Mean Level Of Serum Calcium Research Articles

Serum Alkaline Phosphatase, Iron and Calcium Levels in BreastCancer and Leukemia Patients in Salah Al-Din Province

This study was conducted on 19 breast cancer and 23 leukemia patients with ages ranged between 25-70 years old registered in Tikrit teaching hospital, Tikrit city, rvith the fifty four normal subject's volunteers and age ranged between 30-60 years old. Statistical analysis, show there lvere highly significant differences (p<0.05) between the mean levels of calcium, iron and alkaline phosphatase in breast cancerand leukemia compared rvith the normal strbjects. We found that the mean levels of serum calcium were higher in ler.rkemia than in breast cancer and normal subjects, also we found higher mean values of serllm iron in breast cancer compared with the leukemia and healthy subjects. The activity of the ALP 'uvas found elevated in both patients and increzrsed levels of ALP depends on the concentration of serurn iron. . We done this study to show effect of the age on calcium, iron and ALP levels in breast cancer and leukemia.

Role of Oral versus Intravenous Calcium Supplementation in Plateletpheresis Donors: A Prospective Observational Study

Introduction: Single Donor Platelets (SDP) are in high demand and are the preferred choice for patients requiring recurrent platelet transfusions. Citrate, being the anticoagulant of choice, may result in symptoms of citrate toxicity due to repeated frequent donations or increased procedure time. Aim: The present study aimed to evaluate the role of prophylactic calcium supplementation (oral vs intravenous) on plateletpheresis donors and correlate their effects with adverse donor reactions (citrate toxicity). Materials and Methods: This prospective observational study on plateletpheresis donors was conducted for a period of one year in the Department of Transfusion Medicine at Government Royapettah Hospital, The Tamil Nadu Dr. MGR Medical University, Chennai, India. It included 63 plateletpheresis donors divided into two groups based on random allocation-the Oral calcium supplementation group (n=32 donors) and the intravenous calcium supplementation group (n=31 donors). For both groups, their biochemical parameters (serum calcium, serum ionised calcium, serum magnesium) were measured before and within 30 minutes after the plateletpheresis procedure. The parameters were analysed for symptoms of citrate toxicity. Analysis was carried out using Statistical Package for Social Sciences (SPSS) Software version 20.0, and paired t-test was used for analysing biochemical parameters. Results: A statistically significant decline in serum ionised calcium levels (1.17±0.09 vs 1.10±0.11) (preprocedure level vs postprocedure level) was observed in the oral calcium supplementation group compared to the intravenous calcium supplementation group (1.07±0.25 vs 1.11±0.14). The authors observed a decline in the mean levels of serum calcium in both the oral calcium group (10.33±1.62 vs 9.88±1.00) and the intravenous calcium group (10.31±1.33 vs 10.21±0.88). Furthermore, the authors observed a decline in mean serum magnesium levels in the oral calcium group (2.13±0.30 vs 2.07±0.24) with no difference observed in the intravenous calcium group (2.14±0.22 vs 2.14±0.14). Mild citrate toxicity symptoms in the form of tingling sensation and perioral paraesthesia were observed in 26 out of 32 donors in the oral calcium group, whereas no symptoms were recorded in the intravenous calcium group. Conclusion: Prophylactic intravenous calcium supplementation resulted in better bioavailability of serum ionised calcium levels with no citrate toxicity symptoms compared to oral calcium supplementation. This results in better retention of plateletpheresis donors, enabling smooth and comfortable collection of a high concentration of platelets from a single donor. However, it is imperative to conduct more studies with a larger number of plateletpheresis donors to observe donor adverse reactions specific to the population.

