Reversibility in male idiopathic osteoporosis possible

Summary: A 44-year-old athletic man presented in 2009 with severe low back pain. Dual-energy x-ray absorptiometry revealed severe osteoporosis; serum testosterone was 189 ng/dL while serum estradiol (E2) measured by liquid chromatography/mass spectrometry was 8 pg/mL. DNA was extracted and sequenced from a blood sample from the patient since his maternal first cousin also had low bone mass and both patients were screened for aromatase dysfunction by PCR analysis for the CYP19A1 gene, which encodes aromatase. No known pathologic mutations were observed in the coding exons, but novel single nucleotide polymorphisms were detected both in the proband and in his cousin. Treatment with topical testosterone started in August 2010. Over the next 8 years, testosterone dosage was varied and switched from topical gel to injections and maintained on depo-injections of testosterone at about 60 mg once per week. Re-examination in March 2012 included a brain MRI to exclude pituitary lesions; hyperparathyroidism was ruled out (normal serum parathyroid hormone, calcium, and calcium to phosphorous ratio) and celiac disease was excluded (negative transglutaminase antibodies). Follow-up in October 2018 showed improved bone mineral density of the lumbar spine by 29% and of the left femoral hip by 15% compared to baseline measurements. This reveals the importance of measuring serum E2 for making the correct diagnosis, as well as for monitoring a therapeutic effect. Herein, we propose treatment of male osteoporosis where serum E2 levels are below about 20 pg/mL with testosterone to reverse osteoporosis. Learning points: Estrogen deficiency in the diagnosis of male idiopathic osteoporosis. Importance of serum estradiol in male osteoporosis. Role of polymorphisms in aromatase gene on bone health. Reversal of osteoporosis. Tailored testosterone treatment for bone health

Using INTERCheck® to Evaluate the Incidence of Adverse Events and Drug–Drug Interactions in Out- and Inpatients Exposed to Polypharmacy

Background: Polypharmacy exposes patients with comorbidities (particularly elderly patients) to an increased risk of drug-specific adverse events and drug–drug interactions. These adverse events could be avoided with the use of a computerized prescription support system in the primary care setting. The INTERCheck® software is a prescription support system developed with the aim of balancing the risks and benefits of polytherapy and examining drug–drug interactions. Objectives: This observational study used the INTERCheck® software to evaluate the incidence of adverse events and of drug–drug interactions in outpatients and inpatients receiving multiple medications. Methods: Patients were randomly enrolled from the outpatient department (n = 98) and internal medicine ward (n = 46) of S. Andrea Hospital of Rome. Polypharmacological treatment was analyzed using INTERCheck® software, and the prevalence of risk indicators and adverse events was compared between the two groups. Results: Polypharmacy (use of five or more drugs) applied to all except three cases among outpatients and one case among inpatients. A significant positive correlation was found between the number of medications and the INTERCheck® score (ρ = 0.67; p < 0.000001), and a significant negative correlation was found between the drug-related anticholinergic burden and cognitive impairment (r = − 0.30 p = 0.01). Based on the INTERCheck® analysis, inpatients had a higher score for class D (contraindicated drug combination should be avoided) than did outpatients (p = 0.01). The potential class D drug–drug interactions were associated with adverse events that caused hospitalization (χ2 = 7.428, p = 0.01). Conclusions: INTERCheck® analysis indicated that inpatients had a high risk of drug–drug interactions and a high percentage of related adverse drug events. Further prospective studies are necessary to evaluate whether the INTERCheck® software may help reduce polypharmacy-related adverse events when used in a primary care setting and thus potentially avoid related hospitalization and severe complications such as physical and cognitive decline

Cloning, purification and characterisation of a recombinant purine nucleoside phosphorylase from Bacillus halodurans Alk36

A purine nucleoside phosphorylase from the alkaliphile Bacillus halodurans Alk36 was cloned and overexpressed in Escherichia coli. The enzyme was purified fivefold by membrane filtration and ion exchange. The purified enzyme had a Vmax of 2.03 × 10−9 s −1 and a Km of 206 μM on guanosine. The optimal pH range was between 5.7 and 8.4 with a maximum at pH 7.0. The optimal temperature for activity was 70°C and the enzyme had a half life at 60°C of 20.8 h

