Alterations In Calcium Metabolism Research Articles

Calcium – a possible element behind hypertension

Background. Hypertension is the one of the important reasons of mortality and morbidity worldwide which affects around 6% to 32% of the general population. It has been documented that the serum calcium level has the impact on cardiovascular functions. Patients with essential hypertension display altered calcium metabolism, including elevated cytosolic calcium, reduced serum calcium levels and augmented urine excretion of calcium. Therefore, this study was undertaken in the direction for evaluate the link of calcium in newly diagnosed hypertensive patients. Materials and methods. This cross-sectional study was conducted in isolated newly diagnosed essential Hypertensive subjects who came to the hypertensive OPD, who were free from any other illness or under any medication. 100 cases and 50 controls were included in this study. Body mass index, Blood pressure and serum calcium levels were evaluated in the enrolled subjects. Student's t test and chi-square test were used for statistical analysis. Results. The mean serum calcium in newly diagnosed hypertensive group was 8.35 ± 1.04 and in control group it was 10.04 ± 0.66. The mean corrected calcium in newly diagnosed hypertensive group was 8.40 ± 1.01 and in control group it was 9.87 ± 4.76. These results were highly statistically significant p=0.000. Negative correlation was found between serum calcium and blood pressure among our subjects. Conclusion. Patients with essential hypertension had lower corrected serum calcium levels, and there was a substantial inverse association (negative correlation) between corrected serum calcium levels and blood pressures. So, while treating patients with hypertension, more attention to be given for the serum calcium levels.

In utero, lactational, or peripartal fluoxetine administration has differential implications on the murine maternal skeleton.

The peripartal period is marked by alterations in calcium metabolism to accommodate for embryonic skeletal mineralization and support bone development of offspring in early life, and serotonin plays a critical role in modulating peripartal bone remodeling. Selective serotonin reuptake inhibitors (SSRIs) are commonly used as first-line treatment for psychiatric illness during pregnancy and the postpartum period and considered safe for maternal use during this time frame. In order to evaluate the effect of peripartal alterations of the serotonergic system on maternal skeletal physiology, we treated dams with the SSRI fluoxetine during gestation only, lactation only, or during the entire peripartal period. Overall, we found a low dose of fluoxetine during gestation only had minimal impacts on maternal bone at weaning, but there were implications on maternal skeleton at weaning when dams were exposed during lactation only or during the entire peripartal period. We found that these effects were differential between female mice dosed lactationally or peripartally, and there were also impacts on maternal mammary gland at weaning in both of these groups. Though SSRIs are largely considered safe maternally during the peripartal period, this study raises the question whether safety of SSRIs, specifically fluoxetine, during the peripartal period should be reevaluated.

Ozone therapy in clinical practice of the diabetic necrotizing foot.

