Bone turnover markers for osteoporosis status assessment at baseline in postmenopausal Pakistani females

Objective: To assess bone turnover status in osteopenic and osteoporotic postmenopausal females

Study Design: Cross-sectional analytical study

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January to December 2013

Methodology: A cross-sectional study was conducted on 203 postmenopausal females undergoing bone mineral density testing [BMD] by DXA scan. Patients with clinical history of any disorder or medications affecting bone turnover were excluded. Bone turnover was assessed with osteocalcin and beta-CTx. Data was analyzed by SPSS version 19

Results: Mean age of the participants was 54 +/- 4.66 years with a mean BMI of 28.7 +/- 5.5 kg/m2. Mean beta-CTx [0.28 +/- 0.24 ng/ml] and osteocalcin [21.5 +/- 10.6 ng/ml] levels were within the normal reference range. Subjects were grouped into normal [26.6%], osteopenic [44.8%], and osteoporotic [28.6%] based on the t-scores. Serum levels of osteocalcin and beta-CTx between normal, osteopenic, and osteoporotic groups were not significantly different. beta-CTx was negatively and significantly associated with only lumber spine BMD [r = -0.13, p=0.04]. Positive association [< 0.0001] was noted between both markers in normal, osteopenic, and osteoporotic females. However, association of these markers with BMD in the 3 groups were not found. Multivariate linear regression showed a positive and significant effect of BMI on BMD [beta = 0.332, p= < 0.0001]. beta-CTx had negative but significant effect on BMD [beta = -0.155, p= 0.018] of postmenopausal women

Conclusion: Association between baseline levels of BTM and rate of bone loss is variable and site dependent. beta-CTx correlates better with BMD. However, role of osteocalcin in postmenopausal osteoporosis is uncertain and needs further investigation

Early bone scan imaging protocol: a pragmatic approach to maintain patients throughput in a busy Nuclear Medicine Section

Radionuclide bone scan are acquired 3-4 hours after Technetium-99m Methylene Diphosphonate [[99m] Tc MDP] injection to ensures a better contrast between bone and soft tissue. However, in a busy department with limited gamma cameras this imaging protocol is the limiting factor for reduced patient throughput. Compare the image quality of early [1.5 hr] and delayed [3 hr] acquired bone scans in same patients for image quality and lesion detection efficiency. This prospective study was conducted at Section of Nuclear Medicine, Department of Radiology, Aga Khan University Hospital, Karachi from 1st August 2011 till 15th September 2011. We recruited 12 patients [age range: 18-75 years] with a male: female ratio of 4:8, who were pain free, cooperative and mobile. [99m]Tc MDP was injected intravenously. Patients were asked to have at least 250 cc of water after every 15 minutes] and void urine frequently to minimize bladder dose. At 1.5 hour and 3 hour post-injection, whole body imaging were acquired under a double head, gamma camera [ECAM, Siemens, Germany] with same acquisition parameters for both images. These images were read by an experienced nuclear physician who evaluated the scans for over all image quality [subjective] and lesion detection efficiency [estimation of lesion appreciable on a scan]. The image quality of early [1.5 hr] and delayed scans were labeled as acceptable [fair bone to soft tissue contrast] and good [good bone to soft tissue contrast] respectively by the reader. Twenty three [23] lesions were identified on early scan and all of these lesions were appreciable on delayed studies as well and no discordance was identified. In a busy nuclear medicine section, to maintain patients' throughput, imaging at 1.5 hour may be used safely in those patients who are cooperative and mobile

Isolated tuberculosis thyroiditis as solitary thyroid nodule

Isolated involvement of the thyroid by tuberculosis is very rare as reported in literature. We are presenting a case of isolated tuberculous thyroiditis presented as a solitary thyroid nodule. The patient was treated with anti-tuberculous regimen and he responded well with disappearance of the nodule and normalization of the thyroid scan

Bone scan: a sensitive modality for diagnosing and predicting outcome for reflex sympathetic dystrophy

Reflex sympathetic dystrophy is a consequence of overactive sympathetic nervous system that results in burning pain, stiffness, swelling and discoloration of the affected limb. This case report describes the condition in a man that was diagnosed with the help of radionuclide bone scan

Sentinel lymph node scintigraphy and radioguided dissection in breast carcinoma: an initial experience at Aga Khan University Hospital

To evaluate the efficacy of SLN biopsy using imaging and gamma probe in breast cancer and to establish this technique at Aga Khan University Hospital. Thirty two patients [mean age 33-76 yrs] with operable breast carcinoma [4 with post-neo adjuvant therapy] with clinically negative axilla were studied. In 28 patients simultaneous axillary dissection was performed. Sentinel lymph nodes [SLN] scintigraphy was performed a day before surgery by injecting Tc-99m labeled nannocolloid sub-dermally in the peri-areolar region in 24 and peri-tumoral in remaining 8. First lymph node [LN] to appear to on the scan was labeled as SLN and marked on the skin. Blue dye was also injected in all patients and blue and hot LN was explored in the axilla using gamma probe. The sentinel LN was identified in 31 patients [96.9% success rate] while in one patient [3.1%] SLN was not visualized on the scan [negative study] and this was a post-neo-adjuvant therapy case. The blue dye successfully localized the sentinel LNs in all 32 cases The gamma probe guided localization was successful in all 31 while in one case with post-neo-adjuvant chemotherapy it failed. In 9 out of 32 [28.1%] cases SLN was positive for metastasis and in 6 out of these 9 [66.6%] the SLN was the only metastatic node. This includes the post-neo-adjuvant case as well. There was no case of skip metastasis, i.e. negative SNL and positive other axillary nodes. In remaining 23 [71.9%] cases SLN was negative for metastasis and in all, axilla was free of disease [NPV of 100%]. Lymphoscintigraphy with gamma probe guided SNL biopsy is safe, simple and highly reliable technique. With blue dye technique it reduces the blindness of the procedure if performed independently but increases the cost. Finally, this can accurately stage the axilla, possibly allowing axillary dissection to be foregone in patients where the SLN is clear

Extra pulmonary uptake of Tc 99m MAA perfusion lung scan as a result of right to left intra cardiac shunt

Extra pulmonary accumulation of Tc-99m-macroaggregate of albumin [MAA] is rarely seen on perfusion lung scan, and has been reported in less than 4% of a study population of nearly 380 patients1. It occurs when the agent bypasses the lungs due to a right to left [R-L] cardiac or pulmonary shunt, when it is shunted to the portal vein before reaching the right atrium and ventricle of the heart, and when the agent is degraded to a submicron particle size.2 When a pharmaceutical problem is excluded, extra-pulmonary uptake implies unusual hemodynamics with a shunt. A case is reported in which a clinically unsuspected shunt was diagnosed from the lung perfusion scintigraphy

study on iron deficiency anemia and hematological differences around delivery in women of different socio - economic and age groups

This study was conducted on pregnant women admitted to various hospitals of Faisalabad for delivery. They were randomly divided into 3 socio-economic groups [low, middle and high] and each group was further subdivided into 3 age groups of < 25, 26 33 years of patients. The study revealed an overall higher [p<0.05] birth weight of newborn of those born to women of middle socio-economic groups than low and high. Overall mean RBC [106/