Changes In Serum Calcium Levels Research Articles

A novel minimally invasive endoscopic approach of thyroid surgery-endoscopic thyroidectomy via sternocleidomastoid muscle posteroinferior approach.

Since the endoscopic thyroidectomy was firstly reported by Hüscher in 1997, there has been an ongoing debate regarding whether mainstream endoscopic thyroidectomy can be classified as minimally invasive surgery. In this study, we innovatively proposed the endoscopic thyroidectomy via sternocleidomastoid muscle posteroinferior approach (ETSPIA), a novel minimally invasive surgical technique, and compared its efficacy with the well-established transoral endoscopic thyroidectomy vestibular approach (TOETVA). We retrospectively analyzed 50 patients who underwent ETSPIA and 50 patients who underwent TOETVA at Beijing Tongren Hospital, comparing their clinical characteristics, operative duration, blood loss, postoperative alterations in parathyroid hormone (PTH) and serum calcium, recovery post-surgery, complications, and follow-up data. The ETSPIA group had a shorter operation time compared to the TOETVA group (243.40±58.67 vs. 278.08±78.50 min; P=0.01). The ETSPIA group also had less intraoperative blood loss than the TOETVA group (20.60±10.58 vs. 33.00±11.11 mL; P<0.001). More central lymph nodes were dissected in the ETSPIA group compared to the TOETVA group (5.90±4.72 vs. 3.36±2.80; P=0.002). However, the difference in the number of positive central lymph nodes dissected was not statistically significant (1.38±2.33 for ETSPIA vs. 0.94±1.39 for TOETVA; P=0.26). The ETSPIA group had a shorter length of stay (LOS) compared to the TOETVA group (6.82±2.02 vs. 8.26±2.72 days; P=0.003). The alteration in PTH levels 1 day after surgery was less pronounced in the ETSPIA group compared to the TOETVA group (-26.38%±18.43% vs. -35.75%±22.95%; P=0.04). At the 1-month postoperative mark, the ETSPIA group showed a marginal increase in PTH levels, whereas the TOETVA group exhibited a slight decrease (10.12%±35.43% vs. -11.53%±29.51%; P=0.03). Regarding the average percentage change in serum calcium level 1 day after surgery, the ETSPIA group showed a smaller change, though this difference was not statistically significant (-4.79%±5.47% vs. -5.66%±3.90%; P=0.40). Furthermore, the incidence of hoarseness attributable to transient recurrent laryngeal nerve (RLN) injury in postoperative patients was lower in the ETSPIA group compared to the TOETVA group, but this difference did not reach statistical significance (0% vs. 4%; P=0.15). Overall, compared to TOETVA, the ETSPIA is characterized by a shorter operative route, enhanced protection of the parathyroid glands, reduced trauma, and expedited postoperative recovery.

Acute Serum Calcium Level Changes Following Non-Massive Blood and Blood Product Transfusion in Emergency Department; a Cross-sectional Study.

The specific impact on calcium dynamics after non-massive blood transfusions remains relatively unexplored. This study aimed to compare pre- and post-transfusion calcium levels in patients receiving blood and blood product in the emergency department. This is a single-center, prospective, cross-sectional study conducted at the Emergency Department of Gazi University Health Research and Application Center Hospital in Ankara, Turkey, from January 1, 2020, to August 31, 2020. The study included adult patients who underwent blood and blood product transfusions, and serum calcium levels were measured and compared from samples taken before and after transfusion. A total of 292 participants were enrolled in the study, with 242 participants included in the final analysis. The mean total calcium level was 8.41 ± 0.76 mg/dL before transfusion and 8.34 ± 0.71 mg/dL after transfusion (p=0.012). When examining the corrected calcium values after receiving blood products based on the type of blood products, participants who received apheresis platelets had a post-transfusion corrected calcium value of 8.26 ±0.41 mg/dL, with a pre-transfusion value of 9.09 ±0.49 mg/dL (p<0.01). The post-transfusion ionized calcium value for participants receiving apheresis was 1.04 ±0.08 mg/dL, compared to 1.15 ±0.09 mg/dL for those who did not receive apheresis (p=0.049). There was a significant relationship between receiving fresh frozen plasma and post-transfusion ionized calcium values (p=0.024). This study demonstrated that transfusion-associated hypocalcemia can occur even at mild levels in patients receiving blood and blood product transfusions in the emergency department. However, it is suggested that the clinical effects of hypocalcemia, even when occurring based on the type and quantity of blood products, are minimal and negligible.

