RESUMO
In occlusive vascular brain diseases, the structure of the circle of Willis is of immense importance. A high percentage of variations have been reported in the arteries forming circle of Willis. These have profound clinical implications. With
advances in interventional radiological procedures, the interventional radiologists and neurosurgeons need to have thorough knowledge of these variations. This article will help readers understand the significance of anatomical variations and their clinical effects
RESUMO
Objective: To evaluate the efficacy of four risk assessment tools for identifying low Bone Mineral Density [BMD] in a sample of Pakistani females
Methodology: It was a cross sectional study including 200 females above 40 years. DXA scans were performed. Subjects were categorized into low risk and high risk categories for low BMD on the basis of T scores. Questionnaires were filled and risk indices were calculated for all subjects. Sensitivity, specificity, positive and negative predictive values were calculated, Receiver Operating characteristic [ROC] curves were plotted and Area Under Curve [AUC] were obtained
Results: A total of 200 females including 174[87%] postmenopausal, and 26[13%] premenopausal were included. Average age was 60.76+/-10.52 years with average age of menopause being 47.64+/-6.63 years. In terms of sensitivity, specificity and AUC, the WHO risk assessment tool FRAX showed the best performance with a sensitivity of 79%, specificity 94% and AUC of 0.869 for detecting low BMD
Conclusion: It is not cost effective to use DXA for screening purposes. We propose that risk assessment tools such as FRAX may be utilized to identify individuals with low BMD. This may prove beneficial in minimizing the medical and social burden that fragility fractures pose to developing health care systems