Decrease In Serum Calcium Levels Research Articles

Phototherapy and serum blood calcium levels in neonates: is there a need for calcium supplementation?

Background: Phototherapy is the first line of treatment for physiological jaundice. However, it has its own set of complications. Hypocalcaemia is a less frequent but a potential complication of phototherapy. The purpose of this study was to see the effect of 24 hours of phototherapy on the serum blood calcium levels of the newborn after 24 hours of exposure and the need for supplementation in these new born babies. Methods: A cross sectional observational study was conducted at our institute on 31 newborn babies born between June 2022 to December 2022. All term neonates who developed clinically significant physiological jaundice after 48 hours of life were subjected to double surface phototherapy with LED blue light for 24 hours. These babies were screened for their serum calcium levels by venous blood sampling before the commencement of the phototherapy. The same sampling was repeated after 24 hours of exposure to the phototherapy lights to see the effect on serum calcium levels of the newborn. Results: Phototherapy was given for 24 hours. Mean serum calcium measured at 48 hours of life prior to phototherapy was 9.25±0.62 mg/ml. Also, mean serum calcium at 24 hours post phototherapy was 8.74±0.38 mg/ml. A highly significant decrease in serum calcium level was seen post phototherapy (p=0.0002). Independent samples t test was used. Conclusions: In healthy term neonates exposed for only 24 hours of phototherapy decrease in serum calcium levels to some extend was noted however it is unlikely to cause clinically significant hypocalcemia.

Оценка обеспеченности витамином D и эффективности его саплементации у детей, находящихся длительно на безмолочном типе питания

The purpose — to determine the level of vitamin D availability and to evaluate the effectiveness of its supplementation in children who have been on a dairy-free diet for a long time. Material and methods. At the first stage of the study, the availability of vitamin D and calcium in children were assessed. 62 children were examined who had been on a dairy-free diet (group I). The control group consisted of 30 conditionally healthy children who did not keep any restrictive diets. At stage II, a scheme of vitamin D supplementation was proposed, which consisted in taking an aqueous solution of cholecalciferol in a therapeutic dose during one month, depending on the initial level of calcidiol in blood serum: at the level of 11–20 ng/ml (vitamin D deficiency), 3000 IU/day was prescribed, at the level of 21–29 ng/ml (insufficient vitamin D) — 2000 IU/day, switching to the dose of 1000 IU/day. Children with adequate provision of vitamin D were prescribed a prophylactic dose of cholecalciferol — 1000 IU/day. Subgroup Ia consisted of 32 children who received cholecalciferol supplementation. Subgroup Ib included 30 children who had no supplementation. The importance of daily consumption of foods rich in calcium and vitamin D was explained to children of both subgroups and their parents. The assessment of vitamin D and calcium availability was repeated after 4 months of follow-up. Results. The proportion of children with insufficient vitamin D in group I was 62.9%, which was statistically significantly higher (p < 0.001) relative to the proportion of children with normal concentration or deficiency of vitamin D in blood serum. A decrease in serum calcium levels among patients of this group was found in 64.5% of children, which was statistically significant (p < 0.001) relative to children of the control group. After the course of cholecalciferol supplementation in subgroup Ia, insufficient vitamin D was found in 18.8%. Normal micronutrient availability was established in 81.2%. Among children of subgroup Ib, the proportion of children with normal vitamin D availability at the control visit was 33.3%, which was less (p < 0.01) relative to subgroup Ia. Normal values of calcium in blood serum against the background of complementation were found in 78.1% of children of subgroup 1a and in 36.7% of children in subgroup 1b. Conclusions. For children who follow a dairy-free diet, insufficient vitamin D and calcium levels are characteristic. Supplementation with an aqueous solution of cholecalciferol has shown its effectiveness in normalizing the level of calcidiol and calcium in the blood serum of children on a dairy-free diet.

Unpredictable Blood Product Usage in Orthotropic Liver Transplantation: A Foregone Conclusion or A Problem Solved by Artificial Intelligence?