Ramipril and Risk of Hyperkalemia in Chronic Hemodialysis Patients

Angiotensin converting enzyme (ACE) inhibitors provide well known cardiorenal-protective benefits added to antihypertensive effects in chronic renal disease. These agents are underused in management of patients receiving hemodialysis (HD) because of common concern of hyperkalemia. However, few studies have investigated effect of renin angiotensin aldosterone system (RAAS) blockade on serum potassium in hemodialysis patients. We assessed the safety of ramipril in patients on maintenance HD. We enrolled 28 adult end stage renal disease (ESRD) patients treated by maintenance HD and prescribed them ramipril in doses of 1.25 to 5 mg per day. They underwent serum potassium concentration measurements before ramipril introduction and in 1 to 3 months afterwards. No significant increase in kalemia was found. Results of our study encourage the use of ACE inhibitors in chronically hemodialyzed patients, but close potassium monitoring is mandatory

Arte rupestre: Modelo de la referencia

Este ensayo plantea algunos interrogantes sobre la referencia del arte rupestre y su modelo epistémico. Confiere a éste un contenido heurístico importante y lo examina en relación con el enfoque lacaniano sobre los significantes. Intenta abordar la fenomenología de este arte con instrumentos analíticos que estima no pueden ser dejados de lado incluso ante manifestaciones tan elusivas como las rupestres.This essay raises somequestions about the reference of rock art and its epistemic model. It confers on it important heuristic content and examines it in relation to the lacanian approach to signifiers. He tries to approach the phenomenology of this art with analytical instruments that he estimates can not be left out even in the face of such elusive manifestations as rock art.Fil: Rocchietti, Ana M. Universidad Nacional de Río Cuarto,Argentin

Talleres líticos en altura: India Muerta, Sierra de Comechingones, Provincia de Córdoba

Esta exposición tiene por finalidad ofrecer una síntesis sobre un tipo específico de registro arqueológico: talleres líticos. Estima que el mismo tiene una correlación estructural con el terreno y procura representarla con mapas de relieve y pendiente, otorgando a ésta última un valor de atractor causal para la explotación eco-económica del ambiente por la población prehispánica. Los talleres estudiados se localizan en el sur de la Sierra de Comechingones, en un sector de cordones serranos erosionados con altitud máxima de 1100 m.s.n.m. Se trata de un tipo de registro arqueológico muy numeroso en esta parte de la sierra; se considera al mismo representativo de un modo de producción y una larga tradición tecno-económica por parte de las poblaciones indígenas que colonizaron este paisaje en tiempos prehispánicos.The purpose of this paper is to offer a synthesis on a specific type of archaeological record: lithic workshops. It considers that it has a structural correlation with the land and seeks to represent it with relief and slope maps, giving the latter a causal attractor value for the eco-economic exploitation of the environment by the pre-Hispanic population. The studied workshops are located in the south of the Comechingones Mountains, in a sector of eroded mountain ranges with a maximum altitude of 1100 m.s.n.m. It is a very numerous type of archaeological record in this part of the mountain range; is considered the same representative of a mode of production and a long techno-economic tradition by the indigenous populations that colonized this landscape in prehispanic times.Fil: Rocchietti, Ana M. Universidad Nacional de Río Cuarto.Laboratorio -Reserva de Arqueología,ArgentinaFil: Ribero, Flavio. Universidad Nacional de Río Cuarto.Laboratorio -Reserva de Arqueología,ArgentinaFil: Reinoso, Denis. Universidad Nacional de Río Cuarto.Laboratorio -Reserva de Arqueología,ArgentinaFil Ponzio, Arabela. Universidad Nacional de Río Cuarto.Laboratorio -Reserva de Arqueología,ArgentinaFil. Echegaray, Emanuel. Universidad Nacional de Río Cuarto.Laboratorio -Reserva de Arqueología,Argentin