Growth pattern in children with X-linked hypophosphatemia treated with burosumab and growth hormone

BackgroundX-linked hypophosphatemia (XLH) is characterized by increased serum concentrations of fibroblast growth factor 23 (FGF23), hypophosphatemia and insufficient endogenous synthesis of calcitriol. Beside rickets, odonto- and osteomalacia, disproportionate short stature is seen in most affected individuals. Vitamin D analogs and phosphate supplements, i.e., conventional therapy, can improve growth especially when started early in life. Recombinant human growth hormone (rhGH) therapy in XLH children with short stature has positive effects, although few reports are available. Newly available treatment (burosumab) targeting increased FGF23 signaling leads to minimal improvement of growth in XLH children. So far, we lack data on the growth of XLH children treated with concomitant rhGH and burosumab therapies.ResultsThirty-six patients received burosumab for at least 1 year after switching from conventional therapy. Of these, 23 received burosumab alone, while the others continued rhGH therapy after switching to burosumab. Children treated with burosumab alone showed a minimal change in height SDS after 1 year (mean ± SD 0.0 ± 0.3 prepubertal vs. 0.1 ± 0.3 pubertal participants). In contrast, rhGH clearly improved height during the first year of treatment before initiating burosumab (mean ± SD of height gain 1.0 ± 0.4); patients continued to gain height during the year of combined burosumab and rhGH therapies (mean ± SD height gain 0.2 ± 0.1). As expected, phosphate serum levels normalized upon burosumab therapy. No change in serum calcium levels, urinary calcium excretion, or 25-OHD levels was seen, though 1,25-(OH)2D increased dramatically under burosumab therapy.ConclusionTo our knowledge, this is the first study on growth under concomitant rhGH and burosumab treatments. We did not observe any safety issue in this cohort of patients which is one of the largest in Europe. Our data suggest that continuing treatment with rhGH after switching from conventional therapy to burosumab, if the height prognosis is compromised, might be beneficial for the final height.

Study of Changes in Serum Calcium Level during Postmenopausal Period of Women in Bangladesh

Introduction: The study was designed to evaluate the serum calcium levels may be altered in postmenopausal women. Materials and Methods: This case control study was carried out in the Department of the Biochemistry, Mymensingh Medical College, Mymensingh, from January 2015 to December 2015. The subjects were selected on the basis of inclusion and exclusion criteria by purposive (non-random) method. This study included 50 postmenopausal women as case. Results: The results were compared with 50 apparently healthy premenopausal women as control. All statistical analysis was done by SPSS windows package. The values were expressed as Mean ± SD. Statistical significance of difference between two groups were evaluated by using student’s unpaired t-test. Serum calcium level was analyzed. Serum calcium was determined by using colorimetric method. The mean value of serum calcium was 8.59±1.02 (mg/dl) respectively in group B (Case) and 6.36 ± 1.06 (mg/dl ) in group A(Control). The levels of serum calcium was significantly decreased in group B. Conclusion: Menopause has an effect on serum calcium which leads to increased risk of development of osteoporosis. The present study may facilitated the clinicians and gynecologists to update their knowledge in regard to serum calcium level of women associated with menopause. Medicine Today 2022 Vol.34(2): 150-152

Levels of Wistar Calcium Serum (Rattus Norvegicus) in Human Adipose-Derived Mesenchymal Stem Cells (hADMSCs) and Chitosan Scaffold by Osteoinduction Examination

