Sambit Das

Efficacy of Autologous Bone Marrow–Derived Stem Cell Transplantation in Patients With Type 2 Diabetes Mellitus

Progressive and inexorable beta-cell dysfunction is the hallmark of type 2 diabetes mellitus (T2DM) and beta-cell regeneration using stem cell therapy may prove to be an effective modality. A total of 10 patients (8 men) with T2DM for >5 years, failure of triple oral antidiabetic drugs, currently on insulin (> or = 0.7 U/kg/day) at least for 1 year, and glutamic acid decarboxylase antibody negative were included. Patients on stable doses of medications for past 3 months were recruited. Primary end points were reduction in insulin requirement by > or = 50% and improvement in glucagon-stimulated C-peptide levels at the end of 6 months of autologous bone marrow-derived stem cell transplantation (SCT), while secondary end points were a change in weight and HbA1c and lipid levels as compared to baseline. Seven patients were responders and showed a reduction in insulin requirement by 75% as compared to baseline. Mean duration to achieve the primary objective was 48 days. Three patients were able to discontinue insulin completely, although it was short-lived in one. Mean HbA1c reduction was 1% and 3 of the 7 responders had HbA1c value <7%. A significant weight loss of 5.5 kg was noted in the responders, whereas, nonresponders gained 2.2 kg of weight. However, weight loss did not correlate with reduction in insulin requirement (r = 0.68, P = 0.06). There was a significant improvement in both fasting and glucagon-stimulated C-peptide level in the group (P = 0.03) and responders (P = 0.03). HOMA-B increased significantly in the whole group (P = 0.02) and responders (P = 0.04) whereas, HOMA-IR did not change significantly (P = 0.74). Reduction in insulin doses correlated with stimulated C-peptide response at the baseline (r = 0.83, P = 0.047) and mononuclear cell count of infused stem cells (r = 0.57, P = 0.04). No serious adverse effects were noted. Our observations indicate that SCT is a safe and effective modality of treatment to improve beta-cell function in patients with T2DM. However, further large-scale studies are needed to substantiate these observations.

Which is the better option: recombinant human PDGF-BB 0.01% gel or standard wound care, in diabetic neuropathic large plantar ulcers off-loaded by a customized contact cast?

This study compares the efficacy of 0.01% rh-PDGF-BB with standard wound care in 20 patients with diabetes mellitus with neuropathic large plantar ulcers off-loaded with modified total contact cast. The incidence, duration and rate of healing were compared. An accelerated rate of healing in rhPDGF group was observed.

Thrombotic thrombocytopenic purpura following zoledronic acid infusion with a fatal outcome

A 56-year-old woman presented with generalised bone pain with bone mineral density showing severe osteoporosis for which she received a single 4 mg infusion of zoledronic acid (ZA). On the second day following the infusion, she developed fever with altered sensorium. A complete blood count showed anaemia and thrombocytopenia with peripheral blood smear repeatedly showing schistocytes, anisopoikilocytes and target cells. Serum biochemistry revealed elevation of serum creatinine at 1.5 mg/dl. In view of microangiopathic haemolytic anaemia, fever, renal insufficiency, neurological abnormality and thrombocytopenia, the patient was presumed to have developed thrombotic thrombocytopenic purpura (TTP). Accordingly, a combination therapy with glucocorticoids and fresh frozen plasma transfusion was begun pending plasmapharesis. She manifested a fluctuating level of mental status with progressive purpuric and ecchymotic lesions and she sustained cardiorespiratory arrest from which she could not be revived. The temporal sequence of events following ZA infusion with typical manifestations of TTP strongly suggests ZA as the most probable cause of her fatal TTP.

Bilateral adrenal masses: varying aetiologies

We describe three cases of bilateral adrenal masses with different aetiologies. Their clinical details are provided in table 1. View this table: Table 1 Clinical details Figure 1 (A) Contrast enhanced abdominal computed tomography (CT) scan showing bilateral adrenal masses (right adrenal 4.4×2.2 cm and left adrenal 2.2×1.6 cm) with a speck of calcification. (B) Fine needle aspiration cytology …

An unusual association of corpus callosum agenesis in a patient with acromegaly

Midline developmental abnormalities are usually associated with isolated growth hormone deficiency or multiple pituitary hormone deficiencies due to pituitary transcription factor defects.1 We describe a case with midline defects presenting as corpus callosum agenesis and acromegaly. A 39-year-old male presented with congestive cardiac failure with overt clinical features of acromegaly. He was a graduate, was mentally normal and had …

True precocious puberty with vision loss.

A 7-year-old boy presented with progressive vision loss and simultaneous development of precocious puberty. On evaluation he was found to have a solid cystic tumour in the sellar and suprasellar region. He underwent trans-sphenoidal resection of the tumour and histopathological examination revealed pilocytic astrocytoma. However, he later succumbed to postoperative sepsis.