The present paper is the most extensive approach of the effect of ozone therapy on the diabetic foot. Out of all the 45 cases that have been studied in the timeline 2020-2022, some of them who were incredibly severe with little hope for improvement, had a tremendous impact on me and I will try to describe them in a few words and raise your awareness about this not yet explored field that has real potential in aiding those who suffer. A female patient of 49 years old had diabetes mellitus, multiple necrotic lesions, post peritoneal dialysis with skin calcifications of both legs, chronic kidney disease, renal osteodystrophy, calciphylaxis with secondary cutaneous necrosis in remission, renal lithiasis, secondary arterial hypertension, ischemic cardiac disease, paroxistic atrial fibrillation, polycystic kidney disease, hyperuricemia, calcium metabolism alterations, hyperphosphatemia, moderate proteic malnutrition. The first ozone therapy session was done according to ozone therapy protocol for the diabetic foot, after debridement, disinfection of the wounds and disposal of the necrotizing tissue. Drainage from the wound was examined and revealed an E. coli infection. After 30 sessions, the result was spectacular. A 51-year-old patient presented to the clinic with an open wound after amputation of his left leg. A year after, he came back to the clinic with an infected wet gangrene of his right leg, who also caught the first 3 toes. His medical history included type II diabetes mellitus, end stage renal disease with a double kidney transplant until the age of 28. In both cases debridement of the wound was done, exposing healthy tissue, antibiotics were administered according to antibiogram and the entire procedure of ozone therapy was done as follows: washing the wound with oxygenated water, disinfection of the wound, local infiltrations with ozone, major autohemotherapy and ozonized bag. The result: the left leg had a rapid favorable outcome, and after only 20 ozone sessions, the wound closed. The right leg had a total of 45 ozone therapy sessions done, with a 100% improvement. After 5 months, the patient came to the clinic with a postblockage necrotizing fistula on his right second finger, which healed after 6 ozone therapy sessions. Among those 45 patients included in the study, 10 of those who had major amputations presented to the clinic for a primary intervention and only 2 of them for a reintervention. Nevertheless, most of the minor amputations were done as a primary intervention. In many cases though, to obtain the healing of the patients, reinterventions were necessary. Analyzing these data, the necessity of applying a new method of correctly assessing the severity of the lesions to avoid an undervaluation of it, which would unnecessarily prolong the hospitalization and more importantly their suffering. I have encountered 4 cases of extensive wet gangrene associated with severe sepsis. The mortality in this category of patients was 50%. Studies and research in this field have a special and decisive con tribution in treating and recognizing the effects of ozone therapy in curing the diabetic foot. Through their results, studies will allow the free circulation of information in this field, because if we don’t communicate efficiently, we will not be able to present publicly the results we obtained from the studies and research regarding ozone therapy. Free circulation of information, of innovating ideas – can and has to surpass all frontiers, to allow all specialists in this field to contribute in solving the major problem that is the diabetic foot, this ailment of mankind. The most spectacular effects of ozone therapy in the case of diabetics can only be seen in well informed patients, who come to the doctor with impressive ulcerations of the calf. The clinical specter of the diabetic foot is very large, from the simple presence of neuropathy and/or arteriopathy of the legs, without any existing characteristic lesions, to the necessity of an amputation; ozone therapy can cure without an amputation.

Early detection of the low dose of Lead exposure prevents mental disorders using non-invasive fluorescence and multi-omics

Lead poisoning is an epidemic that can affect anyone. Lead toxicity most commonly affects children and causes neurodevelopmental problems chronically. Lead is a heavy metal that alters calcium metabolism and deactivates enzymes essential in activating heme in the blood. Heme is an integral part of homeostasis and body defense in the shuttling of oxygen throughout the tissues, most notably the brain metabolism. The lack of oxygen throughout the brain slows down brain development (e.g., Neuronal cell migration, polarization, neuronal cell differentiation) and leads to lower IQs, learning disabilities, and lifelong ailments. The most common form of lead exposure comes from lead-based paint, toys, cosmetic materials, other household materials, various environments, and occupational pollutants. The current biomarkers used for lead toxicity successfully detect current lead levels in the blood but are not excellent at determining duration. Bone-Pb allows for the detection of lead toxicity duration, but it is not widely accepted throughout the United States. Significant limitations exist because all biomarkers test for lead poisoning after it has already happened which makes it challenging to prevent lead exposure in a clinical setting. Prevention needs to happen at the governmental and, more importantly at the individual levels. The focus of this study is on lead toxicity and prevention followed by reducing risk and improvement of detection utilized tools-driven molecular-based assessment along with visual imaging technique. It examines how lead finds its way into the human body for storage or metabolomic by-products. Identifying the risks of exposure would inform the mechanisms that can be employed to prevent further exposure and toxicity in other organs or intervene with metabolism or biotransformation. It predicts the potential counteract mechanisms through which lead affects the health of pregnant mothers, or interaction between prenatal, or the unborn, and post-natal status, different stages of developmental, and post-menopausal women. The study outlines the various ways of detecting the presence of low levels of lead in the blood and bones using non-invasive fluorescence combined with multidimensional omics such as metabolomic and proteomic by which early detection of organ dysfunction can be used to monitor Ca2+ metabolism in the cell or tissue/organ level before the onset of disease

Myosin Heavy Chain Converter Domain Mutations Drive Early-Stage Changes in Extracellular Matrix Dynamics in Hypertrophic Cardiomyopathy.