MO806: Change in Pth Measuring Method Affects the Cost of Pth-Lowering Treatment

Abstract BACKGROUND AND AIMS To control mineral and bone disorders in haemodialysis (HD) patients, doses of vitamin D analogues and calcimimetics are adjusted based on serum parathyroid hormone (PTH) levels. Accordingly, method-related differences in PTH results may influence the prescribed dose of those drugs and PTH-lowering treatment costs. The aim of this study was to clarify the influence of inter-method variability in PTH measurement on PTH-lowering treatment costs. METHOD We used data from 30 maintenance HD patients in our facility. The Intact-PTH measuring assay was changed from the Elecsys PTH to the Alinity Intact PTH Reagent Kit (Alinity PTH) in March 2021, following a 2-month transitional period when PTH levels were measured using both assays. We examined method-related differences in PTH levels, using the results obtained in the transitional period. Using prescription records from October to December 2020, when the Elecsys PTH assay was used, and those from March to May 2021, when assay system was fully changed to the Alinity PTH, we examined the influence of the PTH measuring method on medication cost by evaluating the monthly cost of vitamin D analogues and calcimimetics in our facility. We evaluated the mean levels of serum calcium, phosphorus and PTH in 30 patients in the corresponding period. RESULTS Inter-method variability in PTH results was evaluated using 60 specimens from 30 patients. PTH results of 60 specimens ranged from 11 to 802 pg/mL and 8.8 to 1198 pg/mL in the Elecsys PTH and in the Alinity PTH, respectively. Compared with PTH levels obtained with the Elecsys PTH, those measured with the Alinity PTH were significantly higher (P < .001). On average, results obtained with the Alinity PTH were 1.58-fold higher than those provided by the Elecsys PTH. When the Elecsys PTH assay was used, the average monthly cost of vitamin D analogues and calcimimetics was €44 and €1668, respectively. After the assay was changed to the Alinity PTH, the average monthly costs were €40 for vitamin D analogues and €2471 for calcimimetics (€1 = ¥130). There were no notable changes in the mean serum levels of calcium, phosphorus and PTH throughout the study period. CONCLUSION Inter-method variability in PTH results would have an influence on the cost-effective assessment of PTH lowering therapy. Standardization of PTH measurement is required.

IRON & CALCIUM DEFICIENCY – POTENTIAL RISK FACTOR IN THE FORMATION OF BILIARY CALCULI – A PROSPECTIVE STUDY CONDUCTED IN A TERTIARY CARE HOSPITAL OF EASTERN INDIA.

Alteration in the serum level of trace elements may be an important causative factor in the formation of biliary calculi. Better understanding of the pathophysiology will help in prevention of this one of the commonest surgical problem in future. Deciency of the trace elements especially iron & calcium interferes with the hepatic enzyme function that precipitates gall stone formation. This hypothesis is supported by few recent studies in animal & human model in India and abroad. This prospective study was planned to evaluate serum concentration of iron & calcium in 2 groups of patients, one group having cholelithiasis and another group undergoing other elective surgical procedures, named cases and controls respectively, over a period of one and half years. It was found that the level of serum iron of the patients with gallstone was signicantly lower than that of the patients without gallstone [p=0.04]. The risk of gallstone formation was also 5.44 times more among the patients with serum iron deciency as compared to the patients with normal level of serum iron and the risk was signicant [OR-5.44(1.61, 48.39);p=0.04]. Moreover, further analysis in the case group shows that the mean level of serum iron for Pigment stone was the highest and that for Cholesterol stone was the lowest and the 2 difference is statistically signicant. Corrected Chi-square (χ ) test showed that there was signicant association between level of serum calcium and patients of the two groups (p=0.026). The risk of gallstone was 7.97 times more among the patients with serum calcium deciency as compared to the patients with normal level of serum calcium and the risk was signicant [OR-7.97(1.04, 67.45);p=0.026]. Also, t-test showed that there was signicant difference in the level of serum calcium of the patients with gallstone than that of the patients without gallstone [t98 = 1.98; p=0.04] . Among the 3 stone groups in the Case arm the mean level of serum calcium for Pigment stone was the highest and that for Cholesterol stone was the lowest, but this difference is not statistically signicant (p=0.08).

Cross-sectional Study of Calcium Phosphate Product and Intact Parathyroid Hormone Levels in Predialysis and Postdialysis Patients with Stage 5 Chronic Kidney Disease.

