Incidence Of Hypocalcemia Research Articles

Dose-specific effects of denosumab on serum calcium levels in patients with osteoporosis and various renal functions.

Patients with osteoporosis and advanced chronic kidney disease (CKD) are at increased risk for hypocalcemia when initiating denosumab. It remains unclear if subsequent doses of denosumab pose similar hypocalcemia risk as the initial dose does. To study dose-specific hypocalcemia risks of denosumab. An observational study of 10,398 consecutive patients with varying renal function who received denosumab within Mass General Brigham healthcare system between 1/1/2016 and 2/29/2024. Dose-specific effects of denosumab on serum calcium levels and incidence of hypocalcemia (albumin-corrected serum calcium level < 8.5 mg/dl). In 159 patients with sufficient data for three consecutive doses of denosumab, the initial dose of denosumab reduced serum calcium levels by an average of 0.34, 0.52, and 1.12 mg/dl, in patients with GFR of ≥60 (n=89), 30-59 (n=46) and < 30 (n=24) ml/min/1.73m2, respectively (p<0.001). Among patients with GFR of < 30 ml/min/1.73m2, the initial, second, and third dose of denosumab reduced serum calcium levels by an average of 1.12, 0.72, and 0.60 mg/dl, respectively (p=0.014).In a cohort of 325 patients with sufficient data for two doses of denosumab, a Kaplan-Meier analysis revealed a trend of higher incidence of hypocalcemia following the initial dose compared to the second dose in patients with GFR of < 30 ml/min/1.73m2. The magnitude of serum calcium decrease following subsequent dose(s) was smaller than that following the initial dose of denosumab among patients with osteoporosis and advanced CKD.

Sutureless FOCUS harmonic scalpel versus clamp-and-tie techniques for thyroidectomy: A meta-analysis of 43 randomized controlled trials

Background: One of the most important surgical steps during thyroidectomy is the safe ligation of vessels. In fact, it is crucial to avoid postoperative bleeding and nerves’ injury. The “clamp and tie” technique was first introduced in the 19th century. Since then, a lot of other techniques have been adopted to facilitate the safe ligation and sectioning of thyroidal vessels; however, one of the most relevant advances is the introduction of energy-based devices (EBDs), which occurred three decades ago. Purpose: The aim of this systematic review and meta-analysis is to evaluate the safety and effectiveness of sutureless FOCUS harmonic scalpel (second generation EBDs) versus conventional clamps-and-tie technique) in total thyroidectomy. Results: This systematic review and meta-analysis represent the largest comparison in literature between the thyroidectomy procedure with the second-generation Advanced Harmonic Scalpel Ultrasonic Focus (UAS FOCUS) versus the conventional Clamp-and-Tie (CT) technique: as a matter of fact, it includes 43 randomized controlled trials (RCTs) and a total of 10.361 patients. The incidence of transient recurrent laryngeal nerve was statistically lower in patients undergoing UAS (3.99%) rather than CT (5.23%) (RR 0.79, 95% CI 0.63 to 0.99). The incidence of transient hypocalcemia was 11.3% in patients who underwent thyroidectomy with UAS FOCUS and 15.4% in those who underwent thyroidectomy with CT. Conclusion: Sutureless EBD is associated with a lower risk of damage to the laryngeal nerves and parathyroid glands. The rate of hypocalcemia and nerve paresis is indeed lower due to less thermic damage. Sutureless EBD can also diminish the rate of postoperative bleeding and cervical hematoma, a rare but potentially fatal complication.

Hyperchloremic metabolic acidosis potentially benefiting sodium bicarbonate therapy: A multi-center cohort study