Bone tissue reconstruction with extensive damage is one of the challenges for dentists because its healing process of bone tissue. Bone graft is the gold standard for bone repair. However, the use of bone graft has a limited amount of tissue produced. Tissue engineering is the latest method in terms of bone regeneration. Tissue engineering has three main components, first is stem cells that have self renewal ability and multineage differentiation, second is bioreactor / growth factor, and then scaffold. The combination of hADMSC and chitosan scaffold, is expected to trigger osteoinduction shown by osteogenic markers such as calcium levels. Purpose to prove osteoinduction in a combination of Human Adiposed Derived Mesenchymal Stem Cell (hADMSC) and chitosan scaffold using blood serum calcium levels. Methods: This study uses 12 treatment groups with each group having 4 samples. Groups 1 to 4 were the negative control group at 1st,3rd,7th, and 14th days which maxillary bone drilling only. While groups 5 to 8 were the positive control group at 1st,3rd,7th, and 14th days which were given chitosan scaffold. Groups 9 to 12 were treatment group at 1st,3rd,7th, and 14th days which were given hADMSC and chitosan scaffold. Blood collection is carried out in each group to check serum calcium levels. Result there were differences in calcium levels in blood serum in each group. Conclusion the application of hADMSC and chitosan scaffold caused a significant change in serum calcium levels on the 1st, 3rd, 7th and 14th days which meant that the combination of hADMSC and chitosan scaffold could trigger osteoinduction.

“A STUDY OF SERUM TOTAL CALCIUM AND SERUM CALCIUM TO PHOSPHORUS RATIO IN ESSENTIAL HYPERTENSION”

Hypertension is an increasingly important medical and public health burden globally. Worldwide, hypertension is estimated to cause 7.7million deaths, which is about 12- 15% of all total deaths. In recent years a various models of calcium metabolism involving cellular calcium level, membrane binding transport, altered permeability and transport kinetics have been described in individuals with hypertension and in animal models as well. The objective for identifying variations in levels of calcium and phosphorus in hypertensive patients helps to address and reduce risk of Cerebrovascular disease, Coronary artery disease, Chronic kidney disease and Peripheral vascular diseases and thereby morbidity and mortality worldwide. In this study, we attempt to review the evidence that calcium metabolism, thereby change in serum calcium levels that are implicated in primary hypertension in patients visiting medicine OPD and admitted under Department of Internal medicine in Mahatma Gandhi Memorial Hospital, Warangal.

Phototherapy Induced Hypocalcaemia in Neonates with Jaundice

Introduction: Neonatal hyperbilirubinemia is seen mainly in the first week of life and in many of the cases it is only in physiological range which requires no intervention. Approximately 5-10% of them have clinically significant jaundice that requires phototherapy and even exchange transfusion. Phototherapy can produce various adverse effects; hypocalcaemia is one of the lesser known effects. So, estimation of calcium levels before and after phototherapy should be done in neonates with jaundice. Aims: The aim of this study is to determine hypocalcaemia, in neonates receiving phototherapy, by measuring serum calcium levels. Methods: This cross sectional study was conducted, from February 2020 to August 2020, on 50 neonates admitted in Neonatal Intensive Care Unit of Nepalgunj Medical College, Kohalpur with unconjugated hyperbilirubinemia requiring phototherapy. Serum calcium levels were evaluated before and after phototherapy. Neonates were assessed for clinical features of hypocalcaemia i.e. jitteriness, irritability/ excitability and convulsions. Data were analyzed using SPSS version 25.P value &lt;0.05 was taken as significant. Results: Frequency of hypocalcaemia after phototherapy was 26%. There was significant change in serum calcium levels before and after phototherapy (p&lt;0.01). Among hypocalcaemic neonates, 56% were symptomatic; 38% developed jitteriness, 18% developed irritability / excitability and none of them developed convulsions. Conclusion: Neonates undergoing phototherapy are at increased risk for hypocalcaemia. Monitoring for hypocalcaemia and its complications should be considered. However, universal recommendation of calcium supplementation is yet to be established but seems reasonable.

Microcystin-LR Affects Ultimobranchial Gland of Catfish Heteropneustes fossilis

Microcystin-LR (2.5 µg/25 g) was injected intraperitoneally to the fish Heteropneustes fossilis on day 1, 10 and 20 kept in either freshwater or freshwater containing ZnCl2. The fishes were killed on day 5, 10, 20 and 30 day. The serum calcium levels was estimated and ultimobranchial glands were processed for routine histology. Microcystin-LR administration to fish Heteropneustes fossilis induced hypocalcemia and ultimobranchial gland exhibit decreased nuclear volume of the ultimobranchial cells. Degenerative ultimobranchial gland cells were obtained after day 20. While the fish injected with MC-LR kept in ZnCl2 has shown no change in serum calcium levels as well as in histology of ultimobranchial gland cells.

