A follow-up study on the effects of a milk supplement on bone mineral density of postmenopausal Chinese women in Malaysia

BACKGROUND

A previous study on a randomized controlled trial in 173 postmenopausal Chinese women in Kuala Lumpur showed that milk supplementation was effective to reduce bone loss at the total body, lumbar spine, femoral neck and total hip compared to the control group on a usual diet (Chee et al. 2003).

OBJECTIVE

The objective was to determine whether the results were sustained after the conclusion of the study.

DESIGN

A follow-up study, 18 months after a randomized controlled trial of milk supplementation was concluded. A total of 139 participants were followed up 21 months after the study ended. Bone mineral density (BMD) was measured at the total body, lumbar spine, femoral neck and total hip by dual energy X-ray absorptiometry, and anthropometric measurements as well as changes in dietary habits were measured.

RESULTS

At the follow-up, the milk supplement group did not show significant bone loss from baseline at most sites (mean differences +/- SE) (total body 0.42 +/- 0.25%, femoral neck 0.44 +/- 0.58%, total hip -0.06 +/- 0.46%), unlike the control group (total body -1.07 +/- 0.28% p < 0.005, femoral neck -1.49 +/- 0.56% p < 0.05, total hip -0.89 +/- 0.57% p < 0.05). However, both the milk and control groups showed bone loss from baseline at the lumbar spine (milk -2.01%, control -3.29%, p superior 0.05). The calcium intake of the milk group remained significantly higher than the control group (milk 710 mg/day, control 466 mg/day, p < 0.005) despite discontinuation of the milk supplement.

CONCLUSIONS

The results showed that some of the beneficial effects of a milk supplement were still evident at follow-up and it was possible to motivate subjects to adopt a positive change in dietary calcium intake after intervention.

Dengue maculopathy: a case report

INTRODUCTION

Dengue fever is endemic in many countries of South East Asia. In spite of the occasional epidemics, dengue maculopathy remains a rare entity.

CASE HISTORY

A 31-year-old gentleman was admitted with a 6-day history of fever, generalised rash, headache and myalgia after a trip to Malaysia. There were no bleeding manifestations. The lowest platelet count was 71 x 10,000/ml, the haematocrit was 42.7%, and dengue serology was positive. On the 8th day of illness, he complained of bilateral blurred vision. Detailed visual examination showed visual acuity of right eye 6/30 and left eye 6/50. Fundoscopy revealed dilated veins, hyperaemic optic discs, flame and blot haemorrhages, soft exudates and macular ischaemia. After a course of high-dose steroids, the visual acuity as well as colour vision improved markedly.

DISCUSSION

The pathology of maculopathy is not obvious in this case, but an immunological reaction is suspected. There is a risk of residual visual impairment, and there is no definitive treatment. The use of high-dose steroids seemed to improve visual acuity and colour vision. However, it is not known whether immunosuppression improves the prognosis. Time for resolution is from 8 weeks to 4 months. Since there is an increase in the incidence of dengue fever in our region, coupled with rising international travel, one could postulate that global incidence of dengue-related maculopathy may become significant.

CONCLUSION

Ocular complications associated with dengue fever are rare but may result in permanent visual impairment. Dengue fever should be suspected in travellers, particularly those returning from endemic areas, and they should be systematically screened for maculopathy when visual disturbances arise.

Plasmid-electroporated primary hepatocytes acquire quasi-physiological secretion of human insulin and restore euglycemia in diabetic mice

We describe the durable correction of streptozotocin-induced murine diabetes by in vivo implantation of primary mouse hepatocytes electroporated ex vivo with a human proinsulin cDNA plasmid construct controlled by glucose and zinc regulatory elements. Transfected hepatocytes increased insulin transgene transcription and secretion within 10-20 min of exposure to 25 mM glucose or 60 microM zinc. Insulin release did not occur from secretory granules. Electroporated Rosa26 hepatocytes ( approximately 8 x 10(5) viable cells) were implanted in C57BL/6J diabetic mice in one of three sites: unresected liver, regenerating liver or mesentery. Control diabetic mice were implanted with untransfected hepatocytes. At 30 days after implantation, 8/15 control mice were alive, while 19/19 treated mice were alive. The ratio of body weight on day 30/nadir body weight was significantly higher for all treated groups compared with controls. All eight surviving control mice were hyperglycemic 30 days post-implantation, while 16/19 treated diabetic mice remained normoglycemic. Treated mice had lower mean glucose values (P< or =0.001) without fasting hypoglycemia and better glucose tolerance (P< or =0.0003) than untreated controls. All (6/6) diabetic mice implanted in regenerating liver and 71% (5/7) implanted in unresected liver were alive 77 days after implantation. Engrafted hepatocytes were identified, mainly around central veins, by staining for beta-galactosidase activity and with anti-human insulin antibody.

Evaluation of live renal donors with three-dimensional contrast-enhanced magnetic resonance angiography in comparison to catheter angiography

BACKGROUND

Catheter angiography is traditionally used to determine renal arterial anatomy in live renal donors. Three-dimensional (3D) contrast-enhanced magnetic resonance imaging (MRA) has been suggested as a noninvasive replacement. We assessed the possibility of using MRA in live renal donors in Malaysia.

METHODS

Twenty-six consecutive live renal donors were recruited from 2000 to 2002. All potential donors underwent evaluation of the renal arteries using both techniques. Angiographic findings from both modalities were subsequently compared with surgical findings at the time of donor nephrectomy. The total number and diameter of the arteries and the presence of early branching and renal abnormalities were noted.

RESULTS

Both angiographic modalities were able to detect multiple renal arteries with catheter angiography having a sensitivity of 100% and MRA a sensitivity of 97%. MRA missed one 1-mm artery due to a low index of suspicion. Renal artery caliber measurements were not significantly different between the two methods. However, both techniques tended to overestimate the caliber of the renal arteries when compared with measurements taken at surgery. Early branching was found in two arteries at the time of surgery, but only one was detected by both techniques. Renal cysts seen on MR were not detected by catheter angiography.

CONCLUSIONS

Our findings suggest that noninvasive MRA is a promising substitute for catheter angiography to evaluate the renal arteries of live donors.