BackgroundThe use of sodium bicarbonate for metabolic acidosis has been a topic of debate, primarily due to the lack of clinical efficacy evidence. This study aims to identify which types of patients with various acid-base balance parameters can benefit from sodium bicarbonate therapy. MethodsPatients diagnosed with metabolic acidosis were screened from a large multi-center critical care database to form a retrospective cohort. Mortality curves, logistic regression analysis, simulation methods, and propensity scores were used to compare data between sodium bicarbonate (SOB group) and non-treated (Non-SOB group) patients. ResultsThere was an interaction between baseline chloride, anion gap levels and sodium bicarbonate therapy on patients' in-hospital death. As chloride levels increased, the in-hospital mortality curves of the SOB group and Non-SOB group gradually converged, with the difference narrowing from approximately 20 % to 10 %, and then gradually widened with the increase of the anion gap. Furthermore, when patients had high chloride levels (≥112 mmol/L), those in the SOB group exhibited a higher incidence of hypernatremia, hypokalemia, and hypocalcemia at 24 h, and a lower incidence of hyperchloremia. Patients in SOB group also had a lower simulated mortality. Among patients treated with sodium bicarbonate, those with low chloride had more difficulty in normalizing pH compared to those with high chloride. ConclusionsThis study identified an interaction between baseline chloride and sodium bicarbonate therapy on patient survival. Hyperchloremic metabolic acidosis may potentially benefit from sodium bicarbonate therapy. Further prospective randomized controlled studies are warranted.

Audit of hypocalcemia as a clinical marker following total thyroidectomy: a retrospective chart review

Background: Surgical removal is one of the most important treatment options for the thyroid swellings. Metabolic derangement due to injury to parathyroid glands is one of the complication to be dealt with frequently. The aim of this study is to assess the incidence of postoperative hypocalcemia after total thyroidectomy and to analyze various pre-operative risk factors that lead to the same. Methods: A retrospective study was conducted on patients who underwent total thyroidectomy at department of ENT and head and neck surgery over a period of 2 years. The level of post-operative serum calcium was analyzed, to determine the incidence of hypocalcemia. In all the patients the following parameters were assessed – age, gender, pre and post-operative serum calcium and type of thyroid disease. Unpaired t test and Mann-Whitney U test was used for statistical analysis. Results: The total study population was 65. The mean age of the patients was 45.5 and 83% of the patients were female. The incidence of postoperative hypocalcemia was noted to be 37%. Pre-operative serum calcium (p&lt;0.0001) was found to be significant risk factor (p&lt;0.05) for prediction of post-operative hypocalcaemia. The same was not noted between variables like age, gender and type of thyroid disease and incidence of hypocalcemia. Conclusions: A thorough knowledge of normal anatomy of neck, possible anatomical variations and parathyroid physiology is of paramount importance to prevent complications during thyroid surgery. Early identification of hypocalcemia can be achieved only by stringent postoperative monitoring, which in turn will reduce morbidity to the patient.

Incidence and predictors of hypocalcemia in end-stage renal disease patients on denosumab therapy: A systematic review and meta-analysis

Incidence and predictors of hypocalcemia in end-stage renal disease patients on denosumab therapy: A systematic review and meta-analysis

Comparison of actual prognosis between unilateral and bilateral central neck dissection in modified radical neck dissection patients with no clinical central lymph node metastasis: a retrospective cohort study.

This study aimed to evaluate the long-term prognosis of contralateral central neck dissection (CND) in papillary thyroid cancer (PTC) patients with ipsilateral lateral neck metastasis. We compared the actual recurrence rate according to the extent of CND-ipsilateral and contralateral sides. A total of 708 PTC patients who underwent total thyroidectomy and concomitant ipsilateral or bilateral CND with ipsilateral lateral neck dissection between January 1997 and December 2022 at Samsung Medical Center were retrospectively analyzed. The median follow-up time was 118 months. Locoregional recurrence was observed in 26 patients (7.9%) and 30 patients (7.9%) in the ipsilateral and bilateral CND groups, respectively. There were 6 contralateral recurrence cases (1.8%) in the ipsilateral CND group and 6 cases (1.6%) in the bilateral CND group. There was only 1 contralateral central neck recurrence in the ipsilateral CND group. The incidence of hypocalcemia (P = 0.007) was higher in the bilateral CND group compared to the ipsilateral CND group. Surgeons may consider performing only unilateral CND-the side where tumor is for therapeutic purposes to reduce surgical complications.

