Subject(s)
Adenoma/surgery , Hyperparathyroidism, Primary/surgery , Parathyroid Neoplasms/surgery , Pregnancy Complications/surgery , Adenoma/complications , Adult , Female , Humans , Hyperparathyroidism, Primary/etiology , Parathyroid Neoplasms/complications , Parathyroidectomy , Pregnancy , Pregnancy Complications/etiology , Pregnancy Trimester, ThirdABSTRACT
Receptor activator of nuclear factor-kappaB ligand (RANKL) is a cytokine essential for osteoclast differentiation, activation, and survival. Denosumab, a human monoclonal antibody against RANKL, constitutes a promising antiresorptive agent for osteoporosis. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and other trial registries through January 2009. We selected randomized controlled trials (RCTs) of denosumab in women with low bone mass that described the changes on bone markers and bone mineral density (BMD) as well as the adverse events including fracture risk. We analyzed data from nine RCTs involving 10 329 participants. Although denosumab universally decreased bone markers and increased lumbar and hip BMD, the efficacy evaluation based on percentage (%) mean change from the baseline was not possible due to missing data. Denosumab was not associated with a significant reduction in fracture risk [OR (95% CI) 0.74 (0.33 to 1.64), p=0.45]. Increased risk of serious adverse events [OR (95% CI) 1.83 (1.10 to 3.04), p=0.02] and serious infections [OR (95% CI) 4.45 (1.15 to 17.14), p=0.03] were evident. In conclusion, although effective as an antiresorptive agent, denosumab has not yet proved its efficacy on fracture risk reduction while increased infection risk questions its safety.
Subject(s)
Antibodies, Monoclonal/pharmacology , Bone Density/immunology , Osteoporosis, Postmenopausal/immunology , RANK Ligand/immunology , RANK Ligand/pharmacology , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Bone Density/drug effects , Bone Remodeling/immunology , Denosumab , Female , Fractures, Bone/immunology , Fractures, Bone/prevention & control , Humans , Osteoporosis, Postmenopausal/drug therapy , RANK Ligand/adverse effects , RANK Ligand/therapeutic useABSTRACT
Although toxoplasmosis is considered harmless for a non-pregnant woman, it is potentially harmful during pregnancy, especially at first trimester. The aim of this study is to increase our alertness and monitoring in case of toxoplasmosis during pregnancy, given that when diagnosed it can be effectively treated.We present a case of a healthy 26 years old adult woman, found with toxoplasmosis during the 13th week of pregnancy. The role of frequent maternal and fetus immunological tests, PCR-tests of the amniotic fluid and ultrasound screening of the fetus throughout pregnancy was of great value. The patient was treated with spiramycin (1 grx3) from the 16th week of pregnancy. The patient was subjected to cesarean delivery at the 36th week of pregnancy due to preterm contractions and history of previous cesarean delivery. The newborn was a healthy girl with a birth weight of 2880 gr. A two-year follow up of the baby revealed no medical condition. Maternal infections are a serious medical condition during pregnancy. Toxoplasmosis when diagnosed on time and treated properly can lead to healthy offspring.
