martin Tichý

V V EPANOV, A A EPANOVA, A K LEBEDEV et al.

Эпидемиология переломов проксимального отдела бедренной кости (ПОБК) в Якутске, столице Республики Саха (Якутия), изучалась в 1997-2001 гг. (А.Н. Комиссаров, 2004), при этом источником информации были документы травматологической службы. Мы предположили, что за прошедшие 15 лет за счет улучшения организации помощи этим пациентам и повышения обращаемости инцидентность перелома ПОБК могла возрасти. Это определило цель данного исследования - определение инцидентности перелома ПОБК в Якутске за период 2011-2013 гг. Материал и методы. Исследование проведено в рамках международного проекта ЕВА («Эпидемиология остеопоротических переломов в странах Евразии»), инициированного Российской ассоциацией по остеопорозу. Население Якутска составляет 274 406 чел., национальный состав представлен преимущественно якутами (49,0%) и русскими (39,7%), что соответствует средним показателям по Республике Саха (49,9% и 37,8% соответственно). Целевой исследуемой группой населения были люди в возрасте 40 лет и старше. Общее количество их в г. Якутске составляло 93680 чел., в том числе 39365 мужчин и 54315 женщин. При сборе информации учитывались все возможные источники информации, включавшие помимо травматологической службы также первичную и скорую медицинскую помощь. При сборе информации исключалась возможность повторной регистрации одного и того же пациента при обращении по поводу одного и того же перелома. Результаты. За три года зарегистрировано 426 переломов ПОБК: в 2011 г. - 135 (144,1 на 100 000), в 2012 г. - 137 (146,2 на 100 000), в 2013 г. - 154 (208,1 на 100 000). Только 8 пациентов с переломом ПОБК не были зарегистрированы в документах травматологической помощи. Общее количество переломов у женщин составило 315 (67,5%), у мужчин - 152 (32,5%). Соотношение мужчин и женщин - 1:2. Среди населения 50 лет и старше общая инцидентность составила 216,64 на 100000 населения: среди женщин -246,21, среди мужчин - 168,05. Полученные цифры существенно превышали данные 1997-2001 гг. (162,2; 99,1 и 203,6 на 100000 населения соответственно) (А.Н. Комиссаров, 2004). Выводы. Таким образом, инцидентность перелома ПОБК в г. Якутске выросла существенно на последние 15 лет, что может быть связано с улучшением обращаемости пациентов за медицинской помощью и, как следствие, повышением их регистрации в документах травматологической помощи. Нельзя также исключить и реальный рост случаев перелома ПОБК из-за увеличения продолжительности жизни населения.

S S KhARChENKO, N A GUSEVA, M N LOBANOV et al.

Цель. Оценка состояния минеральной плотности костной ткани (МПКТ) у детей с диагнозом ДЦП после реконструктивных операций на тазобедренном суставе. Материал и методы. В исследовании приняли участие 15 детей с диагнозом ДЦП с оценкой по международной шкале двигательных возможностей GMFCS III-V. Все пациенты находились на восстановительном лечении в детском травматолого-ортопедическом отделении Центра после проведения реконструктивных операций на тазобедренном суставе. Оценивалось физическое развитие: масса и длина тела, индекс массы тела (ИМТ). Для определения МПКТ детям выполнялась двухэнергетическая рентгеновская абсорциометрия поясничного отдела позвоночника L1-L4 позвонков в прямой проекции (Spine AP) и всего тела (Whole body) на аппарате EXСELL XR-46 («Norland», США) с оценкой по Z-критерию, согласно рекомендациям ВОЗ. Результаты. Средний возраст детей 7,4±1,9 лет. Из них 7 девочек и 8 мальчиков. Антропометрические параметры у данной группы пациентов: средняя масса тела 19,8±7,1 кг, средняя длина тела 118,6±14,8 см, средний ИМТ 13,8±2,7, что ниже, чем у здоровых сверстников. В анамнезе у 3 пациентов (20%) наблюдались низкоэнергетические переломы. По результатам двухэнергетической рентгеновской абсорциометрии по программе Whole body у 11 пациентов (73,3%) отмечалось снижение костной массы по сравнению с возрастной нормой (Z-критерий менее -2,0 SD), среднее значение -3,74±0,81. В тоже время, среднее значение Z-критерия МПКТ L1-L4 позвонков находилось в пределах возрастной нормы и составило -0,77±0,641. Заключение. У детей с тяжелой формой церебрального паралича (GMFCS III-V) в восстановительном периоде после реконструктивных операции на тазобедренном суставе наблюдается значительное снижение МПКТ. Это усугубляется длительным периодом иммобилизации после оперативного лечения. Таким образом, необходимо дооперационное определение МПКТ у данной категории пациентов с целью коррекции выявленных нарушений и снижения риска внепозвонковых переломов в послеоперационном периоде.

Río Martínez PS, Moreno García MS, Casorrán Berges MP et al.

Las fracturas de estrés se producen cuando un hueso con resistencia elástica normal es sometido a cargas superiores a su resistencia mecánica. Aunque pueden producirse en cualquier localización, son más frecuentes a nivel de metatarsos, al ser zonas anatómicas sometidas a mayor carga. La clínica de las fracturas de estrés es muy inespecífica, por lo que una historia detallada es clave para el diagnóstico de sospecha. La radiología puede ser normal en los primeros estadíos, siendo la gammagrafía y la resonancia magnética los gold standards para el diagnóstico en etapas iniciales. Es recomendable realizar un estudio de posibles causas subyacentes que hayan podido contribuir a la fractura. Generalmente el tratamiento es conservador, aunque en algunos casos, como en las localizadas en el 5º metatarsiano, puede ser necesario tratamiento quirúrgico.