Endoscopic assisted parathyroid surgery via a subclavian approach

Objective:To explore the safety and efficacy of airless endoscopic surgery in the treatment of parathyroid diseases. Methods:By retrospective comparison, clinical treatment of 26 patients with primary hyperparathyroidism admitted to the Department of Otolaryngology and Head and Neck Surgery of the Hospital, Sun Yat-sen University from January 2018 to January 2023 were collected. They were divided into traditional group（13 cases） and endoscopic group（13 cases） according to the surgical method. The traditional group underwent traditional open parathyroid surgery, and the endoscopic group underwent airless endoscopic surgery through the subclavian approach. The efficacy, postoperative incision pain, incidence of adverse events, and aesthetic effects of the two groups were evaluated. Results:A total of 26 patients were included, including 13 patients in the traditional group and 13 patients in the endoscopic group. There was no significant difference in the incidence of hypocalcemia and transient hypoparathyroidism on the first day after surgery between the two groups（P>0.05）. No patients with incision pain（>3 points） or swallowing pain were found in both groups after the operation, and they were afraid or unwilling to cough and expel phlegm. There were no significant differences in the amount of blood loss, duration of operation, incidence of temporary recurrent laryngeal nerve palsy and transient hypocalcemia, and postoperative pain score between the two groups. The endoscopic group's scar evaluation score and aesthetic effect satisfaction score at 6 months after surgery were higher than those of the traditional group（P<0.01）. Conclusion:Airless Endoscopic parathyroid surgery via the subclavian approach has good effectiveness and safety, which did not significantly increase the risk of surgery. It can safely remove the lesion and leave no surgical scar on the anterior neck, which has the advantage of a good cosmetic effect. It is a safe and feasible endoscopic parathyroid surgery and can be used as a new choice for patients undergoing parathyroid surgery.

The Impact of Thyroid Surgery on Calcium and Magnesium Homeostasis: A Prospective Study.

Total thyroidectomy constitutes one of the bread-and-butter procedures of surgeons all over the world. Like with any surgical procedure, complications form a part and parcel of the postoperative course in the hospital. Hypocalcemia represents one such prevalent complication post-total thyroidectomy. This study aimed to evaluate the impact of total thyroidectomy on calcium and magnesium levels and to assess the role of magnesium in postoperative hypocalcemia. This study was carried out at a tertiary health center over a two-year period from 2022 to 2024. It involved 100 participants with thyroid conditions (benign/malignant) who required total thyroidectomy. Patients with pre-existing conditions affecting calcium levels (e.g., chronic renal failure, medullary carcinoma thyroid, etc.) were expressly excluded.Preoperative calcium, magnesium, and parathyroid hormone (PTH) levels were recorded. Intraoperative parameters such as time and fluid volume were also measured. Postoperatively, serum calcium and magnesium levels, PTH levels, and complications like hypocalcemia and hypomagnesemia were monitored. The descriptive statistics were computed to delineate the study sample. After completion of data collection, data analysis was achieved using IBM SPSS Statistics for Windows, V. 16.0 (SPSS Inc., Chicago, IL). The chi-squared test of significance was utilized to establish statistical correlations between calcium and magnesium levels post-total thyroidectomy. A p-value of less than 0.05 was considered statistically significant. The study analyzed 100 total thyroidectomy patients. The mean age of patients in our study was 50.7±8.86 years, with 97 females and three males. The most common pathology indicating total thyroidectomy was diffuse colloid goiter (46%), followed by multinodular goiter (38%). Only a single patient had preoperative biochemical hypocalcemia or hypomagnesemia, but none exhibited symptoms. After total thyroidectomy, 15% (n=15) developed hypocalcemia, and 11% (n=11) developed hypomagnesemia. Postoperative mean PTH levels slightly decreased to 28.8±11.75 pg/dl, indicating similar variability to preoperative levels. Patients who underwent intra-capsular dissection had a mean postoperative ionic calcium level of 4.89±0.54 mg/dl, while those who underwent extra-capsular dissection had a slightly lower mean ionic calcium level of 4.72±0.76 mg/dl. Hypocalcemia is one of the most prevalent complications associated with total thyroidectomy. The role of magnesium in maintaining calcium homeostasis after thyroidectomy should be further explored to improve the management of hypocalcemia. Additionally, the type of capsular dissection performed during the surgery can impact the occurrence of hypocalcemia, and using intra-capsular dissection whenever possible may help reduce the incidence of hypocalcemia.