Chronic kidney disease (CKD) gradually deteriorates the mineral homeostasis, with a disruption of normal serum phosphorus, calcium, and intact parathyroid hormone (iPTH). Hemodialysis is one of the replacement therapies used to treat CKD patients to achieve normal kidney function. The present study aimed to evaluate the impact of dialysis on serum levels of calcium, phosphorus, and iPTH in CKD patients. A cross-sectional observational study was conducted between May 2015 and April 2017 in patients with CKD stage 5. The demographic characteristics including age, sex, body weight, and estimated glomeruli filtration rate were recorded. Serum levels of calcium, phosphorus, and iPTH were measured. A total of 100 patients divided into predialysis (n = 50) and postdialysis group (n = 50) with the mean age 50.34 and 51.88 years were included in this study, respectively. Mean levels of serum calcium and iPTH in the postdialysis patients were significantly lower than predialysis patients (P = 0.0183 and P <0.001). The proportion of patients (74%) with serum phosphorus level >4.5 mg/dL was significantly higher in postdialysis group (0.003). The risk of having high level of iPTH was 3.20 times more among the patients with level of phosphorus between 2.5 and 4.5 mg/dL [odds ratio (OR), 3.20; 95% confidence interval (CI), 1.16-8.80; P = 0.02] and 2.82 times more among patients with level of calcium <8.5 mg/dL (OR, 2.82; 95% CI, 1.13-7.01; P = 0.02). Overall observations suggest a significant reduction in levels of serum calcium and iPTH after dialysis in patients with CKD stage 5.

EFFECT OF PHOTOTHERAPY ON SERUM CALCIUM LEVELS IN NEONATAL JAUNDICE IN FULL TERM NEONATES

Introduction: The most prevalent anomalous physical finding during the first week of life is neonatal hyperbilirubinemia (NNH). It is estimated that more than two thirds of newborn babies have acquired clinical jaundice. It was also discovered that in the unconjugated hyperbilirubinemia of most neonates represents a common or exaggerated physiological syndrome. The physical immaturity of infants to handle increased production of bilirubin is referred to as Jaundice. This becomes potentially neurotoxic if severe unconjugated hyperbilirubinemia is left untreated. One of the routine strategies for treating hyperbilirubinemia is known as phototherapy. However it is not a harmless interference. This can produce negative results, such as dehydration, temperature volatility, blood flow redistribution, genotoxicity, rashes on the skin, loose skin, stools, damage to retinas, hypocalcemia and bronze baby syndrome. One of the lesser known but which has a potential adverse effect of phototherapy is hypocalcemia. A total serum calcium concentration of &lt; 7 mg / dl or ionised calcium concentration &lt; 4mg / dl (&lt; 1mol / L) is classified as neonatal hypocalcemia. Hypocalcemia increases the permeability of cells to sodium ions and increases the excitability of cell membranes.&#x0D; Material &amp; Methods: 60 full term neonates were included in present cross sectional study who was admitted to Neonatal Intensive Care Unit (NICU). Full term neonates who completed 37 weeks of gestation with unconjugated hyperbilirubinemia who require phototherapy. Under the normal protocol, traditional phototherapy equipment containing four blue light fluorescent lamps with wavelengths of 410-470 nm was mounted at a distance of 25-35 cm from the skin surface of neonates with entirely covered eyes and genitals. At 15μW / cm2 /nm at the level of the infant's skin, the irradiance during phototherapy was assessed and maintained consistently.&#x0D; Results: Among 60 neonates included in this study there were 27 (45%) male whereas 33 (55%) female neonates. In present study the mean levels of serum calcium before phototherapy was 9.21 with standard deviation of 0.83 while the serum calcium levels after phototherapy were 8.36 with standard deviation of 0.78. There was a statistically significant difference between serum mean calcium levels before and after phototherapy (p=0.001).&#x0D; Conclusion: A major issue is phototherapy induced hypocalcemia. Before beginning and during phototherapy for neonatal jaundice and close monitoring of neonates for signs of hypocalcemia, careful calcium status calculation should be carried out.. After phototherapy, there is a substantial reduction in the amount of serum calcium, but the risk of hypocalcemia in stable full-term neonates is minimal.

