Consensus Evidence-Based Clinical Practice Recommendations for the Diagnosis and Treat-To-Target Management of Osteoporosis in Chronic Kidney Disease Stages G4-G5D and Post-transplantation: An Initiative of Egyptian Academy of Bone Health.

Objective: The aim of this study was to reach a consensus on an updated version of the recommendations for the diagnosis and Treat-to-Target management of osteoporosis that is effective and safe for individuals with chronic kidney disease (CKD) G4-G5D/kidney transplant. Methods: Delphi process was implemented (3 rounds) to establish a consensus on 10 clinical domains: (1) study targets, (2) risk factors, (3) diagnosis, (4) case stratification, (5) treatment targets, (6) investigations, (7) medical management, (8) monitoring, (9) management of special groups, (10) fracture liaison service. After each round, statements were retired, modified, or added in view of the experts' suggestions, and the percent agreement was calculated. Statements receiving rates of 7-9 by more than 75% of experts' votes were considered as achieving consensus. Results: The surveys were sent to an expert panel (n = 26), of whom 23 participated in the three rounds (2 were international experts and 21 were national). Most of the participants were rheumatologists (87%), followed by nephrologists (8.7%), and geriatric physicians (4.3%). Eighteen recommendations, categorized into 10 domains, were obtained. Agreement with the recommendations (rank 7-9) ranged from 80 to 100%. Consensus was reached on the wording of all 10 clinical domains identified by the scientific committee. An algorithm for the management of osteoporosis in CKD has been suggested. Conclusion: A panel of international and national experts established a consensus regarding the management of osteoporosis in CKD patients. The developed recommendations provide a comprehensive approach to assessing and managing osteoporosis for all healthcare professionals involved in its management.

The role of laryngeal electromyography in vocal fold immobility.

AIM OF STUDY: To assess the utility of laryngeal electromyography (EMG) as a diagnostic method for patients with immobile vocal folds and to evaluate its possible role as a prognostic indicator in the management of those cases. METHODOLOGY: The study included 35 patients with unilateral vocal fold immobility (VFI) and 10 normal controls. All patients were subjected to full history taking and thorough clinical examination and radiological investigations. Laryngeal EMG was performed for all the patients and controls. RESULTS: The specificity of EMG was 100%, while the sensitivity was 65.7% in detecting VFI. Seventeen cases (74%) with abnormal EMG data had a combined lesion of recurrent and superior laryngeal nerves and 6 cases (26%) had isolated recurrent laryngeal nerve lesion. In both groups there was no statistical difference as regards the position of the paralyzed vocal fold in either paramedian or lateral positions. Clinical follow-up with indirect laryngoscopy, 6 months later, revealed recovery in 10 of the 25 cases (40%). None of the recovered patients showed abnormal EMG data at presentation, while 13 out of 15 cases of non-recovered patients showed abnormal EMG data, i.e. the specificity of EMG was 100%, while the sensitivity was 86.6% in predicting recovery in patients with VFI. The quantitative analysis of the interference pattern was more sensitive (65.7 and 86.6%) than the conventional methods of analysis (60 and 80%) in detecting and predicting recovery in patients with immobile vocal folds, respectively. CONCLUSION: The clinical use of laryngeal EMG is an efficient and objective test in the study of patients with immobile vocal folds and in predicting recovery of those cases. It is also a useful tool in the diagnostic algorithm in vocal fold paralysis.