Investigating the Incidence and Risk Factors of Hypocalcemia After Laryngectomy.

Laryngeal cancer is a common advanced head and neck cancer. Surgery, radiation, chemotherapy, or a combination of these treatments are used to treat locally advanced laryngeal cancer. Total laryngectomy is generally preferred for T3-4 laryngeal cancers, despite being an invasive procedure. Post-surgical hypocalcemia is a known complication of neck compartment surgeries, and patients who have undergone laryngectomy are at a higher risk of developing hypoparathyroidism, leading to hypocalcemia. This study aims to investigate the prevalence and risk factors of hypocalcemia in individuals following laryngectomy. This retrospective study examined 50 consecutive laryngectomy patients over eight years. Data on demographic characteristics, medical history, surgical details, pre-and post-operative calcium levels, neck dissection laterality, history of radiotherapy were collected. Hypocalcemia was defined as calcium levels < 8.5mg/dl or corrected calcium < 8.5mg/dl. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and binary logistic regression using R studio. The mean age of participants was 59 years, predominating males (94%) and habitual smokers (94%). Squamous cell carcinoma was the most prevalent (98%) pathological diagnosis, and various surgical techniques were employed. While initial comparisons showed no significant changes in calcium levels pre-and post-operatively, adjusting for albumin levels revealed a significant association. Logistic regression identified neck dissection, low pre-operative calcium, radiotherapy, and total thyroidectomy as significant predictors of post-operative hypocalcemia (p < 0.05). Surgical factors such as neck dissection and total thyroidectomy, alongside albumin levels, significantly impact postoperative hypocalcemia. These findings underscore the need for meticulous monitoring and potential preventive measures to manage calcium imbalance post-laryngectomy.

Vitamin D Deficiency is Associated with Hypocalcemia in Preterm Infants

Background: Vitamin D deficiency results in various problems, like rickets, osteomalacia, heart problems, cancer, diabetes, and autoimmune diseases. Hypocalcemia is a common disorder among preterm infants, indicating vitamin D deficiency. This study was conducted to analyze the association of vitamin D deficiency with hypocalcemia in preterm infants.Materials and methods: A cross-sectional study was performed in preterm infants born in our hospital from December 2022 to May 2023. Venous blood was collected within the first 24 hours to assess vitamin D and calcium levels. Chi-square test and logistic regression analysis were used to assess the association of gestational age, sex, birth weight, and vitamin D with the incidence of hypocalcemia. The significance was determined with p&lt;0.05.Results: There were 40 preterm newborns, comprising 37.5% moderately preterm, 20% very preterm, and 42.5% extremely preterm. Most subjects were female (52.5%). Low birth weight, very low birth weight, and extremely low birth weight occurred in 55%, 27.5%, and 17.5%, respectively. Vitamin D insufficiency and deficiency were observed in 20% and 80% subjects, respectively. Most subjects had hypocalcemia (62.5%). Chi-square test obtained a significant association of vitamin D deficiency with hypocalcemia (p=0.029).Conclusion: Vitamin D deficiency is significantly associated with the incidence of hypocalcemia in preterm infants.Keywords: Vitamin D, hypocalcemia, preterm neonates

Clinical protocol using calcium and calcitriol after paediatric total thyroidectomy decreases postoperative hypocalcaemia and inpatient blood tests

