Bone Microstructure Changes due to Once-/Twice-Weekly Teriparatide Administration: A Report of Five Cases Using High-Resolution Peripheral Quantitative Computed Tomography

This study was conducted with the aim of presenting cases in which high-resolution peripheral quantitative computed tomography (HR-pQCT) was used to investigate changes in bone microstructure due to once-weekly/twice-weekly administration of teriparatide (TPTD). Of osteoporosis patients who participated in a non-inferiority trial (TWICE study: once-weekly vs twice-weekly TPTD) with lumbar bone mineral density (BMD) as the primary endpoint, five cases scanned by HR-pQCT before TPTD administration were analyzed. Two cases were given once-weekly TPTD, three were given twice-weekly TPD, and HR-pQCT was repeated after 48 weeks. A sufficient anabolic effect of once-weekly/twice-weekly TPTD on the trabecular and cortical bone at the tibia was obtained. In addition, the average change in cortical porosity (Ct.Po) was only 0.3% in the tibia and 0.2% in the radius. These findings indicate that once-weekly and twice-weekly TPTD can be expected to improve bone microstructure, and the increase in Ct.Po may be suppressed.

Prophylactic Heme Arginate Infusion for Acute Intermittent Porphyria

Objectives: This study aimed to evaluate the efficacy of long-term weekly prophylactic heme arginate (HA) infusions in reducing attack frequency and severity in female AIP patients.Methods: We report the results of five female AIP patients with frequent recurrent attacks (>9/year) before and after institution of weekly prophylaxis with heme arginate (3 mg/kg body weight). All five cases had confirmed disease-associated mutations in the porphobilinogen deaminase gene, and all had received genetic and clinical counseling about AIP.Results: In the five included patients, average annual attack rate (AAR) in the year prior to HA prophylaxis was 11.82 (range 9.03–17.06), and average total HA usage was 32.60 doses (range: 13.71–53.13). After 2.58–14.64 years of HA prophylaxis, average AAR was reduced to 2.23 (range 0.00–5.58), and attack severity (i.e., doses required per attack) was reduced from 2.81 to 1.39 doses/attack. Liver and renal function remained stable during weekly administration of HA prophylaxis. The most common complications were port-A catheter-related events. No other complications or safety concerns occurred with long-term use of HA prophylaxis.Conclusion: Our study demonstrated women with AIP receiving weekly prophylactic HA infusions resulted in fewer episodes that required acute HA treatment while maintaining stable renal and liver function. Weekly prophylactic HA infusions effectively prevent frequent porphyric attacks and reduce attack severity.

Variations in administration of Covid-19 vaccine during last 20 weeks at a vaccination center of Agra, Uttar Pradesh

Background: Covid-19 pandemic has created havoc around the world and vaccination is an effective tool against this demon. Study of variations in administration of daily doses of Covid-19 vaccine at vaccination centre can help in better resource management. Material & methods: This record based descriptive study was conducted among beneficiaries of Covid-19 vaccination at S. N. Medical College, Agra. Record of administration of daily doses and vaccine wastage, vaccination of different groups of beneficiaries and occurrence of various national and local events related to vaccination was also analyzed. Result: A total of 33,571 doses of any Covid-19 vaccine (Covaxin/Covishield) were administered during past 88 working days in 20 weeks expanded over 5 months. On an average 165 doses were administered every day by each team and overall vaccine wastage was 0.85%. Maximum average of 199 doses per day by each team was observed on Mondays. There are many peaks and drops in administration of daily doses of Covid-19 vaccine at our center which can be attributed to either some national or local events related to supply of vaccine at our center, addition of a new group of beneficiary, any news or political controversy related to Covid-19 vaccination etc. Conclusion: Understanding of spikes and drops in the curve of daily/weekly administration of Covid-19 vaccine, in view of occurrence of various national and local events related to vaccination, can help in better formulation of strategies specially related to human resource allocation for success of National Covid-19 vaccination program.

Alpha-1 antitrypsin deficiency: clarifying the role of the putative protective threshold

AATD is the only readily identifiable monogenic cause of COPD. To date the only condition-specific treatment for AATD-associated COPD is weekly administration of intravenous purified pooled human AAT (IV-AAT). Uncertainties regarding which AATD genotypes should benefit from IV-AAT persist. IV-AAT is costly and involves weekly administration of a plasma product. Much of the risk stratification has been centred around the long-accepted hypothesis of a “putative protective threshold” of 11 µM (0.57 g·L−1) in serum. This hypothesis has become central to the paradigm of AATD care, though its derivation and accuracy for defining risk of disease remain unclear.We review the literature and examine the association between the 11 µM threshold and clinical outcomes to provide context and insight into the issues surrounding this topic.We found no data which demonstrates an increased risk of COPD dependent on the 11 µM threshold. Moreover, an abundance of recent clinical data examining this threshold refutes the hypothesis. Conversely, the use of 11 µM as a treatment target in appropriate ZZ individuals is supported by clinical evidence, although more refined dosing regimens are being explored.Continued use of the 11 µM threshold as a determinant of clinical risk is questionable, perpetuates inappropriate AAT-augmentation practices, may drive increased healthcare expenditure and should not be used as an indicator for commencing treatment.Genotype represents a more proven indicator of risk, with ZZ and rare ZZ-equivalent genotypes independently associated with COPD. New and better risk assessment models are needed to provide individuals diagnosed with AATD with reliable risk estimation and optimised treatment goals.

Latter-Day Saint Liturgy: The Administration of the Body and Blood of Jesus

Latter-day Saint (“Mormon”) liturgy opens its participants to a world undefined by a stark border between the transcendent and immanent, with an emphasis on embodiment and relationality. The formal rites of the temple, and in particular that part of the rite called “the endowment”, act as a frame that erases the immanent–transcendent border. Within that frame, the more informal liturgy of the weekly administration of the blood and body of Christ, known as “the sacrament”, transforms otherwise mundane acts of living into acts of worship that sanctify life as a whole. I take a phenomenological approach, hoping that doing so will deepen interpretations that a more textually based approach might miss. Drawing on the works of Robert Orsi, Edward S. Casey, Paul Moyaert, and Nicola King, I argue that the Latter-day Saint sacrament is not merely a ritualized sign of Christ’s sacrifice. Instead, through the sacrament, Christ perdures with its participants in an act of communal memorialization by which church members incarnate the coming of the divine community of love and fellow suffering. Participants inhabit a hermeneutically transformed world as covenant children born again into the family of God.