Intradialytic Calcium Kinetics and Cardiovascular Disease in Chronic Hemodialysis Patients

Background/Objective: Calcium loading has been associated with cardiovascular risk in hemodialysis (HD) patients. However, it remains to be elucidated whether alterations of intradialytic calcium buffering add to the increased cardiovascular disease burden in this high-risk population. Methods: Intradialytic calcium kinetics was evaluated in a cross-sectional observational study by measuring dialysate-sided ionized calcium mass balance (iCa_MB), calcium buffer capacity, and change in serum calcium levels in 40 chronic HD patients during a routine HD session. A dialysate calcium of 3.5 mEq/L was used to adequately challenge calcium buffer mechanisms. Aortic pulse wave velocity and serum osteocalcin levels were measured prior to the HD session. Presence of cardiovascular disease and diabetes was assessed. Results: The mean dialysate-sided iCa_MB, extracellular fluid ionized calcium mass gain, and buffered ionized calcium mass were 469 (±154), 111 (±49), and 358 (±145) mg/HD, respectively. The mean ionized serum calcium increase (∆iCa) was 0.42 (±0.14) mEq/L per HD. The mean intradialytic calcium buffer capacity was 73 (±18)%. Multivariate regression analysis revealed significant independent association of (1) iCa_MB with the dialysate-to-blood calcium gradient at HD start and (2) intradialytic calcium buffer capacity with undercarboxylated osteocalcin. The presence of coronary heart disease was associated with higher ∆iCa but not iCa_MB in the multivariate model. Conclusions: In line with our proof-of-concept study, we provide clinical evidence for a rapidly accessible and exchangeable calcium pool involved in intradialytic calcium regulation and for the role of osteocalcin as a potential biomarker. Our findings argue for evaluating the prognostic potential of intradialytic calcium kinetics in prospective clinical trials.

Association between phototherapy and serum calcium levels in newborns: A institutional cross-sectional study

Introduction: Hyperbilirubinemia is one of the most prevalent problems in neonates. Phototherapy is one of the routine methods for management of hyperbilirubinemia. AIM: The aim of this study is to evaluate significant change in serum calcium level in term newborns who are undergoing phototherapy and to find out the association between effect of phototherapy on serum calcium levels in newborns. Methods: 60 newborns with neonatal hyperbilirubinemia admitted in newborn nursery were selected for the study. Serum calcium estimation was done before phototherapy. All newborns were subjected to double surface phototherapy. After 48 hours of phototherapy serum calcium was estimated and compared with earlier value. Results: Mean serum bilirubin level and mean serum calcium levels before phototherapy were 15.2 1.25 mg/dl and 9.2 1.2 mg/dl respectively. While after phototherapy we observed that mean serum bilirubin level and mean serum calcium levels were 11.2 2.6 mg/dl and 8.11 0.54 mg/dl respectively. The difference of these before and after phototherapy were also found to be statistically significant (p=

Perinatal Risk Factors for Early Onset Hypocalcemia in Moderate-to-Late Preterm Infants

Objective: Early onset neonatal hypocalcemia (ENH) occurs within 72 hours after birth and screening is recommended for high-risk infants. This study aimed to analyze the risk factors predictive of ENH and evaluate the effectiveness of intervention for ENH in moderate-to-late preterm infants. Methods: This was a retrospective study, examining moderate-to-late preterm infants at 32-36 weeks of gestational age. Perinatal factors were compared between infants with and without hypocalcemia. Related factors were further analyzed to evaluate the validity of the predictive factors for ENH. The effect of intervention was analyzed by comparing changes in serum calcium levels on day 3 and day 7. Results: A total of 112 infants were enrolled. There were 65 infants in the non-hypocalcemic group and 47 in the hypocalcemic group. Between the two groups, only lower magnesium levels on day 1 were related to ENH with an odds ratio of 0.247 using a cutoff value of 1.7 mmol/L for hypocalcemia (sensitivity 42.6%, specificity 80.0%, P=0.005). No infant with hypocalcemia exhibited clinical seizures. Intervention was performed with oral calcium supplements or low-phosphorus milk feeding in 30 infants. The intervention was more effective in resolving hypocalcemia than no intervention (n=17). Conclusion: Lower magnesium levels on day 1 were related to lower calcium levels and a 4-fold higher risk for hypocalcemia. Moderate-to-late preterm infants with hypomagnesemia should be closely monitored for ENH. Additionally, interventions were found to be effective in restoring calcium levels in ENH.