More than 60% of hypertrophic cardiomyopathy (HCM)-causing mutations are found in the gene loci encoding cardiac myosin-associated proteins including myosin heavy chain (MHC) and myosin binding protein C (MyBP-C). Moreover, patients with more than one independent HCM mutation may be at increased risk for more severe disease expression and adverse outcomes. However detailed mechanistic understanding, especially at early stages of disease progression, is limited. To identify early-stage HCM triggers, we generated single (MYH7 c.2167C > T [R723C] with a known pathogenic significance in the MHC converter domain) and double (MYH7 c.2167C > T [R723C]; MYH6 c.2173C > T [R725C] with unknown significance) myosin gene mutations in human induced pluripotent stem cells (hiPSCs) using a base-editing strategy. Cardiomyocytes (CMs) derived from hiPSCs with either single or double mutation exhibited phenotypic characteristics consistent with later-stage HCM including hypertrophy, multinucleation, altered calcium handling, metabolism, and arrhythmia. We then probed mutant CMs at time points prior to the detection of known HCM characteristics. We found MYH7/MYH6 dual mutation dysregulated extracellular matrix (ECM) remodeling, altered integrin expression, and interrupted cell-ECM adhesion by limiting the formation of focal adhesions. These results point to a new phenotypic feature of early-stage HCM and reveal novel therapeutic avenues aimed to delay or prohibit disease onset.

Increasing serotonin concentrations alter calcium metabolism in periparturient dairy goats.

Due to the large amounts of calcium transferred to milk from mammary glands, periparturient dairy goats face challenges with calcium metabolism disorder and hypocalcemia. Serotonin (5-hydroxytryptamine, 5-HT), the product of 5-hydroxy-l-tryptophan (5-HTP) catalyzed by tryptophan hydroxylase 1, is a multifunctional monoamine thought to be a homeostatic regulator of the animal. The objective of the current study was to investigate the effects and underlying mechanisms of intramuscular 5-HTP injections on calcium homeostasis in the goat mammary glands. In the in vivo experiment, 30 multiparous Guanzhong dairy goats were randomly assigned to 2 groups, one group was injected with 5-HTP intramuscularly and the other group was injected with normal saline. From the first 10 d of the expected date for delivery, 5-HTP or saline was injected into goats through the shoulder muscle every morning before feeding, with a dose of 1mg/kg per body weight. In the in vitro experiment, goat mammary epithelial cells (GMEC) were treated with 100 μM 5-HT for the evaluation of 5-HT in calcium transportation. The results demonstrated that 5-HTP treatment had no effect on the basic composition of colostrum (P > 0.05) but increased the serum 5-HT concentrations on days -5, -4, -3, and 5 relative to parturition (P < 0.05). The 5-HTP injection group had greater serum calcium concentration on day 4 and greater serum parathyroid hormone-related protein (PTHrP) on days -5, -4, -1, 3, 4, and 5 compared with the saline injection group (P < 0.05). It was further confirmed that 5-HT could increase intracellular calcium levels by increasing PTHrP and decreasing plasma membrane Ca2+-ATPases1 (PMCA1) in GMEC (P < 0.05). In conclusion, 5-HTP treatment in multiparous goats during the transition period from pregnancy to lactation is a feasible way to protect goats from calcium metabolism disorder.

Research Progress of Prion Characteristics and Pathogenesis

Prions are infectious proteins that cause disease in variable species of animals, including human being. The normal, cellular protein PrP (PrPC) is converted into PrPSc through a post translational process during which it acquires a high β-sheet content which made the protein resistant to degradation by proteinase K due to its PrP 27-30 domain that increase its half-life to &gt;48 hours as compared to that of the normal 3-6 hours, its stay leads to self-propagation and toxicity. The disease pathology is associated with many disturbances mainly in central nervous system which resulted from increased oxidative stress and mitochondrial dysfunction, disturbance of iron metabolism, alteration of calcium metabolism, increases of inflammatory cytokines, chemokine’s and nuclear factor-kappa β activity. The entire process creates a spongy hole inside the nervous system which leads to condition called encephalopathy. The agent cause scrapie in sheep and goats, bovine spongiform encephalopathy (BSE) in cattle (known as mad cow disease), transmissible mink encephalopathy (TME) in mink, chronic wasting disease (CWD) in white tailed deer, elk, mule deer and moose, feline spongiform encephalopathy in cats, exotic ungulate encephalopathy (EUE) in Nyala and Oryx. In humans it causes Creutzfeldt-Jakob disease (CJD) and its varieties, Gerstmann-Sträussler-Scheinker syndrome (GSS), fatal familial insomnia (sFI) and Kuru. Prion diseases have zoonotic and interspecies transmission. Banning Meat bone meal and culling infected animals are recommended.

