Bone Mineral Density and Bone Turnover Markers in healthy Pre and Postmenopausal Women and the influence of multiple factors on them

AIM AND/ OBJECTIVES : To study Bone Mineral Density (BMD) and Bone Turnover Markers (BTMs) and factors influencing them in postmenopausal-women and their premenopausal-daughters and to study reference ranges of BTMs and their correlations with BMD. MATERIAL AND METHODS : This cross sectional study was conducted at an urban area in Vellore district. One hundred fifty two subjects which included 76 postmenopausal women and their daughters (n=76) who met the inclusion criteria were recruited from the community after obtaining a written informed consent. Details with regards to age, parity, dietary calcium intake, sunlight exposure and socioeconomic status, physical activity using “International Physical Activity Questionnaire” (IPAQ) and BMI were collected. Fasting blood and second void morning urine samples were obtained for measurement of BTMs (sCTX, sPTNP1, sOC and urine DPD respectively) and bone mineral parameters. BMD was measured by DXA. RESULTS : Osteoporosis was seen in 50% of the postmenopausal women and low bone mass was seen in 9% of daughters at spine. Ethnicity based reference range of BTMs were derived. Significant inverse correlation was found between BTMs and the BMD with good analytical performance (AUC>0.70, P <0.001) in the diagnosis of osteoporosis. Daughters born to mothers with osteoporosis at spine had lower BMD compared to daughters whose mothers did not have osteoporosis (P=0.047). Low socio-economic status (SES) was found to have a detrimental effect on BMD at spine (Odds 3.2, P=0.03). CONCLUSIONS: Osteoporosis was seen in half of the postmenopausal women and low bone mass seen in one tenth of the premenopausal women. The reference range for various BTMs was studied in a well-defined cohort of premenopausal women and their mothers. Lower SES was a significant risk factor for osteoporosis which highlights the importance of simple interventions to improve the peak bone mass and reduce the bone loss by optimising calcium and vitamin D intake, encouraging physical activity, awareness and allocation of resources for screening and treatment of osteoporosis in the community. In view of good analytical performance of BTMs in the diagnosis of osteoporosis and the cost effectiveness and ease of estimation of their assays, in future, it may be possible to use BTMs as a screening tool in osteoporosis. However, it needs further validation in larger studies

A Clinical Study on the efficacy of Laksha Choorna Pratisarana and Tila Taila Kavala in the control of Danta Sharkara

Introduction: Danta Sharkara (Dental Calculus) is one among the Danta Rogas (Diseases of Tooth) characterized by, hardened accumulation of Mala (dirt) on tooth surface which destroys the teeth and its surrounding structures. It can be compared to Dental calculus, which is a calcified mass that forms on and adheres to the surface of teeth causing periodontal diseases. Modern approach of treatment is Scaling and Root planing. Ultrasonic scalers are used widely by the dentists, which is more efficient method, but it has certain drawbacks. Long term use of mouth washes and dentifrices also have shown adverse effects. Considering these drawbacks in modern dentistry present study was taken up to evaluate the efficacy of local therapeutic procedure mentioned in our classics for calculus removal and its control. Materials and Methods: 40 patients were selected and randomly divided into Group A and B consisting of 20 patients each. Group A was treated by Lakshachoorna Pratisarana (rubbing lac) with Madhu (honey) after Scaling followed by Tilataila Kavala (gargle with gingelly oil) for a period of 3 months. Group B was treated by Ultrasonic Scaling followed by Chlorhexidine mouth wash for a period of 3 months. Result: In the present study, It was found that Group A showed better improvement in calculus index and lesser recurrence rate

Carney complex with PRKAR1A mutation: A case report

Carney complex is a multiple endocrine neoplasia syndrome with various features which include myxomas, endocrine tumours and lentigines lesions. We report a case of Carney complex with components of lentigines, ACTH independent adrenal Cushing’s syndrome (with a paradoxical increase in 24 hour urinary cortisol following the high dose (8mg) dexamethasone suppression test – and is likely to be due to primary pigmented nodular adrenal hyperplasia) positive for a protein kinase A type 1A regulatory subunit (PRKAR1A) gene mutation

Association of metabolic syndrome and lower urinary tract symptoms amongst South Indian postmenopausal women

Background: Women spend one third of their life in menopause. The age related anatomical and physiological changes predispose them to MetS and lower urinary tract symptoms (LUTS). The aim was to study the prevalence of metabolic syndrome (MetS) and lower urinary tract symptoms in postmenopausal women attending menopause clinic, to study the correlation of LUTS and body composition among women with MetS.Methods: 154 post-menopausal women who attended menopause clinic at the Christian Medical College Hospital Vellore, were recruited. MetS was diagnosed using IDF criteria. LUTS were assessed BFLUTS questionnaires. Blood was taken to assess serum fasting glucose and lipid profile. DEXA was performed to assess the whole-body composition.Results: Of 154 postmenopausal women, 64% had MetS and 43% of women had a total LUTS score > 5. 90% of women had filling symptoms,57% had incontinence,17% had voiding symptoms,14 % had quality of life issues and 6 % had sexual symptoms. However, there was no statistical significant difference between two groups in correlating the variables of MetS with LUTS (P >0.05). The percentage of total body fat by DEXA scan was significantly greater (P=0.006) in women with MetS (37.32±5.04) when compared to the women without MetS (34.629±3.65).Conclusions: Prevalence of MetS among the study population was 64 %. LUTS were observed in 43% of the patients. There was no significant difference in LUTS in women with MetS and without Mets. However, there was a significant difference in body composition among women with and without MetS