Low serum calcium levels occur in Nigerian adults with type 2 diabetes and correlates negatively with their glycosylated hemoglobin levels: A case-control study

Background: The prevalence of diabetes mellitus (DM) has increased globally making it a major public health concern. Serum calcium levels, together with other minerals, play an important role in the regulation of plasma glucose. The aim of this study was to determine the serum calcium levels in individuals with Type 2 DM (T2DM) as well as its relationship with their clinical characteristics and glycemic control. Materials and Methods: This was a cross-sectional study carried out at the University of Nigeria Teaching Hospital, Enugu State. A total of 300 participants were recruited, comprising 150 participants with DM and 150 age- and gender-matched normal participants as control. A questionnaire was administered to obtain clinical characteristics. Serum calcium and glycosylated hemoglobin (HbA1c) were measured. Mean ± standard deviation was calculated, and an independent t-test was used to determine the mean difference. Pearson's correlation was done to establish the correlation between serum calcium and HbA1c. Data were analyzed with SPSS version 23. Results: This study showed that the mean serum calcium level for the T2DM participants was significantly reduced (2.16 ± 0.17) when compared to that of the controls (2.21 ± 0.17)(P= 0.02). Furthermore, individuals with T2DM showed a significant negative correlation between serum calcium levels and HbA1c-a long-term measure of glycemic control (r = 0.273; P = 0.001). Conclusion: Participants with T2DM were found to have a lower mean level of serum calcium. In addition, T2DM participants who had poor glycemic control were more likely to have hypocalcemia.

A Study of Vitamin D and Calcium Level in Beta Thalassemia Major in Duhok Province

β-thalassemia major is severe hemolytic anemia which requires repeated blood transfusion and for survival, which leading to iron overload. Serious complications due to iron over load are recognized in the thalassemia patients. objectives Vitamin D and calcium are important factors for homeostasis of calcium in this study. This study was conducted for a period of two year including from patients with β- thalassemia major from Duhok Thalassemia Centre between 2014 -2015. Thirty eighth β- thalassemia major patients and thirty eighth persons with age- matched as control group were enrolled in the study. Serum concentration of 25- hydroxy vitamin D and calcium were estimated by enzyme linked fluorescent assay and colorimetric method, respectively. In patients, the level of serum 25- hydroxy vitamin D was significantly lower 11.11±4.36 ng/mL compared with control group (14.03±5.96ng/mL). Vitamin D deficiency is observed about 94.73% in patients. The mean level of serum calcium in patients group is 7.9±0.47mg/dL and 8.98±0.77 mg/dL in control group. There was a statistically significant difference in serum calcium value between patients and control group. 44.73% of patients have hypocalcaemia. This study demonstrated a high prevalence of Vitamin D deficiency and low total serum calcium levels in thalassemia patients with a significantly lower than healthy group. Hypocalcemia and vitamin D deficiency may be results from the negative effect of the repeated blood transfusion and malnourishment.

A study to evaluate the efficacy of intra oral periapical radiographs (IOPA) in the diagnosis of osteoporosis in postmenopausal women, as compared to ultrasonography of calcaneus

Introduction: The risk factors for the development of osteoporosis include ageing, menopause, insufficient consumption of food containing calcium, familial education and decreased physical activity. Dual-energy X-ray absorptiometry (DXA) and quantitative ultrasound are among the techniques developed to identify individuals with osteoporosis and serve as the gold standard. These methods are very expensive and hence there is a need to develop alternative methods to diagnose osteoporosis in postmenopausal women. Objectives: 1. To evaluate digital IOPAs in post-menopausal women for changes in the trabecular pattern, to assess osteoporosis in postmenopausal women by comparing with USG-calcaneus; 2. To assess the changes in the serum calcium levels in osteoporosis in postmenopausal women by comparing with USG-calcaneus. Materials and Methods: 100 patients were divided into 2 groups (pre and post-menopausal women.) Each patient underwent digital radiographic examination of premolar molar region of the mandible on the right side using bisecting angle technique and the density measurements i.e. grey values were measured and trabecular patterns were assessed in these radiographs. 2 ml of blood sample was taken from antecubital vein by venipuncture method and serum calcium was estimated. USG - Calcaneus Estimation was done and the speed of sound in m/sec for every patient was also noted. Results: It was found that 46% of patients in the postmenopausal group had a sparse trabecular pattern, while only 2% in the premenopausal group showed similar findings. Significantly higher numbers of patients with sparse trabeculation were observed in the postmenopausal group (p < 0>p-value 0.0009). (54%). No significant differences in the mean levels of serum calcium were observed between the postmenopausal and premenopausal groups. Conclusion: Intra oral periapical radiographs (IOPA) seem to be a promising tool in screening post-menopausal women for osteoporosis. The indices used in th