Concentration of essential chemical elements in whole blood and in paranasal sinuses mucosa is related to chronic rhinosinusitis severity in children

Objectives to evaluate the association between essential chemical element levels in whole blood and in pathologic mucosa and chronic rhinosinusitis severity in children.&#x0D; Material and methods. A total of 154 children aged from 6 to 17 years were examined. Among them, 88 children had chronic rhinosinusitis (CRS) and underwent functional endoscopic sinus surgery (FESS). The 66 healthy children were included in the control group. Life quality was assessed using SNOT-20 (Sino-Nasal Outcome Test-20). Endoscopic and computer tomography findings were evaluated using Lund Kennedy and Lund Mackay scales, respectively. The assessment of essential element levels in whole blood samples was performed using inductively-coupled plasma mass-spectrometry.&#x0D; Results. The obtained data demonstrate that total SNOT-20 scores in CRS patients were 68% higher than in controls. At the same time, whole blood calcium, selenium, zinc, and magnesium levels were 6%, 28%, 20%, and 3% lower than the respective control values. The analysis of pathologic mucosa demonstrated that the chemical element contents were reducing in the following order: Ca Mg = Fe Zn Cu Mn Se. However, only whole blood selenium level correlated significantly with its tissue level. In multiple regression models, the whole blood Se level was inversely associated with SNOT-20 and Lund Mackay total scores.&#x0D; Conclusion. Therefore, the obtained data allow to propose the potential role of altered calcium, magnesium, zinc and selenium metabolism in CRS progression.

“COMPARATIVE STUDY OF CALCIUM LEVEL IN PREECLEMPTIC AND NORMAL PREGNANT TRIBAL & NON-TRIBAL WOMEN IN JHARKHAND”

Introduction- Pregnancy is a physiological stress in which many biochemical changes changes occur in the body. Preeclampsia, the complication of pregnancy, refers to a syndrome of new onset of hypertension proteinurea after 20 weeks of gestation in previously normotensive women, is due to rise in blood pressure,which is related with calcium change in blood. Recent study, implicated alterations in calcium metabolism in the pathogenesis of hypertension in pregnancy. Serum calcium level of 75 Material &amp; Methodnd rd normal pregnant and 75 preeclemptic Tribal &amp; non-tribal women at 2 &amp; 3 trimesters were estimated by using Arsenazo 3 method, one of the most standard method used for estimation of serum calcium based on colorimetric principle and compared.Observation &amp; Result- The Mean serum calcium level in cases of normal pregnant women in Jharkhand 9.65±0.58mg/dl while mean total serum calcium level of pre-eclamptic was 6.97mg/dl is lesser in comparison to normal pregnancy. There is signicant Conclusion- decrease in total serum calcium level in preeclemptic as compare to normal pregnant women in Jharkhand.

The influence of habitual salt intake on bone remodelling in young healthy people

Introduction: Sodium alters calcium metabolism by increasing calcium excretion, thus possibly influencing bone metabolism. The hypothesis of the present study is that amount of dietary sodium intake affects the bone remodelling. This study aimed to assess whether a habitual intake of sodium has an effect on peak bone mass and biochemical indicators of bone metabolism.&#x0D; Subjects and Methods: In a cross-sectional study that involved 41 young men and women, six biochemical markers were assessed from blood samples using ELISA: osteocalcin, C-terminal procollagen type I peptide, receptor activator kappa B ligand, pyridinoline, parathyroid hormone, and osteoprotegerin, while bone mineral density (BMD) and bone mineral content (BMC) were measured by dual x-ray absorptiometry. Subjects were divided into two groups according to habitual sodium intake (low-Na and high-Na group) assessed by questionnaire.&#x0D; Results: No difference was found between groups of low and high Na intake in BMD and BMC, or in biochemical markers of bone metabolism. Since the groups differed in Ca intake, energy and vitamin D, adjustments were made for those cofounders. Regression analysis showed that only the dietary intake of vitamin D was associated with dual femur BMD and BMC, and no correlation was found between bone remodelling indicators and Na intake after adjustment for vitamin D intake.&#x0D; Conclusion: The present results could not confirm that habitual sodium intake above recommended levels affects bone remodelling processes or decreases bone mineral density in young healthy people if combined with adequate calcium intake.