Abstract Introduction/Objective Orthotropic liver transplantation (OLT) is a complex procedure requiring coordination between operative and transfusion medicine staff. Unanticipated blood product demands during these surgeries strain blood bank inventory, especially when units are needed for patients with significant alloantibodies. Currently, transfusion medicine services issue set numbers of crossmatched red blood cell (RBC) units for these procedures. At our institution, 10 units are issued for each OLT. This project categorized OLT patients into three groups by RBC unit requirements: <5 units, 5-9 units and >10 units. Furthermore, we identified pre-operative clinical and lab factors predicting placement into each category. From this data, we developed an artificial intelligence platform (CCBBAI-1). Methods/Case Report We collected data from 474 adults (>18 years old) that underwent OLT from Jan. 1, 2021, to Dec. 31, 2022. Demographic, anticoagulant, and lab testing data generated within 24 hours of admission were obtained. Data analysis was performed in R-studio. CCBBAI-1 was built using machine intelligence learning optimizer platform (MILO). Results (if a Case Study enter NA) Based on univariate regression analysis (p-value<0.05, 95% confidence interval (CI)), the following lab variables were predictive of >10 RBC units issued: high INR (OR 3.48 [CI 2.35-5.26]), admission heparin dosage (2.61 [1.56-4.31]), total bilirubin (1.06 [1.04-1.08]), conjugated bilirubin (1.08 [1.04-1.11]), PTT (1.04 [1.03-1.06]), BUN (1.03 [1.02-1.04]), and creatinine (1.55 [1.33-1.83]). Low albumin (1.50 [1.13-2.22]) and MCV (1.04 [1.02-1.07]) also projected a 10 RBC unit procedural requirement. The univariate regression analysis variables predictive in categorizing patients requiring 5-9 units vs < 5 units were as follows: decreased albumin (2.17 [1.42-3.33]), decreased serum calcium level (1.72 [1.13-2.63]) and elevated INR (2.14 [1.36-3.40]). The mean number of units issued for each patient group including those requiring >10, 5-9, and <5 units were 22, 7, and 2 units, respectively. CCBBAI-1 achieved a sensitivity of 87.0% and specificity of 70.0% in classifying patients requiring >10 RBC units. Patients needing <10 units were analyzed in a second module to determine if they needed 5-9 units, achieving a sensitivity of 64.7% and a specificity of 62.4%. Conclusion Our study divided OLT patients into three categories and identified predictive laboratory values characterizing each group, a step towards improving transfusion medicine efficacy in this context.

FRI154 Saline Suppression Testing And Acute Hypocalcemia: Impacts On Diagnostic Testing For Primary Aldosteronism

Abstract Disclosure: W.W. Parksook: None. J.M. Brown: Consulting Fee; Self; Bayer, Inc. J. Milks: None. A. Moore: None. Y. Niebuhr: None. B. Honzel: None. A. Vaidya: Consulting Fee; Self; HRA Pharmaceuticals, Mineralys. Background: Calcium ion signaling is a critical factor required for the physiologic production of aldosterone. Emerging evidence has revealed that the majority of cases of primary aldosteronism involve pathogenic somatic mutations that ultimately increase calcium signaling and autonomous aldosterone production. Therefore, testing for primary aldosteronism that modulates calcium homeostasis may influence the diagnostic interpretation of the results. Method: Overweight to obese participants with metabolic risk factors and pre-hypertension or stage 1 hypertension (n=56) underwent a standard seated saline suppression test (SSST). Measurement of blood pressure, plasma aldosterone, serum calcium, as well as other factors, was performed at times 0, 120, and 240 minutes during SSST. Linear regression models were used to analyze the association between changes in calcium and each parameter. Results: Following 2 liters of saline infusion during SSST, all 56 participants (100%) had a significant decrease in serum calcium levels from baseline, with 26 (47%) developing new-onset frank hypocalcemia (calcium <8.6 mg/dL). The mean baseline serum calcium was 9.2 ± 0.3 mg/dL, which declined to 8.9 ± 0.4 mg/dL at 120 mins (P<0.001), and to 8.6 ± 0.4 mg/dl (P<0.001) at 240 mins when the SSST concluded. Consistent with the known vasopressor effect of calcium, greater drops in serum calcium levels were associated with lower blood pressure at 240 minutes (β;= 13.5, P<0.01 for DBP; β;= 10.7, P= 0.06 for SBP). Among those with post-SSST aldosterone levels <10 ng/dl (a categorical threshold used to exclude primary aldosteronism), greater reductions in serum calcium levels were associated with larger drops in aldosterone levels (β;= 9.9, P<0.05). Conclusion: The standard SSST induced a substantial decline in serum calcium levels in 100% of participants, with nearly half of all participants developing frank hypocalcemia at the end of saline infusion. Since calcium is known to play a critical role in physiologic and pathophysiologic production of aldosterone, these findings raise the question whether hypocalcemia induced by the acute loading of 2 liters of saline may confound the interpretation of aldosterone changes. Further research should focus on better understanding the diagnostic implications of these results and potential limitations of the SSST to exclude primary aldosteronism. Presentation: Friday, June 16, 2023