Correlation between Serum Magnesium and Calcium Level in Children with Idiopathic Nephrotic Syndrome during Nephrosis

Background: Biochemical alteration is a common phenomenon in all kidney disease including nephrotic syndrome (NS).Objective: To evaluate the magnesium (Mg) level in patients with nephrotic syndrome and its relation to calcium.Methods: In this observational cross sectional study,we measured serum magnesium and serum calcium levels in children with nephrotic syndrome.It was conducted in the Department of Pediatrics, Dhaka Shishu(children) Hospital, Dhaka, from January 2015 to June 2015. A total of fifty four diagnosed cases of nephrotic syndrome were divided into initial episode, first relapse,infrequent relapse and frequent relapse. Mean level of serum magnesium and calcium of all four groups were then compared.Results :The mean level of serum magnesium during initial episode was 2.28±0.36mg/ dl and it was 2.04±0.29,2.06±0.29 and 1.76±0.32mg/dl during first relapse, infrequent relapse and frequent relapse respectively. The mean serum magnesium level in different patterns of nephrotic syndrome was found to be statistically significant. Hypomagnesemia was mostly found in frequent relapse nephrotic syndrome patients. The mean level of serum calcium during initial episode was 2.01±0.16 and it was 1.98±0.17,2.06±0.13 and 2.05±0.15 during first relapse, infrequent relapse and frequent relapse respectively. The mean serum calcium level in different patterns of nephrotic syndrome was found to be statistically insignificant. There was no significant corelation between calcium level with magnesium level (r = -0.08, p = 0.28).Conclusion: Hypomagnesemia is commonly found in frequent relapse nephrotic syndrome. There was no significant correlation between calcium with magnesium level.Bangladesh J Child Health 2016; VOL 40 (3) :139-143

Predicting postoperative total calcium requirements after parathyroidectomy in secondary hyperparathyroidism.

Background/Aims:To prevent hypocalcemia after parathyroidectomy (PTX), parenteral calcium is required in addition to oral calcitriol and calcium. After switching to oral calcium, patients can be discharged from the hospital. The aim of this study was to analyze the clinical characteristics and outcomes of PTX performed at a single Korean center and to investigate the associated laboratory factors used to analyze the total amount of postoperative calcium required. Methods:We enrolled 91 hemodialysis patients undergoing PTX from November 2003 to December 2011. We collected clinical and laboratory data preoperatively, 12 and 48 hours postoperatively, at discharge, and 3 and 6 months postoperatively.Results:In total, 59 patients underwent PTX with autotransplantation (AT), 6 underwent total PTX without AT, 11 underwent subtotal PTX, and 15 underwent limited PTX. Total PTX without AT showed the lowest recurrence rate. At all postoperative time points, the mean levels of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) decreased significantly, compared with preoperative levels; however, alkaline phosphatase (ALP) increased significantly from 48 hours postoperatively to discharge (p < 0.001). On multiple linear regression analysis, the total amount of injected calcium during hospitalization showed a significant correlation with preoperative ALP (p < 0.001), preoperative iPTH (p = 0.037), and Δphosphorus at 48 hours (p < 0.001). We developed an equation for estimating the total calcium requirement after PTX.Conclusions:Preoperative ALP, preoperative iPTH, and Δphosphorus at 48 hours may be significant factors in estimating the postoperative calcium requirement. The formula for postoperative calcium requirement after PTX may help to predict the duration of postoperative hospitalization.

