Noninvasive screening of osteoporosis using bio-impedance and quantitative ultrasound

Bone mineral loss is a serious health issue all over the globe resulting in osteoporosis, without showing any pre-indication of its occurrence. Dual Energy X-ray Absorptiometry test is a widely accepted method for its diagnosis which gives areal information about the bone mineral. Other methods like Quantitative Computed Tomography (QCT) and Peripheral QCT give volumetric information. Application of these methods for mass screening is not recommended due to the use of ionizing radiations. Few non-ionizing methods, namely Bioelectric Impedance Analysis and Quantitative Ultrasound, have evolved in the past few decades. Bioelectric Impedance Analysis, a non-invasive and low-cost tool, has been immensely recognized for its promising use in estimating body composition and body fluids. Similarly, Quantitative Ultrasound is another non-invasive technique for determining bone density at fixed locations, making noninvasive assessment much faster, easier to use, and portable. A multi-parametric approach combining these two modalities has yielded higher efficiency for the detection of bone mineral loss. These developments are briefly reviewed in this paper.

Wrist Deformity in Children and Adolescents with b-thalassemia on Oral Iron Chelation Therapy

Objective: To describe a novel wrist deformity in β-thalassemia major patients, and theirradiographic and magnetic resonance imaging findings. Methods: 30 patients withβ-thalassemia major who were noticed to have ulnar deviation at wrist joint were evaluated forprevious history of medications, serum ferritin levels, presence of pain and swelling at thewrist joint, and the duration of iron chelation therapy. Radiographs of wrist and limitedmagnetic resonance imaging (MRI) sequences were obtained in 30 and 15 patients,respectively. Results: Radiographs revealed varying severity of distal ulnar shortening, distalradial slanting and presence of soft tissue distal to the ulna. MRI showed similar deformitiesalong with abnormal marrow signal at distal ulnar ends; in 8 patients, a soft tissue distal to thedistal end of ulna was noted.Conclusion: Varying severity of radiological abnormalities,predominantly affecting the distal ulna, are present in children and adolescents with β-thalassemia receiving oral chelation therapy

Evaluation of osteopathy in thalassemia by bone mineral densitometry and biochemical indices.

Objective To evaluate osteopathy in thalassemia by bone mineral densitometry (BMD) and biochemical indices. Methods Prospective review analysis with no follow up from 2006 to 2007 of 42 regularly transfused thalassemics aged 10–25 years (27 boys, 15 girls) was done. Anthropometry, pubertal stage and symptomatology were noted. Urinary C–terminal cross–linked telopeptide of type–1 collagen (Crosslaps) by ELISA; serum 25–OH vitamin D and osteocalcin by RIA; parathyroid hormone (PTH) and ferritin by chemiluminescence and IGF–1 by Enzyme immunoassay were evaluated. Dual Energy X-ray Absorptiometry (DEXA) of lumbar spine and femur was done on Lunar prodigy system. Data was entered and analyzed using the SPSS for Windows software. Mean comparisons were done by ANOVA 1 and data was compared using Chi–square test and p value<0.05 was taken as significant. Results Of 42 patients, 81% had osteoporosis by Z–score of DEXA. Urinary crosslaps was high in 55%; 36% had increased osteocalcin; 62% had low vitamin D levels; 38% had high parathyroid levels and IGF–1 was low in 52%. Mean serum ferritin level was 5344±2855 ng/dl. There was statistical significance (p=0.046) between chronological age and BMD. All 42 cases were divided into two groups: Group–1 (Normal DEXA), Group–2 (Abnormal DEXA) and analysis of biochemical indices between two groups showed no significant difference in any of the biochemical parameters. Conclusion This study revealed majority of thalassemics with inadequate chelation have bone resorption with advancing chronological age and BMD should be evaluated regularly for early diagnosis to prevent morbidity.

Neuro-cysticercosis with Japanese encephalitis: magnetic resonance imaging with diffusion and spectroscopy.

Neuro-cysticercosis (NCC) and Japanese encephalitis (JE) are common in tropical countries. Two cases of NCC with coexistent JE are presented, which share same socio-demographic and ecologic factors and have the same intermediate host (pig). Patients were on treatment for NCC and presented in comatose state. Sudden clinical deterioration of a patient with NCC should warrant a search for coexistent JE. We report findings of magnetic resonance spectroscopy and diffusion-weighted imaging of the JE.

Role of magnetic resonance perfusion studies in moyamoya disease.

Moyamoya disease, Japanese for 'puff of smoke', is a rare disease that presents most commonly with recurrent TIAs (transient ischemic attacks) / stroke in childhood. Ischemic symptoms in patients with moyamoya disease are usually due to hemodynamically-mediated perfusion failure. Identification of abnormal tissue perfusion is an important aspect of the evaluation of these patients. We present the radiological features including the Magnetic Resonance (MR) Perfusion findings illustrating the hemodynamic changes of cerebral ischemia in a case of moyamoya disease.