Severe hypocalcemia after denosumab treatment leading to refractory ventricular tachycardia and veno-arterial extracorporeal membrane oxygenation support: a case report

BackgroundSevere hypocalcemia may lead to life-threatening arrhythmias. Denosumab is an effective treatment for osteoporosis that allows long intervals between doses. However, there is a risk of hypocalcemia in some patients. Due to the long half-life of denosumab, emergency physicians caring for patients presenting with symptoms of hypocalcemia may not be aware of the medication, and adverse effects may last longer.Case presentationA 55-year-old woman with a history of systemic lupus erythematosus (SLE) and anxiety disorder called for an ambulance for symptoms of hyperventilation and muscle cramps. After evaluation at the local hospital, she developed pulseless ventricular tachycardia and was resuscitated by defibrillation by the hospital staff. After conversion to sinus rhythm, she was transported to a tertiary center. Upon arrival, pulseless ventricular tachycardia occurred again, and veno-arterial extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pumping (IABP) were implemented. Laboratory results showed severe hypocalcemia (corrected calcium level of 5.3 mg/dL) whereupon intravenous calcium supplementation was started. She had received the first dose of denosumab (60 mg) by subcutaneous injection 24 days prior to hospitalization. She was eventually weaned from ECMO and IABP support.ConclusionCardiac arrest due to hypocalcemia is relatively rare but can be fatal. In the present case, hyperventilation may have acutely exacerbated pre-existing hypocalcemia, leading to ventricular tachycardia. The patient had a slightly decreased serum calcium level prior to denosumab. Close monitoring may be preferable after the primary dose of denosumab in selected patients. Emergency physicians caring for patients who may be suffering from symptoms/signs of hypocalcemia must be mindful of medications that have long half-lives and affect electrolyte balance when treating fatal arrhythmia due to hypocalcemia.

Hospitalizations, emergency room visits and causes of death in 198 patients with permanent hypoparathyroidism: a retrospective Austrian study (2005-2022).

Chronic hypoparathyroidism (HP) is associated with acute and chronic complications, especially those related to hypocalcemia. We aimed to analyze details on hospital admissions and the reported deaths in affected patients. In a retrospective analysis, we reviewed the medical history of 198 patients diagnosed with chronic HP over a continuous period of up to 17 years at the Medical University Graz. The mean age in our mostly female cohort (70.2%) was 62.6 ± 18.7 years. The etiology was predominantly postsurgical (84.8%). About 87.4% of patients received standard medication (oral calcium/vitamin D), 15 patients (7.6%) used rhPTH1-84/Natpar® and 10 patients (4.5%) had no/unknown medication. Two hundred and nineteen emergency room (ER) visits and 627 hospitalizations were documented among 149 patients, and 49 patients (24.7%) did not record any hospital admissions. According to symptoms and decreased serum calcium levels, 12% of ER (n = 26) visits and 7% of hospitalizations (n = 44) were likely attributable to HP. A subgroup of 13 patients (6.5%) received kidney transplants prior to the HP diagnosis. In eight of these patients, parathyroidectomy for tertiary renal hyperparathyroidism was the cause of permanent HP. The mortality was 7.8% (n = 12), and the causes of death appeared to be unrelated to HP. Although the awareness for HP was low, calcium levels were documented in 71% (n = 447) of hospitalizations. Acute symptoms directly related to HP did not represent the primary cause of ER visits. However, comorbidities (e.g. renal/cardiovascular diseases) associated with HP played a key role in hospitalizations and deaths. Hypoparathyroidism (HP) is the most common complication after anterior neck surgery. Yet, it remains underdiagnosed as well as undertreated, and the burden of disease and long-term complications are usually underestimated. There are few detailed data on emergency room (ER) visits hospitalizations and death in patients with chronic HP, although acute symptoms due to hypo-/hypercalcemia are easily detectable. We show that HP is not the primary cause for presentation but that hypocalcemia is a typical laboratory finding (when ordered) and thus may contribute to subjective symptoms. Patients often present with renal/cardiovascular/oncologic illness for which HP is known to be a contributing factor. A small but very special group (n = 13, 6.5%) are patients after kidney transplantations who showed a high ER hospitalization rate. Surprisingly, HP was never the cause for their frequent hospitalizations but rather the result of chronic kidney disease. The most frequent cause for HP in these patients was parathyroidectomy due to tertiary hyperparathyroidism. The causes of death in 12 patients appeared to be unrelated to HP, but we found a high prevalence of chronic organ damages/comorbidities related to it in this group. Less than 25% documented HP correctly in the discharge letters, which indicates a high potential for improvement.