The Correlation between Cerebrospinal Fluid and Levels of Serum Zinc and Calcium in Children With Febrile Seizure

Background: Febrile seizure (FS) is one of the most common neurological conditions in childhood. It seems that zinc and calcium deficiency are related to seizure activity. Objectives: The aim of the present study was to measure zinc and Calcium levels in the serum and cerebrospinal fluids of febrile convulsive children referred to Zanjan University, Valie Asr hospital. Patients and Methods: Three hundred and ten consecutive children with febrile seizure, who were admitted from January 2009 to December 2010, were studied. Forty five children required lumbar puncture based on the discretion of treating physician. Levels of zinc and calcium were measured in the serum and cerebrospinal fluid specimens of patients using atomic absorption spectrometry method. Results: The mean levels of serum calcium, serum zinc, cerebrospinal fluid calcium and cerebrospinal fluid zinc were 14.51 ± 3.69 mg/dL; 184.04 ± 65.49 µg/dL; 5.23 ± 2.21 mg/dL and 87.06 ± 28.25 µg/dL respectively. Conclusions: We did not find any clear abnormality in plasma or cerebrospinal fluid calcium and zinc levels in children with febrile seizures in our patient population.

Familial clustering of medullary sponge kidney is autosomal dominant with reduced penetrance and variable expressivity

Medullary sponge kidney (MSK) is a renal malformation typically associated with nephrocalcinosis and recurrent calcium nephrolithiasis. Approximately 12% of recurrent stone formers have MSK, which is generally considered a sporadic disorder. Since its discovery, three pedigrees have been described in which an apparently autosomal dominant inheritance was suggested. Here, family members of 50 patients with MSK were systematically investigated by means of interviews, renal imaging, and biochemical studies in an effort to establish whether MSK is an inheritable disorder. Twenty-seven MSK probands had 59 first- and second-degree relatives of both genders with MSK in all generations. There were progressively lower mean levels of serum calcium, urinary sodium, pH, and volume, combined with higher serum phosphate and potassium from probands to relatives with bilateral, to those with unilateral, and to those unaffected by MSK. This suggests that most affected relatives have a milder form of MSK than the probands, which would explain why they had not been so diagnosed. Thus, our study provides strong evidence that familial clustering of MSK is common, and has an autosomal dominant inheritance, a reduced penetrance, and variable expressivity.

Vitamin D deficiency in hemodialysis patients

Background:Vitamin D [(25(OH)D] deficiency and insufficiency is common in patients with chronic kidney disease (CKD). 25(OH)D has been found to have beneficial effects on bone, cardiovascular and immune functions. There are little data about vitamin D levels in Indian patients on dialysis. This study was undertaken to determine the vitamin D status of Indian CKD patients on hemodialysis.Materials and Methods:We included 45 patients on maintenance hemodialysis coming to Medanta, Medicity, Gurgaon. 25(OH)D levels were measured with radioimmunoassay (Diasorin) method and parathyroid hormone (PTH) was measured using electrochemiluminiscence immunoassay (ECLIA).Results:The mean age of patients was 55 ± 13 years. 32/45 (71%) were males. 23/45 (51%) were diabetics. The median duration of hemodialysis was 5.5 months (range 1–74 months). 33/45 (74%) patients were on thrice weekly hemodialysis. The mean level of vitamin D was 10.14 ± 8.7 ng/ml. Majority of the patients [43/45 (95.5%)] were either vitamin D deficient or had insufficient levels. 40/45 (88.9%) were vitamin D deficient (levels <20 ng/ml); of these, 29/40 (64.4%) had severe vitamin D deficiency (levels <10 ng/ml) and 3/45 (6.7%) had insufficient levels (20–30 ng/ml) of vitamin D. Only 2/45 (4.4%) patients had normal levels of vitamin D. 23/45 (51%) of patients were receiving calcitriol. The mean levels of serum calcium, phosphorus, alkaline phosphatase, and albumin were 8.8 ± 0.64 mg/dl, 5.0 ± 0.7 mg/dl, 126 ± 10.3 IU/l and 3.6 ± 0.62 g/dl, respectively. PTH levels ranged from 37 to 1066 pg/ml, and the median was 195.8 pg/ml. There was a weak correlation between 25(OH)D levels and weight, sex, hemoglobin, albumin, alkaline phosphatase, and presence of diabetes. There was, however, no correlation with duration of dialysis or PTH levels.Conclusion:Vitamin D deficiency and insufficiency are universal in our hemodialysis patients, with severe vitamin D deficiency in two-third of patients.