IntroductionPostoperative hypocalcaemia is common after thyroidectomy. This study aimed to evaluate whether a standardised post-thyroidectomy protocol using prophylactic calcium and calcitriol reduces hypocalcaemia incidence after total thyroidectomy in children and adolescents. MethodsA cohort children and adolescents ≤18 years of age undergoing total thyroidectomy between January 2016 and October 2022 in one institution were retrospectively identified and divided into pre-protocol and post-protocol groups. The primary outcome measure was hypocalcaemia (total serum calcium of <2.0 mmol/L; ionised serum calcium of 0.9 mmol/L). Secondary outcome measures were the occurrence of hypercalcaemia (serum Calcium >2.7 mmol/L; ionised calcium >1.31 mmol/L), length of hospitalisation and number of postoperative blood tests. ResultsThere were 22 patients in each group (mean age 11.8; SD 4.3 years, female 36 %). The rate of hypocalcaemia was significantly higher in the pre-protocol group than the post-protocol group (54 % vs 13.6 %, p = 0.010). Patients in the pre-protocol group had more inpatient blood tests (mean 5.4; SD 3.2) than the post-protocol group (mean 3.3; SD 1.8, p = 0.011), although the total postoperative blood test count was similar between the groups. Six (13.6 %) patients developed hypercalcaemia. The rate of hypercalcaemia was similar between groups (pre-protocol 2, 9.1 %; post-protocol 4, 18.1 %; p = 0.664). Length of hospitalisation was similar between groups. ConclusionOur standardized protocol decreased hypocalcemia and inpatient blood tests after total thyroidectomy in children. Future research should explore if incorporating preoperative calcium and calcitriol treatment, along with intraoperative PTH levels for risk management, can further reduce hypocalcemia rates in paediatric patients.

Resource setting impacts neonatal but not maternal survival in bitches treated for dystocia: 243 cases (2015-2020).

To compare maternal and fetal outcomes of dystocia managed surgically and nonsurgically at referral hospitals (RHs) versus community medicine clinics (CMCs), determine the rate of C-section, and evaluate the incidence of hypoglycemia and hypocalcemia in bitches presented with dystocia. Bitches presented with dystocia at 2 RHs and 2 CMCs. Information on signalment, presence of hypoglycemia and/or hypocalcemia, diagnostic imaging performed, nonsurgical and surgical interventions performed, maternal and fetal outcomes, and total cost of care was obtained from the electronic medical records of bitches presenting for dystocia between October 2015 and October 2020. Descriptive statistics were performed and outcome compared between RHs and CMCs using a Fisher exact test, with a P < .05 considered significant. 230 bitches were evaluated with 243 separate episodes of dystocia, with 183 (75%) episodes treated at an RH and 60 (25%) at a CMC. There was a low incidence of hypoglycemia (5% [9/178]) and ionized hypocalcemia (1% [2/164]). Seventy-three percent (177/243) of bitches underwent surgical intervention, 25% (61/243) received nonsurgical management, and 2% (5/243) transferred to their primary veterinarian. There was no difference in survival for bitches operated at an RH compared with a CMC. However, bitches operated at an RH were more likely (P = .04) to be discharged with at least 1 live neonate. In bitches diagnosed with dystocia, hypoglycemia and hypocalcemia were rare. The majority of bitches underwent a C-section. The setting where the C-section was performed did not impact maternal survival.

#2590 Electrolyte abnormalities in HIV patients with CKD

Abstract Background and Aims Individuals with HIV infection and CKD are prone to various water &amp; electrolyte disorders with previous studies showing prevalence of 70%. Many of these disturbances remain clinically silent until they reach an advanced stage, emphasizing the need for a high level of clinical suspicion and awareness, as they contribute to both morbidity and mortality. The prevalence of CKD in HIV patients has been increasing, yet data on electrolyte disturbances is sparse. The study we conducted aims to determine electrolyte imbalances in this population. Method Prospective observational single center study for a period of 2 years including HIV seropositive patients &amp;gt;18 years of age who were screened for CKD as per KDIGO definition (eGFR &amp;lt; 60 ml/min/1.73 m2 or significant proteinuria &amp;gt; 300 mg/day for more than 3 months). Demographic features, laboratory investigations for serum electrolytes including Sodium, Potassium, Phosphorous &amp; Calcium levels were done at baseline with follow up at 3, 6 &amp; 12 months. Results Out of 695 HIV patients screened, 56 who had CKD were included in our study. The average age was 53.8 ± 11.3 years, including 41 males (73.2%). Median creatinine at baseline was 1 (1.3) mg/dL, &amp; median eGFR was 59 (24.82) ml/min/1.73 m2 (Table 1). Commonest abnormality at baseline was hyponatremia (53.6%), and only 8.9% had severe hyponatremia (&amp;lt;125 mmol/L). Other abnormalities prevalent were hypocalcemia (35.7%) and hypophosphatemia (46.4%). Follow up details are presented in Table 2. Conclusion CKD was prevalent in 56 (8%) of our patients. Dyselectrolytemias were seen in 91% of study population. Hyponatremia (89.2%) was the commonest electrolyte imbalance followed by Hypophosphatemia (62.5%) &amp; Hypocalcemia (57.1%). Notably, our study identified a significantly higher incidence of hypocalcemia, and hypophosphatemia compared to other studies.