Hypercalcemia affected in metastatic breast cancer patients without bone metastasis: report of three cases

BackgroundSince humoral hypercalcemia of malignancy (HHM) in breast cancer patients without bone metastasis is rare, the clinical features of this condition are not fully understood.Case presentationDuring the recent 12 years, 3602 patients were diagnosed with breast cancer in our institution, and only three patients developed HHM without bone metastasis. They were all recurrent breast cancer patients with visceral metastases including the lung and the liver. It took no more than 2 months since symptomatic onset to hospitalization because of hypercalcemia. The maximum serum calcium concentrations were 15.0 mg/dL or higher. All patients had symptoms related to hypercalcemia. Treatment of hypercalcemia including hydration, calcitonin, bisphosphonate, and diuretics was initially effective in the three patients. However, two of three cases were eventually fatal because of unsuccessful treatment of breast cancer.ConclusionsThe common features of HHM without bone metastasis in breast cancer patients include acute onset, severe symptomatic hypercalcemia, and presence of visceral metastasis. Treatment of hypercalcemia decreased serum calcium level in a short period, while successful treatment of breast cancer was essential for a long-term management of HHM. This report provides a consideration to help elucidate the pathophysiology and medical care of breast cancer patients with HHM without bone metastasis.

The Impact of COVID-19 (SARS-CoV-2) Virus Infection on the Endocrine System: A Review Study

The global coronavirus disease 2019 (COVID-19) pandemic is rapidly growing, and high mortality rates are reported in this regard. Coronaviruses are known to cause multi-organ system damage. Few data are available on the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on different endocrine glands. As angiotensin-converting enzyme-2 (ACE2) receptor is extensively expressed in the endocrine organs, and thus several important questions have arisen regarding whether the function of the endocrine organ changes in COVID-19 disease and patients with the SARS-CoV-2 infection develop endocrine disorders. Databases including PubMed, Web of Sciences, Scopus, and Google Scholar were searched for studies published from 1996 to February 15, 2021. New-onset diabetes mellitus has been reported by different studies at rates ranging from 5.8% to 35%. Hypercortisolism in admission time could predict disease severity. Tissues from the hypothalamus and the pituitary gland in animals are rich in ACE2, and some endocrinopathy may be secondary. Thyroiditis and thyrotoxicosis have also been recognized in the COVID-19 infection. Hypocalcemia and vitamin D deficiency may be correlated with disproportionate parathormone levels. Patients with decreased serum calcium levels had worse clinical variables and higher incidences of complications such as septic shock. Men are more susceptible to hypogonadism, and differences in the COVID-19 infection and mortality rates between males and females are due to the differential effects of estradiol and testosterone on the immune system. Considering that different glands have the ACE2 receptor, the coronavirus may be able to alter their function. Hence, this review mainly focused on COVID-19-associated endocrinopathy.

Atorvastatin lowers serum calcium levels in lithium-users: results from a randomized controlled trial

BackgroundAlthough lithium is considered the gold-standard treatment for bipolar disorder (BD), it is associated with a variety of major endocrine and metabolic side effects, including parathyroid hormone (PTH) dependent hypercalcemia. Aside from surgery and medication discontinuation, there are limited treatments for hypercalcemia. This paper will assess data from a randomized controlled trial (RCT).MethodsThis is a secondary analysis of an RCT that explored the effects of atorvastatin (n = 27) versus placebo (n = 33) on lithium-induced nephrogenic diabetes insipidus (NDI) in patients with BD and major depressive disorder (MDD) using lithium (n = 60), over a 12-week period. This secondary analysis will explore serum calcium levels and thyroid stimulating hormone (TSH) measured at baseline, week 4, and week 12.ResultsAt 12-weeks follow-up while adjusting results for baseline, linear regression analyses found that corrected serum calcium levels were significantly lower in the treatment group (mean (M) = 2.30 mmol/L, standard deviation (SD) = 0.07) compared to the placebo group (M = 2.33 mmol/L, SD = 0.07) (β = − 0.03 (95% C.I.; − 0.0662, − 0.0035), p = 0.03) for lithium users. There were no significant changes in TSH.ConclusionIn lithium users with relatively normal calcium levels, receiving atorvastatin was associated with a decrease in serum calcium levels. Although exciting, this is a preliminary finding that needs further investigation with hypercalcemic patients. Future RCTs could examine whether atorvastatin can treat PTH dependent hypercalcemia due to lithium and other causes.

