Severe osteoporosis: diagnosis and follow-up. Lessons for clinical practice

The management of osteoporosis has improved considerably, leading to the development of new goals. A major concern today is the management of patients with severe osteoporosis, in whom the need for pharmacotherapy is clear [1]. Epidemiological data have established that osteoporosis is associated with severe complications [2,3]. Furthermore, osteoporosis is now recognized as a complication of several chronic diseases, whose presence adversely affects the management of osteoporosis. The ODISSEE task force (Osteoporosis DIagnosis and Surveillance of SEvErity) was established to answer practical questions regarding the management of severe osteoporosis, based on evidence in the literature. Several groups conducted an exhaustive literature review, and advice was obtained from a panel of French rheumatologists. The ODISSEE scientific committee then developed the first consensus statement on the diagnosis, follow-up and management of severe osteoporosis. This statement was validated by a panel of 70 French rheumatologists at the first national ODISSEE meeting held on November 13-14, 2009

Knowledge and awareness of dental students regarding human papillomavirus and oral cancer in Saudi Arabia

Objective: This study aimed to evaluate the knowledge and awareness of dental students and interns in Saudi Arabia regarding human papillomavirus and oral cancer using a cross-sectional web-based survey. Materials and methods: A cross-sectional survey was undertaken to assess the knowledge of dental students and dental interns regarding oral cancer and awareness of human papillomavirus (HPV) in public and private dental schools in Saudi Arabia. The survey included 18 questions grouped into three sections. The responses were analyzed for variations between dental students and interns, among males and females, and those attending private or public colleges. The Chai-square test assessed the correlation between participants’ demographic data and their knowledge/awareness of oral cancer and HPV. Results: A total of 451 dental students and dental interns responded. The results show that dental students at private and public dental schools in Saudi Arabia are generally knowledgeable regarding knowledge of oral cancer and awareness of human papillomavirus. The dental interns exhibited significantly superior knowledge compared to the undergraduate dental students (p<0.05), particularly in the areas of identifying the most common location of oral cancer and recognizing the signs and symptoms of oral cancer (76.5% versus 65.1% correct answers). The dental interns showed a significant difference and better awareness (p<0.05) than dental students regarding HPV having a relationship with AIDS and HPV causing common warts. Conclusion: Dental students and interns in this study presented a good but less than optimal knowledge and awareness regarding HPV and its prevention. Improving education courses and training for dental students in Saudi Arabia is crucial for improving their knowledge and awareness regarding oral cancer and HPV infection

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or ≥ 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Evaluation of the potential use of trabecular bone score to complement bone mineral density in the diagnosis of osteoporosis: a preliminary spine BMD-matched, case-control study.

The trabecular bone score (TBS) is a new parameter that is determined from gray-level analysis of dual-energy X-ray absorptiometry (DXA) images. It relies on the mean thickness and volume fraction of trabecular bone microarchitecture. This was a preliminary case-control study to evaluate the potential diagnostic value of TBS as a complement to bone mineral density (BMD), by comparing postmenopausal women with and without fractures. The sample consisted of 45 women with osteoporotic fractures (5 hip fractures, 20 vertebral fractures, and 20 other types of fracture) and 155 women without a fracture. Stratification was performed, taking into account each type of fracture (except hip), and women with and without fractures were matched for age and spine BMD. BMD and TBS were measured at the total spine. TBS measured at the total spine revealed a significant difference between the fracture and age- and spine BMD-matched nonfracture group, when considering all types of fractures and vertebral fractures. In these cases, the diagnostic value of the combination of BMD and TBS likely will be higher compared with that of BMD alone. TBS, as evaluated from standard DXA scans directly, potentially complements BMD in the detection of osteoporotic fractures. Prospective studies are necessary to fully evaluate the potential role of TBS as a complementary risk factor for fracture

Arthrite réactionnelle associée à une ano-rectite à Chlamydia trachomatis génovar L2b

Reactive arthritis associated with Chlamydia trachomatis genovar L2b proctiti

Role of anti-tumour necrosis factor-α therapeutic agents in the emergence of infections

ABSTRACTThere is increasing interest concerning the possible impact of anti-tumour necrosis factor (TNF)-α therapeutic agents on the emergence of infections. However, these agents do not seem to increase the incidence of adverse infectious events significantly. Published observations concern mostly infections of the urinary and upper respiratory tracts that develop in the setting of co-morbidities, such as anterior or concomitant immunosuppressive treatment. Infliximab appears to increase the risk of tuberculosis, but this effect has not been observed with other anti-TNF-α agents. To better characterise the adverse infectious effects associated with these agents, physicians should be encouraged to notify the microbiological data relating to all cases