Francisella noatunensis subsp. noatunensis triggers calcium metabolism gene modulation in Eleginops maclovinus

Francisella noatunensis subsp. noatunensis is the responsible agent of Francisellosis, a bacterial disease that affects an important amount of aquatic farmed species. Eleginops maclovinus is a fish that cohabits with salmonids cages in Chile and can also act as a vector of this bacterial disease. In the present study, we evaluated calcium metabolism in the liver of E. maclovinus injected intraperitoneally with different doses of F. noatunensis subsp. noatunensis (low 1.5 × 101, medium 1.5 × 105 and high doses 1.5 × 1010 cells/μL). Fish were sampled at 1, 3, 7, 14, 21 and 28 days post injection (dpi). No mortalities nor clinical signs were observed. Plasma calcium levels were higher in the high doses group of F. noatunensis subsp. noatunensis at day 7 and 14 compared to the control group (fish injected with bacterial medium alone). Hypercalcemic factors increased at day 14 and 21 for the medium and low dose (parathyroid hormone-related protein precursor), while vitamin D3 receptor increased its expression at times 1, 3 and 7 for the low dose. On the other hand, hypocalcemic factors such as calcitonin receptor and stanniocalcin increased its expression at time 7 and 14, respectively. Calmodulin involved in calcium storage decreased its expression during all experimental days in fish subjected to high bacterial dose. Proteins involved in calcium transport, such as L-type voltage-gated calcium channel and trpv5 increased their transcription at day 1 and 14, compared to calcium sensing-receptor and plasma membrane Ca2 +- ATPase that showed peak expression at times 14 and 28. The results suggest a clear alteration of calcium metabolism, mainly in high bacterial doses. This study provides new knowledge about the calcium metabolism in fish infected with bacteria.

Balancing Altered Calcium Metabolism with Bone Health in Sarcoidosis.

Abnormal calcium metabolism in sarcoidosis patients can lead to hypercalcemia, hypercalciuria, and kidney stones. Hypercalcemia in sarcoidosis is usually due to increased activity of 1α-hydroxylase in macrophages of pulmonary granulomata, resulting in low levels of 25-hydroxyvitamin D and high levels of calcitriol. Vitamin D supplementation may be dangerous for some sarcoidosis patients and is recommended only for those with decreased 25-hydroxyvitamin D and reduced or normal calcitriol level. Diagnosis, treatment of osteoporosis, and maintenance of bone health are complex issues for sarcoidosis patients. An approach to diagnosis and treatment of bone fragility is presented.

The Effect of Extracellular Calcium Metabolism on Aldosterone Biosynthesis in Physiological and Pathological Status.

Primary aldosteronism (PA) was reported to frequently harbor not only cardiovascular diseases but also some metabolic disorders including secondary calcium metabolic diseases. Recently, the potential association between aldosterone producing cells and systemic calcium metabolism has been proposed. For instance, PA is frequently associated with hypercalciuria or hypocalcemia, which subsequently stimulates parathyroid hormone (PTH) secretion. This altered calcium metabolism in PA patients could frequently result in secondary osteoporosis and fracture in some patients. On the other hand, extracellular calcium itself directly acts on adrenal cortex and has been also proposed as an independent regulator of aldosterone biosynthesis in human adrenals. However, it is also true that both PTH and vitamin D pathways stimulate endocrine functions of adrenal cortical adenomas to co-secret both aldosterone and cortisol. Therefore, it has become pivotal to explore the potential crosstalk between aldosterone and systemic calcium metabolism. We herein reviewed recent advances in these fields.

MON-001 Peripartum Sertraline (Zoloft®) Increases Pup Mortality Immediately Postpartum

Peripartum and postpartum depression can be detrimental to both the mother and the developing child. Use of antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), is common during the peripartal period and SSRIs have been the leading prescribed antidepressant to treat maternal depression. One of the most commonly prescribed SSRIs is sertraline (Zoloft®) because of the limited fetal teratogenic effects observed, unlike maternal paroxetine (Paxil®) usage which can manifest in fetal cardiovascular defects. Fluoxetine (Prozac®), like sertraline, has previously been shown to have limited teratogenic effects, however, we have shown treatment with fluoxetine for the entire period of pregnancy and lactation in mice compromises pup bones at weaning resulting in decreased long bone length and head circumference. Furthermore, maternal fluoxetine usage results in a sustained reduction in maternal bone mineral density post weaning, which may lead to long-term osteopenia, putting the mother at risk for bone-related disorders later in life. We hypothesized sertraline, like fluoxetine, will compromise maternal bone postpartum and fetal bone development at weaning. Treatment with sertraline in C57BL/6 dams throughout pregnancy and lactation reduced litter size (5.4 pups/dam) and increased pup mortality during the first 24 hours postpartum (20% dead pups/litter) compared to controls (6.8 pups/dam, 5% dead pups/litter, respectively; P < 0.018). Maternal calcium transporters (Orai1 and Serca2) were downregulated in the mammary gland in sertraline-treated dams on day 21 of lactation (P < 0.0032). Together, our data suggests in utero pharmacological exposure to sertraline may induce a failure to thrive in the pups and alters calcium metabolism in the dam. SSRI exposure during pregnancy and lactation may adversely affect the developing neonate(s) as well as have lasting impacts on the mother.