A Miniaturized Endoscopic Device Integrating Raman Spectroscopy and Laser Speckle Technology Via an Image Fusion Algorithm for Intraoperative Identification and Functional Protection of Parathyroid Glands

Abstract The importance of parathyroid glands (PGs) protection is increasingly recognized by thyroid surgeons in the field of minimally invasive video-assisted thyroidectomy (MIVAT). However, current techniques for intra-operative identification and vascularity assessment of the PGs are contentious and complex. This study presents the design and validation of a miniaturized device for fusion near-infrared autofluorescence (NIRAF) based on Raman spectroscopy and laser speckle contrast imaging (LSCI) via an image fusion algorithm for functional protection of PGs in the MIVAT. Our light source components include an integrated light emitting diode (LED) light source fiber, an NIRAF optical fiber, an acquisition optical fiber, and a laser speckle optical fiber in the endoscopic system to achieve identification and vascularity assessment of PGs using a single endoscopic probe. It has been validated in ex vivo tissue experiments that the fluorescence intensity detected by the device was equivalent to that of the marker indocyanine green (ICG) in visual images and superior to that of the thyroid and all other tissues in the neck. Based on clinical studies, MIVAT using functional fluorescence endoscopy, compared with the White light pattern group, the NIRAF combined with LSCI modality group increased the number of intra-operative confirmations of the PGs (P &amp;lt; 0.001), declined the decrease in parathyroid hormone (PTH) (P &amp;lt; 0.05) and calcium levels (P &amp;lt; 0.05) on the first postoperative day, and reduced the incidence of symptomatic hypocalcemia (P &amp;lt; 0.05). Our device may reduce the incidence of postoperative permanent hypoparathyroidism. Application of an miniaturized functional fluorescence endoscope for real-time and label-free PGs identification and vascularity assessment in MIVAT could be realized.

Periparturient Mineral Metabolism: Implications to Health and Productivity.

Mineral metabolism, in particular Ca, and to a lesser extent phosphorus (P) and magnesium (Mg), is altered with the onset of lactation because of extensive irreversible loss to synthesize colostrum and milk. The transient reduction in the concentration of Ca in blood, particularly when it lasts days, increases the risk of mineral-related disorders such as hypocalcemia and, to a lesser extent, hypophosphatemia. Although the incidence of clinical hypocalcemia can be reduced by prepartum dietary interventions, subclinical hypocalcemia remains prevalent, affecting up to 60% of the dairy cows in the first 3 d postpartum. More importantly, strong associations exist between hypocalcemia and increased susceptibility to other peripartum diseases and impaired reproductive performance. Mechanistic experiments have demonstrated the role of Ca on innate immune response in dairy cows, which presumably predisposes them to other diseases. Hypocalcemia is not related to inadequate Ca intake as prepartum diets marginal to deficient in Ca reduce the risk of the disease. Therefore, the understanding of how Ca homeostasis is regulated, in particular how calciotropic hormones such as parathyroid hormone and 1,25-dihydroxyvitamin D3, affect blood Ca concentrations, gastrointestinal Ca absorption, bone remodeling, and renal excretion of Ca become critical to develop novel strategies to prevent mineral imbalances either by nutritional or pharmacological interventions. A common method to reduce the risk of hypocalcemia is the manipulation of the prepartum dietary cation-anion difference. Feeding acidogenic diets not only improves Ca homeostasis and reduces hypocalcemia, but also reduces the risk of uterine diseases and improves productive performance. Feeding diets that induce a negative Ca balance in the last weeks of gestation also reduce the risk of clinical hypocalcemia, and recent work shows that the incorporation of mineral sequestering agents, presumably by reducing the absorption of P and Ca prepartum, increases blood Ca at calving, although benefits to production and health remain to be shown. Alternative strategies to minimize subclinical hypocalcemia with the use of vitamin D metabolites either fed prepartum or as a pharmacological agent administered immediately after calving have shown promising results in reducing hypocalcemia and altering immune cell function, which might prove efficacious to prevent diseases in early lactation. This review summarizes the current understanding of Ca homeostasis around parturition, the limited knowledge of the exact mechanisms for gastrointestinal Ca absorption in bovine, the implications of hypocalcemia on the health of dairy cows, and discusses the methods to minimize the risk of hypocalcemia and their impacts on productive performance and health in dairy cows.