Vitamin D Repletion in Patients with Primary Hyperparathyroidism and Coexistent Vitamin D Insufficiency

Vitamin D insufficiency is common in patients with primary hyperparathyroidism (PHPT) and may be associated with more severe and progressive disease. Uncertainty exists, however, as to whether repletion of vitamin D should be undertaken in patients with PHPT. Here we report the effects of vitamin D repletion on biochemical outcomes over 1 yr in a group of 21 patients with mild PHPT [serum calcium <12 mg/dl (3 mmol/liter)] and coexistent vitamin D insufficiency [serum 25 hydroxyvitamin D [25(OH)D] <20 microg/liter (50 nmol/liter)]. In response to vitamin D repletion to a serum 25(OH)D level greater than 20 microg/liter (50 nmol/liter), mean levels of serum calcium and phosphate did not change, and serum calcium did not exceed 12 mg/dl (3 mmol/liter) in any patient. Levels of intact PTH fell by 24% at 6 months (P < 0.01) and 26% at 12 months (P < 0.01). There was an inverse relationship between the change in serum 25(OH)D and that in intact PTH (r = -0.43, P = 0.056). At 12 months, total serum alkaline phosphatase was significantly lower, and urine N-telopeptides tended to be lower than baseline values (P = 0.02 and 0.13, respectively). In two patients, 24-h urinary calcium excretion rose to exceed 400 mg/d, but the group mean 24-h urinary calcium excretion did not change. These preliminary data suggest that vitamin D repletion in patients with PHPT does not exacerbate hypercalcemia and may decrease levels of PTH and bone turnover. Some patients with PHPT may experience an increase in urinary calcium excretion after vitamin D repletion.

Behandlung der Kopfhaut-Psoriasis

The scalp is a problematic area in psoriasis where treatment is often difficult. The lesions often extend beyond the hairline to involve the forehead, neck and sensitive facial skin. Topical corticosteroids and potentially irritant topical preparations have only limited utility in these sensitive areas. Most of the patients additionally suffer from psychosocial problems due to the visibility of lesions. The aim of this multicenter, prospective, randomized, double-blind study, was to assess efficacy, safety and tolerability of once daily tacalcitol emulsion (4 micro g/g) compared to placebo in the treatment of scalp psoriasis. To determine efficacy, safety and tolerability, 273 patients with mild to moderate scalp psoriasis were treated over a 8-week period. Response to treatment was evaluated using the sum score of erythema, infiltration and scaling. Global improvement of psoriasis was rated by the investigators and the patients using a 5-point scale. In addition the single scores of erythema, infiltration and scaling were assessed by the investigators, and the patients were asked to evaluate the intensity of itching and scaling over the treatment period. Tacalcitol was significantly superior to placebo in reducing the severity of scalp psoriasis. At the end of the study, the median sum score decreased by 53% in the tacalcitol group and was significantly better than placebo with 30% (p<0.0001). Global assessment of improvement was significantly greater in the tacalcitol group in both investigator and patient evaluation. 80% of patients on tacalcitol showed improvement to clearance and was statistically significant better than placebo (p <0.0001) in the investigator rating after 8 weeks. Tacalcitol was significantly superior to placebo in reducing erythema, scaling and infiltration, and in the patient assessment in reducing scalp scaling and itching. Treatment was very well tolerated. Local reactions were transient and uncommon. Their incidence was similar in both treatment groups. No serious side effects were reported, including those relating to calcium homeostasis or vitamin D(3) metabolism. No changes in mean levels of serum calcium, parathyroid hormone (PTH), calcitriol and in 24h-urinary excretion were observed. The results of this study indicate that topical application of tacalcitol (4 micro g/g) emulsion once daily is an effective, safe and very well- tolerated treatment for scalp psoriasis.

Comparative study of bone mineral density, calcium, and vitamin D status in the Gujarati and white populations of Leicester

Objectives: To evaluate differences in bone mineral density (BMD), calcium, and vitamin D status between the Gujarati (South Asian) and white populations resident in Leicester and to determine whether this...

Suramin administration is associated with a decrease in serum calcium levels.