De novo a novel variant of CaSR gene in a neonate with congenital hypoparathyroidism

Autosomal-dominant hypocalcemia with hypercalciuria (ADHH) is a genetic disease characterized by hypoparathyroidism with hypercalciuria. Most patients with ADHH have calcium-sensing receptor (CaSR) gene mutations. The CaSR gene controls parathyroid secretions, and mutations in this gene can be detected via changes in serum calcium level. The activating mutation of the CaSR gene results in familial or sporadic ADHH. Most activating mutations of the CaSR gene are reportedly de novo missense mutations. This is the first case report of a novel activating variant of the CaSR gene in a neonate with congenital hypoparathyroidism with hypomagnesemia and hypercalciuria. We also report the 3-month follow-up management of the patient.

Potential association with early changes in serum calcium level after starting or switching to denosumab combined with eldecalcitol.

The aims of this study are to investigate changes in serum calcium (Ca) level after switching from either non-therapy, bisphosphonate, selective estrogen receptor modulators (SERM) or teriparatide treatments to a combination therapy of denosumab (DMAb), and eldecalcitol, and the association between early changes in serum calcium and changes in bone metabolic markers and bone mineral density (BMD). 129 patients with postmenopausal osteoporosis (32 non-pretreatment, 50 bisphosphonates, 18 SERM, and 29 teriparatide) were recruited and switched to DMAb plus eldecalcitol. Serum calcium levels, bone metabolism markers, and BMD measurements of the lumbar spine and femoral neck were evaluated. All groups showed an increase in BMD 6months and 1year after DMAb administration compared to baseline via suppression of bone metabolism markers. The TPD group showed a significant decrease in serum calcium level 1week after the first injection of DMAb and eldecalcitol compared to baseline and the bisphosphonate group. Changes in serum calcium level from baseline to 1week after the first injection of DMAb trended to correlate with changes in bone metabolism markers and lumbar BMD. The risks of DMAb-induced hypocalcemia are different between starting and switching from bone resorption inhibitors and bone formation promoters. Therefore, appropriate assessment before administration of DMAb, including pretreatment therapy as well as serum Ca and bone metabolic markers will help identify the risk of hypocalcemia following DMAb in combination with eldecalcitol. Our findings also showed that early change in serum Ca level after DMAb initiation could potentially predict the efficacy for therapy reaction.

Serum calcium changes and risk of type 2 diabetes mellitus in Asian population.

We examined the association between changes in serum calcium levels with the incidence of type 2 diabetes mellitus (T2DM) in apparently healthy South Korean subjects. A retrospective longitudinal analysis was conducted with subjects who had participated in comprehensive health check-ups at least four times over a 7-year period (between 2006 and 2012). In total, 23,121 subjects were categorized into tertiles based on changes in their albumin-adjusted serum calcium levels. Multivariate Cox regression models were fitted to assess the association between changes in serum calcium levels during follow-up and the relative risk of diabetes incidence. After a median follow-up of 57.4months, 1,929 (8.3%) new cases of T2DM occurred. Simple linear regression analysis showed serum calcium level changes correlated positively with changes in HbA1c and fasting plasma glucose (FPG) levels (B=5.72, p<0.001 for FPG; B=0.13, p<0.001 for HbA1c). An increase in albumin-adjusted serum calcium levels during follow-up was related to an increased risk of T2DM. After adjustment for potential confounders, the risk of T2DM was 1.6 times greater for subjects whose albumin-adjusted serum calcium levels were in the highest change tertile during follow-up than for subjects whose levels were in the lowest tertile (HR 1.65, 95% CI 1.44-1.88, P<0.001). The elevation of albumin-adjusted serum calcium levels was associated with an increased risk of T2DM, independent of baseline glycemic status.

