Efficacy of teriparatide in increasing bone mineral density in postmenopausal women with osteoporosis--an Indian experience.

BACKGROUND AND OBJECTIVE: Osteoporosis is emerging as a leading cause of substantial morbidity in India, particularly in postmenopausal women. Teriparatide (recombinant human parathyroid hormone [1-34]) increases bone formation and improves bone microarchitecture, thereby reducing the risk of fractures. This study was conducted to evaluate the efficacy of teriparatide in increasing bone mineral density (BMD) in postmenopausal women with osteoporosis. MATERIAL AND METHODS: A randomised, prospective, multicentre, open-label, controlled study was conducted on 82 postmenopausal women with established osteoporosis. Patients were randomly divided into control and teriparatide groups, each group consisting of 41 patients. All the patients were supplemented with 1000 mg of elemental calcium and 500 IU of vitamin D throughout the study period of 180 days. Besides, teriparatide group patients were administered teriparatide 20 microg daily subcutaneously. Lumbar spine, femoral neck and total hip BMD, bone mineral content (BMC) and bone area were measured by dual energy x-ray absorptiometry (DXA) at baseline and at the end of 6 months of treatment. Bone biomarkers, such as serum bone specific alkaline phosphatase (BSAP) and serum osteocalcin (OC), representing bone formation, and urinary deoxypyridinoline (DPD), representing bone resorption were assessed at baseline, and at 3 and 6 months of treatment. RESULTS: During the study period, 9 patients (11%) were lost to follow-up--6 in control group (7.3%) and 3 in teriparatide group (3.7%). There was an excellent compliance to both oral and injectable medication. The investigational product teriparatide was well tolerated and there were no serious adverse events. In addition, there were no significant differences between the groups in the incidence of adverse events. The percentage of increase in lumbar spine BMD, which is the primary endpoint, was significantly (P < 0.001) higher in teriparatide group compared to that in control group (6.58% vs. 1.06%). Further, teriparatide significantly increased percentage of change in lumbar spine T-score (P < 0.001), BMC (P < 0.001) and bone area (P < 0.028) compared to control group at 6 months. Administration of teriparatide resulted in a significant percentage of increase in all the bone biomarkers in teriparatide group compared to control group patients at 3 and 6 months over baseline, thereby showing that there was a significant increase in bone turnover in teriparatide group of patients. CONCLUSION: These results show that teriparatide is an effective and safe drug in increasing the BMD and therefore, teriparatide provides yet another new therapeutic option for reducing the risk management of osteoporosis in postmenopausal women (clinicaltrials.gov number, NCT00500409).

Finger nail abrasions in manual strangulation (throttling).

Autopsy surgeons, often observed that the nail abrasions produced over the neck of victims in manual strangulation are almost straight and do not resemble the shape of nails, which are semi-circular/cresentic. A study is undertaken to know the reason for the same. During the study it is observed that the skin gets stretched while the assailant is applying pressure and only then nails produce indentations. Once the pressure is removed the stretched skin reverts back to its original position. Thus the semicircular indentations caused over the stretched skin appear straight after the skin regains its original position.

Allgrove syndrome--a syndrome of primary adrenocortical insufficiency with achalasia of the cardia and deficient tear production.

Primary adrenal insufficiency is an uncommon disease which has worldwide distribution. The commonest cause in underdeveloped countries is tuberculosis followed by autoimmune destruction of the adrenal gland. We report a case of a 15 years boy who had congenital adrenal insufficiency associated with achalasia of the cardia and deficient tear secretion.

Current diagnostic criteria and their impact on outcome and management.

The 1997 American Diabetes Association (ADA) Expert Committee on the Diagnosis and Classification of Diabetes Mellitus and the Provisional Report of the WHO Consultation focus on a fasting plasma glucose (FPG) that is 126 mg/dl or greater and confirmed on a subsequent day as the preferred criterion for the diagnosis of diabetes mellitus. This criterion is supported by studies demonstrating that this threshold accurately differentiates between non-diabetic and diabetic populations and is associated with the development of specific diabetic microvascular complications. It corrects for the inequivalence of the FPG and 2- hour post glucose (2hPG) criteria of the previous National Diabetes Data Group (NDDG) and WHO diagnostic schemes and recognises that oral glucose tolerance tests (OGTTs) rarely are performed in clinical practice. Although the new and the previous criteria produce similar estimates of the prevalence of diabetes, there may be a considerable degree of reclassification. Preliminary studies suggest that the new criteria favour the diagnosis of diabetes in younger and more obese individuals, whereas the older criteria increase the likelihood of diagnosis in older, leaner individuals.

Adrenal tumor presenting as precocious puberty.

We present a case report of a two and a half-year-old boy who presented with precocious puberty. A clinical diagnosis of congenital adrenal hyperplasia was made. Patient was investigated and found to have an adrenocortical tumor. The tumor was about 7 cms in diameter. The tumor was secreting androgens, 17OHP and cortisol. This is an unusual array of hormones to be secreted by an adrenal tumor.

Behavioural intervention in the management of compliance in young type-I diabetics.

OBJECTIVES: a) To examine the efficacy of a behavioural intervention programme in the management of compliance in young Type I diabetics, b) To examine the efficacy of a behavioural management programme in enhancing metabolic control in young Type I diabetics, c) To examine the effect of behavioural intervention on level of diabetes knowledge and quality of life in young Type I diabetics. METHODS: A total of 40 patients (Experimental group n = 20, Control group n = 20) was selected from local hospitals' pediatric, endocrinology and diabetology units. The experimental group received 15 individual sessions of behavioural intervention, consisting of behavioural counseling for family and significant others, relaxation, diabetes education and specific behavioural and cognitive strategies such as reinforcement, target-setting and cognitive restructuring. Assessment was carried out on various psychological measures as well as the glycosylated hemoglobin test (HbA1), at pre and post treatment periods. RESULTS: The scores of the two groups were compared at post treatment point. Results indicate that there was significant improvement in the experimental group in compliance and metabolic control. There were also significant changes noted in the level of diabetes knowledge as well as the reported quality of life. These changes in compliance and metabolic control were maintained at a three month follow-up period. CONCLUSIONS: Behavioural intervention can be included as an effective adjunct to routine medical care in the management of young Type I diabetics, especially in the management of compliance and metabolic control, enhancement of knowledge and quality of life.