Franklin Joseph

Effects of Growth Hormone Administration on Bone Mineral Metabolism, PTH Sensitivity and PTH Secretory Rhythm in Postmenopausal Women With Established Osteoporosis

Introduction: Growth hormone (GH) replacement improves target organ sensitivity to PTH, PTH circadian rhythm, calcium and phosphate metabolism, bone turnover, and BMD in adult GH‐deficient (AGHD) patients. In postmenopausal women with established osteoporosis, GH and insulin like growth factor‐1 (IGF‐1) concentrations are low, and administration of GH has been shown to increase bone turnover and BMD, but the mechanisms remain unclear. We studied the effects of GH administration on PTH sensitivity, PTH circadian rhythm, and bone mineral metabolism in postmenopausal women with established osteoporosis.

Determining predictors of early response to exenatide in patients with type 2 diabetes mellitus.

Exenatide is a GLP-1 analogue used in the management of T2DM yet within a subset of patients fails due to adverse side effects or from failure to attain the end goal. This retrospective observational study aimed to determine whether we could predict response to exenatide in patients with T2DM. 112 patients on exenatide were included with patient age, gender, duration of T2DM, medications alongside exenatide and weight, BMI, and HbA1c at baseline and 3 and 6 months of exenatide use being recorded. 63 responded with 11 mmol/mol reduction from baseline HbA1c after six months and 49 did not respond to exenatide. HbA1c solely differed significantly between cohorts at baseline, 3 months, and 6 months (P < 0.05). Regression analyses identified a negative linear relationship with higher baseline HbA1c correlating to greater reductions in HbA1c by 6 months (P < 0.0001). HbA1c was the sole predictor of exenatide response with higher baseline HbA1c increasing the odds of response by 5% (P = 0.004). Patients with HbA1c reductions ≥15–20% by 3 months were more likely to be responders by 6 months (P = 0.033). Our study identified that baseline HbA1c acted as the sole predictor of exenatide response and that response may be determined after 3 months of exenatide administration.

System Accuracy Evaluation of the GlucoRx Nexus Voice TD-4280 Blood Glucose Monitoring System

Use of blood glucose (BG) meters in the self-monitoring of blood glucose (SMBG) significantly lowers the risk of diabetic complications. With several BG meters now commercially available, the International Organization for Standardization (ISO) ensures that each BG meter conforms to a set degree of accuracy. Although adherence to ISO guidelines is a prerequisite for commercialization in Europe, several BG meters claim to meet the ISO guidelines yet fail to do so on internal validation. We conducted a study to determine whether the accuracy of the GlucoRx Nexus TD-4280 meter, utilized by our department for its cost-effectiveness, complied with ISO guidelines. 105 patients requiring laboratory blood glucose analysis were randomly selected and reference measurements were determined by the UniCel DxC 800 clinical system. Overall the BG meter failed to adhere to the ≥95% accuracy criterion required by both the 15197:2003 (overall accuracy 92.4%) and 15197:2013 protocol (overall accuracy 86.7%). Inaccurate meters have an inherent risk of over- and/or underestimating the true BG concentration, thereby risking patients to incorrect therapeutic interventions. Our study demonstrates the importance of internally validating the accuracy of BG meters to ensure that its accuracy is accepted by standardized guidelines.

Spontaneous hypokalaemia in a man with treated hypertension

An 80 year old man with a history of hypertension, stage 3 chronic kidney disease, and paroxysmal atrial fibrillation presented feeling generally unwell and lethargic. He was taking amiodarone 200 mg, bisoprolol 10 mg, amlodipine 10 mg, and lisinopril 20 mg a day. He did not have a fever and he was haemodynamically stable. His blood pressure was controlled (132/84 mm Hg). Physical examination was unremarkable. Blood tests showed hypokalaemia (1.9 mmol/L, reference range 3.5-5.0), hypomagnesaemia (0.58 mmol/L, 0.6-1.2), and metabolic alkalosis (35 mmol/L, 20-32). His symptoms resolved after electrolyte replacement and he was discharged home. When later reviewed in clinic, a focused history was taken and tests were organised to evaluate the causes of hypokalaemia and hypertension. He had no family history to explain this presentation, or a history of excess use of liquorice, carbenoxolone, or grapefruit juice. Cortisol after overnight dexamethasone (1 mg taken at midnight) suppression was 38 mmol/L (normal response <50). Renin and aldosterone were measured after substituting bisoprolol, lisinopril, and amlodipine with doxazosin. The results showed renin 0.2 ng/mL/h (reference ranges: supine 0.2-2.8, upright 1.8-5.1), aldosterone 977 pmol/L (supine 80-300, upright 140-800); calculated aldosterone:renin ratio 4885 (<590). Given the biochemical abnormality, he underwent computed tomography of the abdomen (figs 1⇓ and 2⇓). Fig 1 Coronal computed tomogram of the abdomen Fig 2 Cross sectional computed tomogram of the abdomen ### 1. What abnormality does the computed tomogram show? #### Answer A 19 mm nodule is seen the right adrenal gland. #### Discussion A 19 mm nodule is seen in the right adrenal gland (figs 3⇓ and 4⇓). The gland is homogeneously hypodense, with a rounded margin suggestive of an adenoma. …

Dietary Management of Diabetic Chronic Kidney Disease

Diabetic chronic kidney disease (diabetic nephropathy) is the most common cause for end-stage renal failure and is associated with increased cardiovascular morbidity and mortality. Multiple interventions, including good control of blood pressure, blood glucose, and lipids, have been shown to slow its progression. Dietary management is being considered an adjunct to retard the progression of diabetic nephropathy. Several animal and human studies have evaluated the rationale and potential benefits of using various dietary interventions in patients with diabetic nephropathy. We provide an overview of the current evidence supporting the use of dietary measures in the management of diabetic chronic kidney disease.