Thymoquinone ameliorates amikacin induced oxidative damage in rat brain tissue

ABSTRACT We investigated the potential neuroprotective effects of thymoquinone (TQ) on amikacin (AK) induced oxidative damage in rat brain. We used 21 male rats divided randomly into three equal groups. The control group was injected intraperitoneally (i.p.) with 0.5 ml 0.9% aqueous NaCl and given 1 ml 0.9% aqueous NaCl orally. The AK group was administered 1.2 g/kg aqueous AK i.p. as a single dose on the day 3 of the study. The AK + TQ group was given a single 1.2 g/kg dose of AK i.p. on the day 3 of the study plus 40 mg/kg/day TQ by oral gavage daily. Treatment with TQ increased serum ferritin and decreased serum calcium levels significantly. TQ also decreased NADPH oxidase-2, NADPH oxidase-4, and caspase-3 levels. Decreased malondialdehyde (MDA) levels and increased superoxide dismutase (SOD) and catalase (CAT) activities were detected in the AK + TQ group compared to the AK group. TQ administration inhibited lipid peroxide formation and blocked oxidative reactions, which reduced the MDA level and increased SOD and CAT activities induced by AK. Oxidative damage caused by AK was ameliorated by TQ treatment owing to its antioxidative and anti-apoptotic effects. TQ may be a potential therapeutic agent for reducing the severity of AK induced oxidative damage to the brain.

Low Serum Calcium Concentration in Patients With Systemic Lupus Erythematosus Accompanied by the Enhanced Peripheral Cellular Immunity

ObjectiveThis study aims to explore the relationship between serum calcium concentration and peripheral lymphocyte status/Th1/Th2 cytokine levels in SLE patients, and the effect of glucocorticoids (GCs) on the calcium concentration and immune cell activation.MethodsThe peripheral blood TBNK lymphocyte subsets and Th1/Th2 cytokines in SLE patients with low or normal serum calcium concentration and healthy people were analyzed and compared retrospectively. Peripheral white blood cells (PWBCs) from SLE patients or healthy people were stimulated with PMA or GCs in vitro to test their extracellular calcium concentration and CD8+ T cell activation.ResultsThe percentages of CD8+ T in SLE patients increased, but the increase of the number of CD8+ T cells only occurred in the SLE patients with low serum calcium concentration, and the number of CD45hiCD8+ T cells also increased, suggesting that SLE patients with hypocalcemia tend to possess an enhanced cellular immunity. The results of Th1/Th2 cytokines in peripheral blood showed that the levels of serum IL-2, IL-10, IL-6 and IFN-γ in SLE patients with hypocalcemia were significantly increased. Although the serum levels of TNF-α in SLE patients were –similar to that in healthy people, it was significantly higher than that in SLE patients with normal serum calcium. When comparing the results of Th1/Th2 cytokines in two times of one patient, the serum levels of TNF-α in SLE patients increased while serum calcium levels decreased. The in vitro experiments showed that the decrease of serum calcium concentration in SLE patients was affected by the immune cell activation and the application of GCs, but GCs did not promote the immune cell activation.ConclusionsLow serum calcium may make SLE patients in an enhanced cellular immune status and GCs aggravates the decrease of serum calcium levels but has no role on the immune cell activation. It suggests that hypocalcemia possibly promotes the disease activity of SLE patient, which should be paid attention to clinically.

FC086: Improved Immunologic Response to COVID-19 Vaccine with Prolonged Dosing Interval in Hemodialysis Patients