Changes in serum calcium and phosphorus levels and their relationship to egg production in laying hens infected with velogenic Newcastle disease virus

ABSTRACTThis study evaluated the changes that occurred in the serum levels of calcium and phosphorus in laying hens infected with velogenic Newcastle disease (ND) virus (vNDV), and their relationship to the decrease in egg production usually associated with ND. Two hundred and forty laying hens (32 weeks old) were randomly assigned into four groups of 60 each viz: VAI – vaccinated with ND vaccines and intramuscularly inoculated with vNDV, VAU – vaccinated uninfected, UNI – unvaccinated infected and UNU – unvaccinated uninfected. At weekly intervals blood was collected from six randomly selected hens in each group for serum calcium and phosphorus assays. Groups VAI and UNI showed a significant (p < .05) drop in egg production. Serum phosphorus levels of groups VAI and UNI were significantly (p < .05) lower than those of groups VAU and UNU. There was a highly positive correlation between serum phosphorus levels and egg production which was highly significant (r = .74; p < .01). The changes in serum calcium levels of infected groups were only slight, and the relationship between serum calcium levels and egg production was low, positive and not significant (r = .26; p > .05). Drop in egg production that occurred in the ND-infected laying hens was positively strongly correlated with the drop in serum phosphorus levels.

Acute Effects of Plyometric Exercises Performed on Land and in Water on the Parameters of Bone Metabolism in Middle-Aged Males

Objectives: This study was performed to investigate the acute effect of plyometric exercise in water and on land on some indices of bone metabolism in middle-aged males. Methods: In this quasi-experimental study, 10 middle-aged disabled people were selected. Participants exercised on two separate weeks, on one week only recorded water-based exercise and the other week reported their land-based plyometric exercise. The blood sample was initially taken 10 minutes before starting plyometric workout on land or in water and 10 minutes after a week of intervention. Serum levels of alkaline phosphatase (ALP) and calcium were measured. Student’s t-test was used and P < 0.05 was considered as significant. Results: There was no significant difference in mean serum calcium level both before (P = 0.322) and after exercise (P = 1.0) between the 2 groups. Mean serum calcium level changes were also similar between the 2 groups (P = 0.300). Serum alkaline phosphatase (ALP) level was similar between the 2 groups both before (P = 0.337) and after exercise (P = 0.147); yet its changes was significantly higher in individuals, who exercised on land than in water (P = 0.003). Conclusions: It seems that land-based plyometric exercise increases serum ALP more than water-based plyometric exercise in middle-aged males.

Thiazide Treatment in Primary Hyperparathyroidism-A New Indication for an Old Medication?

There is no therapy for control of hypercalciuria in nonoperable patients with primary hyperparathyroidism (PHPT). Thiazides are used for idiopathic hypercalciuria but are avoided in PHPT to prevent exacerbating hypercalcemia. Nevertheless, several reports suggested that thiazides may be safe in patients with PHPT. To test the safety and efficacy of thiazides in PHPT. Retrospective analysis of medical records. Endocrine clinic at a tertiary hospital. Fourteen male and 58 female patients with PHPT treated with thiazides. Data were compared for each patient before and after thiazide administration. Effect of thiazide on urine and serum calcium levels. Data are given as mean ± standard deviation. Treatment with hydrochlorothiazide 12.5 to 50 mg/d led to a decrease in mean levels of urine calcium (427 ± 174 mg/d to 251 ± 114 mg/d; P < 0.001) and parathyroid hormone (115 ± 57 ng/L to 74 ± 36 ng/L; P < 0.001), with no change in serum calcium level (10.7 ± 0.4 mg/dL off treatment, 10.5 ± 1.2 mg/dL on treatment, P = 0.4). Findings were consistent over all doses, with no difference in the extent of reduction in urine calcium level or change in serum calcium level by thiazide dose. Thiazides may be effective even at a dose of 12.5 mg/d and safe at doses of up to 50 mg/d for controlling hypercalciuria in patients with PHPT and may have an advantage in decreasing serum parathyroid hormone level. However, careful monitoring for hypercalcemia is required.

BIOCHEMICAL ANALYSIS AND BONE REMODELING IN RESPONSE TO OOPHORECTOMY AND AQUATIC TRAINING

ABSTRACTObjective:To investigate whether swimming could prevent bone loss and could be indicated to assist in treatment of osteoporosis. Methods:Female rats were divided into 4 groups (n=6), two of them were oophorectomized. Animals from two groups, one oophorectomized and another not oophorectomized, underwent aquatic training for eight weeks. After training, the animals were sacrificed and their blood was collected for calcium and alkaline phosphatase serum dosage; the femur was removed and subjected to radiological and histological densitometry analysis to assess bone loss and osteoclast counting on femoral head and neck. Results:Increase in serum calcium was not observed. There was an increasing activity of alkaline phosphatase in the oophorectomized groups. The radiographs suggest that there was a greater bone mass density in the trained groups. Concerning histology, the trained groups had better tissue structural organization than the sedentary groups. In the oophorectomized and sedentary group, higher presence of osteoclasts was observed a. Conclusion:Exercise and oophorectomy did not promote changes in serum calcium levels. The decrease of sex steroids caused by oophorectomy was responsible for severe bone loss, but swimming exercise was able to reduce this loss. Oophorectomy promoted the proliferation of osteoclasts and the exercise proved to be able to diminish it. Level of Evidence I, Experimental Study.