The Role of Urinary Calcium and Chitotriosidase in a Cohort of Chronic Sarcoidosis Patients

Background: Calcium metabolism alterations are quite common in sarcoidosis and have been correlated with disease activity. Objectives: The aim of the study was to investigate the clinical significance of calcium metabolism alterations in patients with chronic sarcoidosis. We paid particular attention to associations with specific disease phenotypes and chitotriosidase (CTO) expression. Methods: 212 chronic sarcoidosis patients (mean age 56.07 ± 12 years; 97 males) were retrospectively recruited. Demographic, clinical, functional, and radiological data, and serum-urinary calcium metabolism were entered into an electronical database for analysis. Levels of CTO and angiotensin-converting enzyme (ACE) were measured and bone mineral density and lung function tests were conducted. Results: Hypercalciuria and hypercalcemia were observed in 18.8 and 1.8% of patients, respectively. Urinary calcium levels correlated with CTO activity (r = 0.33, p = 0.0042). Patients with worsening persistent disease showed the highest levels of urinary calcium. Diffusing capacity of the lung for carbon monoxide (D_LCO) percentage correlated inversely with urinary calcium (r = 0.1482; p = 0.0397). Conclusions: Calcium metabolism alteration, particularly hypercalciuria, was observed in a significant percentage of patients of sarcoidosis. Urinary calcium was correlated with clinical status, D_LCO, and serum CTO activity, suggesting its potential role as a biomarker of the activity and severity of sarcoidosis.

An elderly lady with multiple blisters all over the body: Hailey Hailey Disease

Hailey-Hailey disease (HHD) is an autosomal-dominant genodermatosis, associated with abnormal epithelial cell adhesion due to altered calcium metabolism. Clinical features involve painful red blisters, erosions, fissured and hypertrophic plaques predominantly in the intertriginous areas. Heat, friction, minor trauma, superimposed bacterial or viral infection can aggravate the condition. Here, we report a case of a 50-year old lady with no previous family history presented with severe attack of HHD since last 5 months. Histology showed acantholysis of keratinocytes resembling characteristic dilapidated brick wall appearance in the epidermis layer of skin which helped for the confirmed diagnosis.&#x0D; Bangladesh J Medicine Jan 2020; 31(1) : 29-32

Trousseau’s sign in orthopedic: a rare sequelae of inadequate postoperative pain management

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pain management in orthopedic is very crucial matter to handle, which is many a times not managed properly and that leads to various medical complications to the patients. Trousseau sign of latent tetany is a medical sign observed in patients with low calcium. This is the first and one of a kind case series describing the development and pathogenesis of Trousseau sign in orthopedics.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a case series of 5 patients with lower limb fractures who underwent surgery. All these patients developed Trousseau's sign in immediate postoperative period. All the patients were investigated and were diagnosed with respiratory alkalosis. They were managed with closed bag ventilation which relieved the symptoms.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Here we put forward a direct physiological and psychological relation between a low pain threshold and associated hyperventilation with lead to development of Trousseau's sign in our patients. So, next time in postoperative round, if we see patient hyperventilating and complaining about fixed hand’s position, do not start calcium gluconate drip immediately, it may be due to respiratory alkalosis, then closed bag ventilation would be suffice.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Trousseau’s sign seen postoperatively in Orthopedics may be commonly due to inadequate pain management rather than altered calcium metabolism.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Correlations between plasma strontium concentration, components of calcium and phosphate metabolism and renal function in type 2 diabetes mellitus

