BackgroundA Moroccan model for the FRAX tool to determine the absolute risk of osteoporotic fracture at 10 years has been established recently. The study aimed to assess the discriminative capacity of FRAX in identifying women with prevalent asymptomatic vertebral fractures (VFs).MethodsWe enrolled in this cross-sectional study 908 post-menopausal women with a mean age of 60.9 years ±7.7 (50 to 91) with no prior known diagnosis of osteoporosis. Subjects were recruited from asymptomatic women selected from the general population. Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of Genantsemiquantitative (SQ) approach and morphometry. We calculated the absolute risk of major fracture and hip fracture with and without bone mineral density (BMD)using the FRAX website.The overall discriminative value of the different risk scores was assessed by calculating the areas under the ROC curve (AUC).ResultsVFA images showed that 179 of the participants (19.7%) had at least one grade 2/3 VF. The group of women with VFs had a statistically significant higher FRAX scores for major and hip fractures with and without BMD, and lower weight, height, and lumbar spine and hip BMD and T-scores than those without a VFA-identified VF. The AUC ROC of FRAX for major fracture without BMD was 0.757 (CI 95%; 0.718-0.797) and 0.736 (CI 95%; 0.695-0.777) with BMD, being 0.756 (CI 95%; 0.716-0.796) and 0.747 (CI 95%; 0.709-0.785), respectively for FRAX hip fracture without and with BMD. The AUC ROC of lumbar spine T-score and femoral neck T-score were 0.660 (CI 95%; 0.611-0.708) and 0.707 (CI 95%; 0.664-0.751) respectively.ConclusionIn asymptomatic post-menopausal women, the FRAX risk for major fracture without BMD had a better discriminative capacity in identifying the women with prevalent VFs than lumbar spine and femoral neck T-scores suggesting its usefulness in identifying women in whom VFA could be indicated.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-365) contains supplementary material, which is available to authorized users.

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Background: Cholecystectomy is performed either open or a laparascopic route. the traditional and invasive open cholecystectomy is still in frequent practice for various reasons. Spinal anesthesia (SA) has been widely used as alternative to General Anesthesia (GA) for laparoscopic cholecystectomy. SA could be a safe and effective anaesthetic procedure for open cholecystectomy.  This study was conducted to uncover feasibility and safety of low dose SA for conducting open cholecystectomy.Methods: All consented patients of ASA grade I and II of either sex scheduled for elective open cholecystectomy received SA using 2 ml of 0.5% hyperbaric Bupivacaine mixed with 100 µg Morphine. Peri-operative preparations and management were all standardized. Other drugs being only administered to manage anxiety, pain, nausea/vomiting, hypotension, and any adverse event. Open cholecystectomy by right oblique incision. Intra-operative events and post-operative events were observed for 48 hours, operative difficulty, post operative pain free interval, analgesia requirements, hospital stay and the surgeon and patient satisfaction were studied.Results: 20 patients were included in the study from 1st may 2016 to December 2016. Spinal anesthesia was adequate for surgery in all patients. Operative difficulty scores were minimal and surgery in one patient was converted to open cholecystectomy. Intraoperatively, five patients presented hypotension and Ephedrine was given. Four patients experienced pain and received Fentanyl and midazolam. Postoperatively, pain scores were minimal and paracetamol was not sufficient only in four patients who received ketoprofen and no patient received opioid. One patient required antiemetic for vomiting and two patients suffered urinary retention and one headache. 19 patients were discharged within 48 hours of surgery and patient satisfaction scores were very good.Conclusions: Spinal anesthesia is safe and effective anesthetic technic for uncomplicated open cholecystectomy in terms of peri-operative events and, in prolonged post-operative analgesia, as well as in terms of patient and surgeon’s satisfaction.

This is a prospective study conducted in the operating room for emergencies Military Hospital Moulay Ismail in Meknes on a oneyear period extending from January 2016 to January 2017. Were included patients admitted for surgical emergencies and members with serious violations of cardiorespiratory and metabolic functions and for whom general anesthesia or spinal perished were deemed at risk where ALR device would be a good alternative. Exclusion criteria were patient refusal, allergy to local anesthetics, severe coagulation abnormalities. Peripheral nerve blocks were performed under standard monitoring, post-interventional surveillance room or neurostimulation or ultrasound guidance using local anesthetics like lidocaine 1% and 0.25% bupivacaine.

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