BACKGROUND AND AIMSVaccination against coronavirus disease 2019 (COVID-19) can reduce disease incidence and severity. Dialysis patients demonstrate a delayed immunologic response to vaccines. We determined factors affecting the immunologic response to COVID-19 vaccines in hemodialysis patients.METHODAll patients within a Swedish hemodialysis network, vaccinated with two doses of COVID-19 vaccine 2–8 weeks before inclusion, were eligible for this cross-sectional study. Severe adult respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein antibody levels were determined by the EliA SARS-CoV-2-Sp1 IgG test (Thermo Fisher Scientific, Phadia AB) and related to clinical and demographic parameters. Eighty-nine patients were included.RESULTSPatients were vaccinated with two doses of Comirnaty (BNT162b2, 73%) or Spikevax (mRNA-1273, 23.6%). Three patients received combinations of different vaccines. Response rate (antibody titres >7 U/mL) was 89.9%, while 39.3% developed high antibody titres (>204 U/mL), 47 (43–50) days after the second dose. A previous COVID-19 infection associated with higher antibody titres [median (25th–75th percentile) 1558.5 (814.5–3763.8) U/mL versus 87 (26–268) U/mL; P = 0.002], while the time between vaccine doses did not differ between groups (P = 0.7). Increasing SARS-CoV-2 antibody titres were independently associated with increasing time between vaccine doses, decreasing serum calcium levels and previous COVID-19 (Table 1).CONCLUSIONIn conclusion, a longer interval between COVID-19 mRNA vaccine doses, lower calcium and a previous COVID-19 infection were independently associated with a stronger immunologic vaccination response in hemodialysis patients. While the response rate was good, only a minority developed high antibody titres 47 (43–50) days after the second vaccine dose.Table 1.Multiple regression of predictors of SARS-CoV-2 spike IgG response to COVID-19 vaccinesRegression coefficient(95% CI)P(Constant)0.015 (–0.507 to 0.537)0.95Type of vaccine–0.194 (–0.566 to 0.179)0.30Sodium (1 SD)–0.154 (–0.309 to 0.001)0.051Calcium (1 SD)–0.233 (–0.4 to –0.067)0.007Treatment time (1 SD)–0.05 (–0.234 to 0.133)0.586Bodymass index (1 SD)0.104 (–0.086 to 0.294)0.279IDBWG (1 SD)0.118 (–0.042 to 0.278)0.145Kt/V (1 SD)0.009 (–0.159 to 0.177)0.915Vaccine interval (1 SD)0.241 (0.039 to 0.443)0.02Interval first dose to sample (1 SD)0.027 (–0.142 to 0.197)0.750Previous COVID-191.078 (0.56 to 1.596)<0.001

Improved immunologic response to COVID-19 vaccine with prolonged dosing interval in haemodialysis patients.

Vaccination against 2019 coronavirus disease (COVID‐19) can reduce disease incidence and severity. Dialysis patients demonstrate a delayed immunologic response to vaccines. We determined factors affecting the immunologic response to COVID‐19 vaccines in haemodialysis patients. All patients within a Swedish haemodialysis network, vaccinated with two doses of COVID‐19 vaccine 2‐8 weeks before inclusion, were eligible for this cross‐sectional study. Severe adult respiratory syndrome coronavirus 2 (SARS‐CoV‐2) spike protein antibody levels were determined by EliA SARS‐CoV‐2‐Sp1 IgG test (Thermo Fisher Scientific, Phadia AB) and related to clinical and demographic parameters. Eighty‐nine patients were included. Patients were vaccinated with two doses of Comirnaty (BNT162b2, 73%) or Spikevax (mRNA‐1273, 23,6%). Three patients received combinations of different vaccines. Response rate (antibody titres >7 U/mL) was 89.9%, while 39.3% developed high antibody titres (>204 U/mL), 47 (43‐50) days after the second dose. A previous COVID‐19 infection associated with higher antibody titres (median (25th‐75th percentile) 1558.5 (814.5‐3,763.8) U/mL vs 87 (26‐268) U/mL, P = .002), while time between vaccine doses did not differ between groups (P = .7). Increasing SARS‐CoV‐2 antibody titres were independently associated with increasing time between vaccine doses (B 0.241, P = .02), decreasing serum calcium levels (B −0.233, P = .007) and previous COVID‐19 (B 1.078, P < .001). In conclusion, a longer interval between COVID‐19 mRNA vaccine doses, lower calcium and a previous COVID‐19 infection were independently associated with a stronger immunologic vaccination response in haemodialysis patients. While the response rate was good, only a minority developed high antibody titres, 47 (43‐50) days after the second vaccine dose.

Cornelian cherry (Cornus mas L.) extract reduces cardiovascular risk and prevents bone loss in ovariectomized Wistar rats

• Cornus mas L. ameliorates ovariectomy-induced weight gain and abdominal obesity. • C. mas increases visfatin and resistin and decreases adiponectin serum level. • C. mas restores GPx, and SOD activity, and GSH/GSSG ratio. • C. mas protects against ovariectomy-induced bone loss. The aim of the current study was to to investigate the influence of cornelian cherry ( Cornus mas L.; CM) extract on ovariectomy-induced metabolic changes including bone loss, obesity development, adipokines imbalance and oxidative stress. Intragastrical administration of CM ameliorated ovariectomy-induced weight gain and decreased accumulation of visceral fat tissue. It counteracted adipokines imbalance, increasing visfatin and resistin and decreasing adiponectin levels. CM reduced oxidative stress normalizing GPx, and SOD activity, and GSH/GSSG ratio. It ameliorated ovariectomy-induced decrease in femoral and tibial bone mineral density (BMD), prevented the deterioration in Young’s modulus and flexural strength and counteracted ovariectomy-induced decrease in serum calcium level. To our best knowledge this is the first study that demonstrated bone-protective properties of C. mas and its protection against ovarian-cessation obesity, oxidative stress and adipokines imbalance that belong to important risk factors of cardiovascular diseases.