Renal function decline in diabetic kidney disease is accompanied by calcium and phosphate metabolism alterations. Whereas strontium (Sr2+ ) has many similarities with calcium, little is known about Sr2+ in this respect. We studied the association of plasma Sr2+ concentration and parameters associated with an altered calcium and phosphate metabolism in diabetic kidney disease. Plasma Sr2+ concentration was measured in 450 patients included in the DIAbetes and LifEstyle Cohort Twente-1. Patients were classifiedbased on chronic kidney disease (CKD) stages: stages 1-2, stage 3 and stages 4-5 (estimated glomerular filtration rate of ≥60mL·min-1 ·1.73m-2 , 30-59mL·min-1 ·1.73m-2 and ≤29mL·min-1 ·1.73m-2 , respectively). The associations between log-transformed plasma Sr2+ concentration and parameters of calcium and phosphate metabolism were studied using multivariate linear regression analysis. Overall, median plasma Sr2+ concentration was in normal range, 269nmol/L, but was progressively higher in patients with lower renal function, that is 246nmol/L (CKD 1-2), 347nmol/L (CKD 3) and 419nmol/L (CKD 4-5). In multivariate analysis, independent associations were found between plasma Sr2+ concentration and both eGFR (β=-0.401, P<0.001) and plasma fibroblast growth factor 23 (FGF23) concentration (β=0.087, P=0.04). We found an independent inverse association between eGFR and plasma Sr2+ concentration and an independent association between plasma Sr2+ concentration and plasma FGF23 concentration, a marker of deranged calcium and phosphate metabolism. Further research is needed to determine the mechanisms behind these associations and the impact of an elevation in plasma Sr2+ concentration on bone mineralization and calcification.

Fluoride induced tissue hypercalcemia, IL-17 mediated inflammation and apoptosis lead to cardiomyopathy: Ultrastructural and biochemical findings

An increased prevalence of cardiac complications has been observed in residents of fluorosis endemic areas chronically exposed to fluoride. Fluoride induces soft tissue injury due to oxidative stress, lipid peroxidation (LPO) and mitochondriopathy. It was hypothesized that chronic fluoride exposure induces apoptosis in cardiomyocytes due to inflammation, lysis of extra cellular matrix and altered calcium metabolism. This study was planned to evaluate the effects of chronic fluoride exposure and the mechanism of action in the cardiac muscle. Fifteen week old male Wistar rats were administered a human equivalent dose of fluoride (50 and 100 ppm ad-libitum, HED = 5 & 10 ppm in human) for 75-days. After 75-days of fluoride exposure, the animals were euthanized and fluoride, oxidative stress (SOD, GPX, Catalase activities) and LPO were measured. Histopathological and ultrastructural pathological examinations were conducted on the cardiac tissues using light, atomic force and electron microscopies. The cardiac tissues were also assessed for apoptosis (TUNEL/Caspase assays), and tissue calcium levels (Alizarin-assay and SEM-EDX). Tissue inflammation and expression of IL-17, MMP-9, Caspase-3 and Bcl-2 were evaluated. In the fluoride exposed groups, a significant (≤0.05) increase in levels of oxidative stress, LPO and apoptosis were observed. The IL-17, MMP-9 and Caspase-3 were significantly (≤0.05) higher in the cardiac muscle after chronic fluoride exposure. The fluoride seems to have induced inflammation in the cardiac tissues, as well as an increase in tissue calcium (≤0.05). There was significant damage to cardiac muscle fibres including, thinning, distortion and neo-vasculogenesis following chronic fluoride exposure. Mitochondriopathy, lysis of ground substance, oedema, and hyper-vacuolation was seen in fluoride treated groups. Remarkable levels of distortion and bending in Z band were observed under the AFM. Many of these observed changes mimic those occurring in cardiomegaly, cardiac hypertrophy and cardiomyopathies.

Diagnostic features of pancreatitis in chronic kidney disease in children

Chronic kidney disease is one of the causes that deter­mine acute, recurrent or chronic pancreatitis, in varying degrees, both in adults and children, through the mul­ti­tude of etiological factors involved, such as: systemic vas­cu­lar disease, medications administered, substances used for dialysis, alteration of calcium metabolism, hyper­li­pae­mia. This association of factors contributes to in­creased morbidity and mortality in patients already suf­fering from a chronic disease. The diagnosis of acute pan­creatitis in patients with chronic kidney disease is al­tered by the following causes: loss of renal function, al­te­ration of pancreatic enzyme levels, uremia.