Analysis of the efficacy and safety of bone disease treatment in patients with newly diagnosed multiple myeloma treated with denosumab or zoledronic acid

Objective: This study investigated the efficacy and safety of denosumab (DENOS) versus zoledronic acid (ZOL) in the bone disease treatment of newly diagnosed multiple myeloma. Methods: The clinical data of 80 patients with myeloma bone disease (MBD) at the Fifth Medical Center of PLA General Hospital between March 1, 2021 and June 30, 2023 were retrospectively reviewed. Eighteen patients with severe renal impairment (SRI, endogenous creatinine clearance rate<30 ml/min) were treated with DENOS, and 62 non-SRI patients were divided into DENOS (30 patients) and ZOL group (32 patients) . Results: Hypocalcemia was observed in 26 (33%) patients, and 22 patients developed hypocalcemia during the first treatment course. The incidence of hypocalcemia in the non-SRI patients of DENOS group was higher than that in the ZOL group [20% (6/30) vs 13% (4/32), P=0.028]. The incidence of hypocalcemia in SRI was 89% (16/18). Multivariate logistic regression analysis revealed that endogenous creatinine clearance rate<30 ml/min was significantly associated with hypocalcemia after DENOS administration (P<0.001). After 1 month of antiresorptive (AR) drug application, the decrease in the serum β-C-terminal cross-linked carboxy-telopeptide of collagen type I concentrations of SRI and non-SRI patients in the DENOS group were significantly higher than that in the ZOL group (68% vs 59% vs 27%, P<0.001). The increase in serum procollagen type Ⅰ N-terminal propeptide concentrations of patients with or without SRI in the DENOS group were significantly higher than that in the ZOL group (34% vs 20% vs 11%, P<0.05). The level of intact parathyroid hormone in each group increased after AR drug treatment. None of the patients developed osteonecrosis of the jaw and renal adverse events, and no statistically significant differences in the overall response rate, complete remission and stringent complete remission rates were found among the groups (P>0.05), and the median PFS and OS time were not reached (P>0.05) . Conclusions: In the treatment of MBD, DENOS minimizes nephrotoxicity and has strong AR effect. Hypocalcemia is a common adverse event but is usually mild or moderate and manageable.

Impact of a calcium replacement protocol during massive transfusion in trauma patients at a level 2 trauma center.

Hypocalcemia is associated with increased mortality in trauma patients with hemorrhagic shock who require massive transfusion protocols (MTPs). Despite known risks of potentiating hypocalcemia with blood product administration, there is little research discussing appropriate calcium replacement. The purpose of this study was to evaluate the ability of a standardized calcium replacement protocol to reduce the incidence of hypocalcemia in trauma patients undergoing MTP. This retrospective, single-center, pre-post study evaluated the use of a calcium replacement protocol during MTP. Adult trauma patients with MTP orders who received at least one "round" of product transfusion were included. Patients were excluded if their ionized calcium (iCa) levels were unavailable or they were transferred to a higher level of care within 4 hours of presentation. The primary outcome was incidence of hypocalcemia (iCa of <1.1 mg/dL) within 24 hours of MTP initiation. Secondary endpoints included the incidence of severe hypocalcemia (iCa of <0.9 mg/dL), time to first calcium dose, total calcium dose administered (mEq), resolution of hypocalcemia within 24 hours, hypercalcemia, adherence to the calcium replacement protocol, and mortality. The incidence of hypocalcemia within 24 hours was significantly lower in the postprotocol group (63% vs 95.2%; P = 0.006). There was not a significant difference in the incidence of severe hypocalcemia between the groups (39.1% vs 69.1%; P = 0.083). Time to first calcium dose was significantly shorter in postprotocol patients compared to preprotocol patients (median [interquartile range], 5.5 [0-21] minutes vs 43 [22.8-73] minutes; P < 0.0001), and postprotocol patients were administered more calcium during MTP (40.8 [27.2-54.4] mEq vs 27.2 [14-32.2] mEq; P = 0.005). Adherence to the protocol was seen in only 37% of patients in the postprotocol group. There was no difference in the rate of adverse events or overall mortality. Trauma patients who received massive transfusion of blood products had a significantly lower incidence of hypocalcemia after a calcium replacement protocol was implemented.