Factors associated with mortality in severely malnourished hospitalized children who developed septic shock.

Septic shock can often lead to death, even in resourceful settings, if not handled carefully. Therefore, we sought to evaluate the factors associated with deaths in the context of severe malnutrition and also the effects of early, i.e., within 3 hours of diagnosing septic shock vs. late blood transfusion. Here, all under-five severely malnourished septic shock children were admitted to ICU during 2013-2017. Children who died constituted cases (n = 54), and the survived (n = 39) represented controls. We excluded children who received the blood transfusion for other causes and who left against medical advice. In both descriptive and multivariate analysis, we found that death was significantly associated with the use of fourth-line antibiotics, corticosteroids, and the addition of vasopressors on top of dopamine (all p < 0.05). However, the decrease of serum calcium level was found significantly associated with death only after adjusting (p < 0.05). Even though the cases more often received early blood transfusion than the controls, the difference was insignificant (p = 0.134). When a severely malnourished under-five child develops septic shock, requiring vasopressors, fourth-line antibiotic, and corticosteroid, with reduced serum calcium, the probability of death increases significantly. Our findings underscore the gravity of close monitoring at these points and the niches for early interventions.

Drug-induced hypocalcemia

Hypocalcemia (HCa) is one of the main water-electrolyte disturbances in clinical practice. An acute decrease in serum calcium levels can lead to seizures, ventricular arrhythmias, bronchospasm and laryngospasm. Chronic HCa can result in disorientation and confusion. To prevent these complications, the risk factors for low calcium levels must be carefully evaluated. One of these factors is drugs, in which case we are talking about drug-induced (DI) HCa. The list of drugs-inducers of DI HCa is quite extensive, but the leading role in this disorder is played by drugs for the treatment of osteoporosis, antineoplastic and antiepileptic drugs, as well as drugs for anti-tuberculosis therapy. When taking zoledronic acid, DI HCa is observed with a frequency of up to 39%. When taking imatinib, a targeted anticancer drug, a decrease in calcium levels was observed in 40% of cases. The pathophysiological mechanisms of DI HCa can be a decrease in bone resorption, a decrease in the concentration of vitamin D, inhibition of the action of parathyroid hormone and impaired calcium absorption. Risk factors in most cases of DI HCa are vitamin D deficiency and hypomagnesemia. An acute decrease in calcium levels leads to symptoms of neuromuscular excitability, abnormalities on the electrocardiogram (ECG) and electroencephalogram (EEG). The basis for the treatment of DI HCa is the drug withdrawal and the appointment of calcium. It is also necessary to prescribe vitamin D. The main methods of prevention of DI HCa are to determine the level of calcium and vitamin D before starting therapy with culprit medication, and to correct its level. It is also important to prescribe additional amounts of calcium and vitamin D during therapy with such drugs. Awareness of the attending physicians about the problem of DI HCa, a thorough assessment of its risk factors and the prophylactic administration of calcium and vitamin D preparations will help to effectively prevent those serious complications resulting from a decrease in calcium levels in clinical practice.

Effects of Proton Pump Inhibitors on Serum Calcium Level: A Study on Rabbit Model

Background: Proton Pump inhibitors (PPI) are widely used all over the world as therapeutic agents as well as prophylactic agent at different age groups for multiple gastrointestinal disorders etc. it inhibits the hydrogen potassium pump (H/K ATPase Pump). PPI interferes the calcium absorption and thus disturbs acid secretion which leads to decrease the calcium level in the body.&#x0D; Objective: The present design is to evaluate the effects of PPI on serum calcium level in rabbit model.&#x0D; Study Design: Randomized Control Trial/ Study on Rabbit Model.&#x0D; Place and Duration of Study: This experimental study was done at Department of Pharmacology Isra Medical University Hyderabad (November 2020 to March 2021&#x0D; Material &amp; Methods: A total 20 healthy male rabbits with weight between 1-2kg were included in this study. While female rabbits, ill rabbits and rabbits with weight less than 1kg were excluded from study. Ten rabbits were given omeprazole sachet of 20mg orally dissolve in water once a day and 10 rabbits were given sachet of esomeprazole of 20mg dissolve in water once a day upto 90 days regularly. At different levels of study blood samples were obtained from vein near ear of rabbits and samples were centrifuged for 10minutes to obtain the serum. Then serum was sent to Isra Diagnostic Laboratory for analysis of serum calcium levels of all samples at different levels of study.&#x0D; Results: Serum calcium levels of all rabbits were analyzed at three different levels of study, at zero level before starting of experiment, at level I after completion of one month of experiment and level II after the completion of three months of experiment. The normal serum calcium level in rabbits is 13-15mg/dl.8There was a significant decline in serum calcium level in Group A (Omeprazole Group), while in Group B (Esomeprazole Group) there was no significant relation between decreased serum calcium levels.&#x0D; Conclusion: The study concluded that there is significant relation of longterm usage of PPI on serum calcium level.