A novel variant of the AGPAT2 mutation in generalized congenital lipodystrophy

Inherited lipodystrophies are rare causes of young onset diabetes characterised by abnormal fat distribution with unique set of clinical features. We present a case of 24 year old lady with young onset diabetes mellitus, acromegaloid features, virilisation, hepatomegaly, hypertriglyceridemia with almost complete absence of subcutaneous and visceral adipose tissue as assessed by DXA scan body composition and MRI abdomen. Based on the clinical presentation, a diagnosis of Berardinelli–Seip generalized lipodystrophy was considered. Genetic analysis using next generation sequencing identified a novel homozygous insertion mutation in 1-acylglycerol-3-phosphate O-acyltransferase 2(AGPAT2) gene which was further confirmed with Sanger sequencing

Osteoporosis in Healthy South Indian Males and the Influence of Life Style Factors and Vitamin D Status on Bone Mineral Density

Objective. To study the prevalence of osteoporosis and vitamin D deficiency in healthy men and to explore the influence of various life style factors on bone mineral density (BMD) and also to look at number of subjects warranting treatment. Methods. Ambulatory south Indian men aged above 50 were recruited by cluster random sampling. The physical activity, risk factors in the FRAX tool, BMD, vitamin D, and PTH were assessed. The number of people needing treatment was calculated, which included subjects with osteoporosis and osteopenia with 10-year probability of major osteoporotic fracture >20 percent and hip fracture >3 percent in FRAX India. Results. A total of 252 men with a mean age of 58 years were studied. The prevalence of osteoporosis and osteopenia at any one site was 20% (50/252) and 58%, respectively. Vitamin D deficiency (<20 ng/dL) was seen in 53%. On multiple logistic regression, BMI (OR 0.3; P value = 0.04) and physical activity (OR 0.4; P value < 0.001) had protective effect on BMD. Twenty-five percent warranted treatment. Conclusions. A significantly large proportion of south Indian men had osteoporosis and vitamin D deficiency. Further interventional studies are needed to look at reduction in end points like fractures in these subjects

Metastatic Parathyroid Carcinoma treated with Radiofrequency Ablation: A novel therapeutic modality

Parathyroid carcinoma (PCA), accounting for less than one per cent of all endocrine malignancies, is a rare cause of primary hyperparathyroidism. A diagnosis of parathyroid carcinoma may be challenging in the presence of localised disease and involves a histological diagnosis based on capsular, vascular, or perineural invasion or the presence of metastasis. Distant metastasis remains a rare presentation, with the lung being the most common site. Surgery remains the treatment of choice as radiotherapy and chemotherapy have proved to be of limited benefit in metastatic disease. This case reports suggests that radiofrequency ablation has the potential to be a novel and effective treatment option in these patients

Paraneoplastic polyarthritis in association with metastatic neuroendocrine tumour of the adrenal gland

Paraneoplastic polyarthritis is a rare manifestation described in association with various solid tumours. We describe the clinical presentation, diagnostic evaluation, differential diagnosis, and management of a 28-year-old woman who presented with fever, weight loss, and symmetrical polyarthritis, subsequently diagnosed to have a metastatic neuroendocrine tumour of the adrenal gland with paraneoplastic polyarthritis. Paraneoplastic polyarthritis must be considered in polyarthritis unexplained by common aetiologies. The unusual presentation of this case, alerts us about the atypical presentation of these tumours. To the best of our knowledge, this is the first case study of a neuroendocrine tumour presenting as paraneoplastic polyarthritis

Micronutrients in Adverse Pregnancy Outcomes [version 3; peer review: 2 approved, 1 approved with reservations]

About 10 to 20% of reported pregnancies have complications like spontaneous abortion (SA), preeclampsia (PE), preterm birth (PTB), and fetal growth restriction (FGR); 60% are attributed to maternal nutritional alterations. Multiple micronutrients (MMN) are supplemented in the antenatal period, but no proper validation/guidelines are available regarding dosing/time, the need for initiation, and the duration of supplementation. Studies have reported adverse pregnancy complications related to the overuse/unwanted use of multiple micronutrient supplementations during pregnancy. Identifying the exact population requiring supplementation is necessary to prevent its abuse. This article attempts to review the impacts of micronutrient deficiency/supplementation in cases of SA, FGR, and gestational diabetes mellitus (GDM), preterm delivery and PE. The study used a literature search using PubMed, Google Scholar, Mendeley, and Scopus Databases using search words pregnancy, spontaneous abortion, gestational diabetes mellitus (GDM), fetal growth restriction (FGR), preterm delivery, preeclampsia (PE) or “adverse pregnancy” associated with minerals, micronutrients, or supplementation. The review also considered in-house literature databases, a single-window search at Kasturba Medical College (KMC) Health sciences library, MAHE (Manipal Academy of Higher Education). The figures included in the study were created by Biorender.com. Micronutrients play multiple roles during pregnancy and fetoplacental growth stimulating growth hormone secretion, Lysyl oxidase (LOX), involved in the crosslinking between collagen and elastin in the amniotic membrane, downregulation of interleukin (IL)-1 alpha, IL-1 beta, IL-4, IL-6, Il-10, IL-12, tumor necrosis factor (TNF)-alpha and several chemokines involved in hypertension, immune-inflammatory pathways, attenuate insulin resistance, structural development of neurons and glia. Over-supplementation has led to complications such as spontaneous abortion and gestational diabetes mellitus. Since there is a lack of standardization concerning micronutrient supplementation during pregnancy, there is a need for systematic study related to the role of micronutrients during each trimester of pregnancy to optimize its supplementation and to prevent hazards associated with its abuse