Parathyroid Hormone Replacement Therapy in Hypoparathyroidism: A Meta-Analysis.

This study investigated the effect of human parathyroid hormone replacement therapy on specific disease-related outcomes in patients with hypoparathyroidism. Medline, Cochrane, EMBASE, and Google Scholar databases were searched until January 13, 2015 for randomized trials using the following search terms: hypoparathyroidism, parathyroid hormone/PTH, and hormone replacement therapy. Five randomized controlled trials (n=245) that investigated effect of either PTH (1-34) (3 trials) or PTH (1-84) (2 trials) on serum calcium, phosphate, 1, 25-dihydroxyvitamin D, 25-dihydroxyvitamin D levels, and urine level of calcium were included in the meta-analysis. Both PTH (1-34) and PTH (1-84) therapies were not associated with change in serum calcium level compared with calcitriol/placebo. The level of 24-h urine calcium excretion had a significant decrease in PTH (1-34)-treated group compared placebo/calcitriol (control) group (p≤0.012). PTH (1-34) did not change serum phosphate (p=0.053). PTH (1-84) did not change level of 24-h urine calcium excretion compared with control (p≥0.214) but it did decrease the levels of serum phosphorous (p=0.000). Both PTH-replacement therapies were not associated with change in serum 1,25-dihydroxyvitamin D level compared with control (p≥0.606), but were associated with a significant decrease in serum 25-dihydroxyvitamin D levels (p≤0.04). In conclusion, although the number of randomized trial is limited, our meta-analysis suggests that PTH (1-34) replacement therapy may maintain the serum calcium levels in the normal range by reducing the levels of urine calcium excretion, and both replacement therapies may maintain 1,25-dihydroxyvitamin D serum levels by reducing serum level of 25-dihydroxyvitamin D.

Loose and frequent stools and PTH levels are positively correlated post–gastric bypass surgery due to less efficient intestinal calcium absorption

BackgroundAfter Roux-en-Y gastric bypass, calcium and vitamin D deficiencies are frequently reported. In the presence of adequate vitamin D levels, calcium deficiency is caused by a lower efficacy of the intestinal calcium transport. ObjectiveTo investigate whether the use of a simple clinical score quantifying bowel habits (fecal score [FS]) correlates with the degree of secondary hyperparathyroidism that arises to compensate for calcium deficiency postsurgery. SettingLarge peripheral hospital. MethodsSeventy-five patients supplemented with calcium and vitamin D were prospectively studied before and 6 and 12 months after Roux-en-Y gastric bypass. FS, calcium (mmol/L), phosphate (mmol/L), magnesium (mmol/L), vitamin D (nmol/L), and parathyroid hormone (PTH; pmol/L) were measured in each patient. ResultsMean body mass index was 44.7±5.4 kg/m2 preoperatively and decreased to 34.3±5.0 kg/m2 at 6 months and 30.8±4.8 kg/m2 at 12 months, corresponding to a total weight loss of 23.2±5.9% and 30.9±8.3% respectively. There were no significant changes in serum calcium levels. Mean PTH levels rose from 3.5 pmol/L at baseline to 4.1 pmol/L at 6 months (P = .01) and to 4.9 pmol/L at 12 months (P<.001). Nine patients (12%) had increased PTH levels at 6 months, and 14 patients (19%) had increased PTH levels at 12 months. A significant positive correlation between FS and PTH at 12 months was found, which persisted after adjusting for vitamin D levels. ConclusionFS is positively correlated with secondary hyperparathyroidism using vitamin D–adjusted PTH levels as a biochemical marker. The present study in humans confirms the relation reported in animal studies. These results emphasize that managing stool habits are important after bariatric surgery.