Pharmaceutical Intervention According to Strict Management System Can Normalize Decreased Serum Calcium Level by Denosumab and Prevent Its Aggravation

Denosumab is a fully monoclonal antibody against the receptor activator of nuclear factor kappa-B ligand (RANKL), and prevents skeletal-related events by bone metastasis. Hypocalcemia is the most typical adverse effect of denosumab use. We have developed a management system for the more efficient and safer management of denosumab administration, and evaluated pharmaceutical interventions for the better control of hypocalcemia. All pharmaceutical interventions in the system from April 2016 to March 2020 were retrospectively evaluated. We have also assessed the incidence of hypocalcemia in 158 patients who were administered denosumab for six months or more in the period. A total of 282 pharmaceutical interventions (7.0% of the total administration) were conducted. The most conducted intervention was regarding hypocalcemia, which involved the suspension of the injection and/or the increase of calcium and vitamin D supplement with 65% adoption and 17% temporary treatment suspensions. Other interventions were about hypercalcemia, request of laboratory examination and ordering supplements, dental consultation, and poor renal function. A total of 199 interventions (70.6%) were adopted, with 33 administrations suspended. The frequency of hypocalcemia was 27.8% with just one patient having grade 2 hypocalcemia, suggesting that there were no severe cases. Moreover, hypocalcemia was significantly normalized following pharmaceutical intervention and/or handling by physicians (p=0.02) according to the system. Conversely, the normalization rate in hypercalcemia did not differ according to the countermeasures. In conclusion, pharmaceutical interventions according to our management system benefit safe denosumab treatment, especially in severe hypocalcemia prevention.

The use of hemodialysis in hypercalcemic crisis secondary to primary hyperparathyroidism

Severe hypercalcemia can be either acute or decompensate from a chronic state to a medical emergency, the hypercalcemic crisis. The presence of symptoms such as altered mental status or potentially fatal ECG abnormalities demand an expeditious decrease in serum calcium levels. Standard medical therapy consists of vigorous volume replacement, calcitonin and, depending on the etiology, bisphosphonates, cinacalcet or glucocorticoids. Hypercalcemic crisis is a rare indication for urgent hemodialysis and is reserved for patients with severe symptoms, ineffective medical therapy or end stage renal disease. The use of hemodialysis in this scenario is not commonly reported. We hereby report a patient who presented with altered mental status and acute kidney injury due to a hypercalcemic crisis secondary to primary hyperparathyroidism. Treatment included urgent hemodialysis to effectively lower calcium levels.

Calcium Levels Differences in Men with Schizophrenia Treated with Olanzapine and Risperidone in Prof. Dr. M Ildrem Psychiatric Hospital Medan

BACKGROUND: Second generation of antipsychotic medications is widely administrated in Indonesia and there is a distinctive difference in plasma calcium level in those receiving risperidone and olanzapine. According to several studies, decreased bone density is one of the deleterious effects affecting schizophrenic individuals receiving risperidone and olanzapine. AIM: The objective of the study was to determine the difference in serum calcium levels between men with schizophrenia who treated with olanzapine and risperidone at Prof. Dr. M Ildrem Psychiatric Hospital, Medan. METHODS: This is an experimental pre-test and post-test that compares two groups, namely the intervention group and the control group. Eligible subjects are those who meet our inclusion criteria in the following; age between 15 and 35 years old, total score of PANSS between 90 and 150, and normal serum calcium level. The subjects of the study were 60 men with schizophrenia, namely 30 who received olanzapine and 30 who received risperidone. The sampling method is non-probability sampling with a consecutive sampling type. RESULTS: There was a decrease in the total serum calcium level with the antipsychotic risperidone and olanzapine after 4 weeks, and a higher decrease occurred in the risperidone treatment group compared to olanzapine (p = 0.023). CONCLUSION: There was a significant decrease in serum calcium levels among men with schizophrenia who received risperidone therapy compared with those who received olanzapine therapy between the beginning and the end of week 4. It is expected that clinicians can consider giving antipsychotic therapy olanzapine in people with schizophrenia with low calcium levels.