OBJECTIVE: Osteoporosis is a rapidly rising cause of concern for elderly patients. Various classes of drugs are available in the market. Bisphosphonates are considered as a first-line therapy for the prevention and treatment. Denosumab is an antiresorptive agent which is a RANK ligand inhibitor. There is a scarcity of comparison between these two classes of drugs. The aim of this study is to compare efficacy of Bisphosphonates and Denosumab in various parameters. MATERIALS AND METHODS: Literature search was done for randomized controlled trials (RCTs) comparing bisphosphonates with denosumab. RCTs with a treatment period of at least one year with a baseline bone mineral density (BMD) and bone turnover markers (BTM) and follow up values at one year were included in the study. All included studies were also analysed for complications. The study has also been registered in PROSPERO International prospective register of systematic reviews. RESULTS: A total of five RCTs were identified providing data on 3751 participants. In all five studies, the BMD changes at both hip and spine were statistically significant in favour of denosumab. Result was similar in three studies that studied BMD changes at the wrist. Denosumab also produced significant reduction in BTM as early as one month, but at one year there was no difference compared to the bisphosphonates. There was no statistically significant differences in the complication rates. CONCLUSION: Though both bisphosphonates and denosumab were effective with similar side effects, the latter was statistically superior in increasing the BMD and reducing the BTM.
Aged ; Bone Density ; Bone Remodeling ; Denosumab* ; Diphosphonates* ; Female ; Follow-Up Studies ; Hip ; Humans ; Osteoporosis ; Osteoporosis, Postmenopausal* ; Prospective Studies ; RANK Ligand ; Spine ; Wrist

Introduction: The link between Chlamydia trachomatis (C. trachomatis) and ectopic pregnancy is mainly based on early sero-epidemiological case-control studies. Recent studies have shown divergent results concerning the risk of ectopic pregnancy following C. trachomatis infection. There has been no study done in Brunei to establish a correlation between the two. The purpose of this study was to de- termine whether chlamydial infection was more prevalent in young women with ectopic pregnancy at- tending RIPAS Hospital, Brunei Darussalam. Materials and Methods: This was a prospective study. All ectopic pregnancies encountered in RIPAS Hospital (January 2010 to December 2011) were included in the study. For comparison, 100 normal pregnancy cases were included. Endocervical swabs were taken and analysed with rapid immunoassay using Clearview Chlamydia MF®. Results were analysed using Fisher's exact test on Graphpad software®. Results: During the study period, a total of 123 ec- topic pregnancies were encountered. Majority of patients with ectopic and normal pregnancies were in the 25-30 and 31-36 year age groups. There were no significant differences observed between the two group in the age groups (p=0.468 for trend) and their nationalities (p=0.572 for trend). Among pa- tients with ectopic pregnancies, 6.5% (n=8) tested positive for Chlamydia infections compared to 5% (n=5) of normal pregnancies (p>0.05). Conclusion: There was no statistically significant difference in the incidence of Chlamydial infections between ectopic and normal pregnancies in our study.

Intrauterine contraceptive device (IUCD) is one of the most widely used family planning methods. Although considered to be generally safe, it can be associated with problems such as missing IUCD. There have been many reports of isolated missing IUCD but reports of two missing IUCDs in the same patient are very rare. We report the case of a 35-year-old lady with such an occurrence that was diagnosed incidentally on a routine kidney, ureter and bladder (KUB) radiography.
Complications ; Contraception ; Intrauterine Device Migration