Suramin has been shown to have an effect on bone resorption in in vitro models. It is not clear if a similar effect is seen in patients treated with suramin. The clinical effect of suramin treatment on total serum calcium was examined in two groups of patients with hormone-refractory prostate cancer. In all, 28 patients in group 1 were examined within 2 weeks before and 2 weeks after suramin treatment and 72 patients in group 2 were examined within 2 weeks before, during, and after treatment with suramin. In addition, calcium controls spiked with suramin were run in three different commercially available assays for evaluation of the effect of suramin dose on calcium determination. Group 1 patients showed a decrease in serum calcium after treatment with suramin. The mean uncorrected serum calcium level was 2.29 +/- 0.025 mmol/l before treatment and 2.09 +/- 0.025 mmol/l after treatment (P < 0.0001, paired Wilcoxon test). The mean serum calcium value corrected for albumin was 2.33 +/- 0.02 mmol/l before treatment and 2.24 +/- 0.02 mmol/l after treatment (P = 0.0022, paired Wilcoxon test). Group 2 patients also displayed a decrease in serum calcium after treatment with suramin. The mean baseline value was 2.23 mmol/l (median 2.26 mmol/l, range 1.20-2.54 mmol/l). The mean level of serum calcium corrected for albumin as determined at the end of treatment was 2.14 mmol/l (median 2.16 mmol/l, range 0.98 2.46 mmol/l). In all, 48 patients for whom pre- and post-treatment values were available for analysis displayed a median calcium decrease of 0.09 mmol/l (P = 0.0005, Wilcoxon signed-rank test for the null hypothesis of no change). For 68 patients in group 2, data on serial serum calcium measurements during treatment were available for analysis. A projected median decrease in serum calcium of 0.06 mmol/l (range 0.43 to 0.72 mmol/l) over an 8-week interval of suramin therapy was found. Overall, 47 of the 68 slopes were negative (P = 0.0022, Wilcoxon signed-rank test). Nine patients were treated with suramin for less than 6 weeks. These patients' calcium levels were significantly higher than those of 50 patients treated for longer periods (median value 2.24 versus 2.16 mmol/l, P = 0.035, Wilcoxon rank-sum test). No correlation was found between suramin dose and calcium level using the Kodak Ektachem, Hitachi 914, or Synchron Clinical System CX3 method. In conclusion, suramin treatment was consistently associated with decreases in serum calcium in two groups of patients with hormone-refractory cancer. Suramin placed in calcium controls did not affect calcium determination using three commercially available methods.

Seasonal variation in serum-25-OH-D3 in mothers and newborn infants in northern finland.

Two groups, each consisting of twenty Finnish mother-neonate pairs and ten non-pregnant controls were studied for serum calcium, serum phosphate, serum alkaline phosphatase, parathormone index (PTHind) and S-25-OH-D3. The first series was collected in winter and the other in summer. The serum samples were taken on the third day after delivery. The concentrations of S-25-OH-D3 were significantly lower in the mothers than in the non-pregnant controls in winter, but the difference was not significant in summer. The concentrations of S-25-OH-D3 in the serum of the mothers were similarly significantly lower in winter than in summer, ten mothers exhibiting a value below the detection line in winter, but only two in summer. The concentrations of S-25-OH-D3 in the mothers and their newborn infants showed a close relationship, but when extremely low values existed in the mothers, the infant concentrations were slightly higher. The seasonal variation in S-25-OH-D3 was also significant in the neonates. Although calcium was decreased and alkaline phosphatase elevated when compared with the non-pregnant controls in the mothers in both groups, these values showed no seasonal variation, and the mean levels of serum calcium, phosphate, alkaline phosphatase and PTHind in the neonates also remained unaltered between the two groups. The results indicate that additional vitamin D should be supplied during pregnancy in the winter months at this latitude.

Uremic polyneuropathic motor paralysis and immobilization hypercalcemia.

Among 35 patients with chronic uremia and treated with intermittent hemodialysis, reversible hypercalcemia was observed in 7 out of 9 patients with uremic polyneuropathia and distal motor paralysis, but only in 2 out of 24 patients without paralysis. The hypercalcemia appeared in 3 cases in strict connection with immobilization. The patients with distal motor paralysis had a higher mean level of serum calcium, a higher frequency of metastatic calcifications and an increased tendency to progressive osteoporosis. This is regarded as the result of an increased calcium flow from the bones caused by inactivity and immobilization. The assumption that renal insufficiency may be a primary factor in immobilization hypercalcemia is discussed.