Incidence and Outcome of Hypocalcaemia after Total Thyroidectomy

Incidence and Outcome of Hypocalcaemia after Total Thyroidectomy

Recurrent severe hypocalcemia following chemotherapy regimen changes in advanced breast cancer: two case reports

BackgroundAs an oncologic emergency related to abnormalities in calcium metabolism, hypercalcemia associated with paraneoplastic syndrome and bone metastases is well known. Meanwhile, the incidence of hypocalcemia is low, except in cases associated with bone-modifying agents used for bone metastases. Hypocalcemia induced by bone-modifying agents typically occurs early after the initial administration, and its incidence can be significantly reduced by preventive administration of calcium and vitamin D3 supplements.Case reportWe report two cases of recurrent severe hypocalcemia occurring during chemotherapy for metastatic breast cancer with multiple bone metastases.Case 1: A 35-year-old Japanese woman developed metastases in the bone, liver, and ovaries during postoperative endocrine therapy for invasive lobular carcinoma of the breast. She underwent chemotherapy and treatment with denosumab. She experienced recurrent episodes of severe hypocalcemia subsequent to a change in the chemotherapy regimen. Case 2: A 65-year-old Japanese woman encountered multiple bone metastases after postoperative anti-human epidermal growth factor receptor 2 therapy and during endocrine therapy for invasive ductal carcinoma of the breast. She underwent anti-human epidermal growth factor receptor 2 therapy and treatment with denosumab. She experienced recurrent severe hypocalcemia subsequent to a change in the chemotherapy regimen to letrozole + lapatinib, trastuzumab emtansine, and lapatinib + capecitabine.ConclusionsWe observed two cases of recurrent severe hypocalcemia in patients with advanced breast cancer and bone metastases after modifications to their therapy regimens. These cases differed from the typical hypocalcemia induced by bone-modifying agents. It is possible that antitumor drugs affect calcium and bone metabolism associated with bone metastases. While these cases are rare, it is crucial for oncologists to be aware of hypocalcemia not only at the initiation of bone-modifying agents but also throughout the entire antitumor therapy, as hypocalcemia can lead to fatal outcomes.

Harmonic scalpel versus conventional hemostasis: Impacts on thyroid surgery outcomes

Objectives: This study aimed to compare the effectiveness and safety of the harmonic scalpel and traditional methods. Patients and Methods: In this retrospective study data from 180 patients (132 females, 48 males; mean age: 49.1±14.2 years; range, 18 to 86 years) who underwent total thyroidectomy between January 2015 and December 2022 were analyzed. Age, sex, diagnosis, thyroid size, operative time, hospital stay, and complications were recorded. The patients were divided into two groups based on the hemostasis method: harmonic scalpel and conventional methods. All surgeries were performed under general anesthesia with the same surgical teams. Results: The harmonic scalpel group demonstrated a lower incidence of hypocalcemia and shorter operation times compared to the conventional method group. No significant differences were found in vocal cord paralysis, hematoma, seroma, and wound infection rates between the groups. The harmonic scalpel was associated with a shorter mean hospital stay. Conclusion: The harmonic scalpel presents itself as a viable alternative in thyroid surgery, offering shorter operation times and hospital stays with a reduced rate of hypocalcemia.