Mean Serum Alkaline Phosphatase Levels Research Articles

SAT181 Clinical Profile And Treatment Outcomes Of Patients With Sporadic And Multiple Endocrine Neoplasia Syndrome-related Primary Hyperparathyroidism

Abstract Disclosure: U.E. Mathew: None. V.P. Jyotsna: None. A.S. Upadhyay: None. A. Goyal: None. D. Kandaswamy: None. C. Bal: None. A. Sharma: None. C.K. Sharma: None. S. Aggarwal: None. N. Tandon: None. Primary hyperparathyroidism (PHPT) is the most frequent endocrine disorder in MEN-1. The MEN-1 related PHPT (MPHPT) differs from sporadic (SPHPT) in many aspects. The distinction between them is very important at the point of diagnosis as it enables planning on treatment and subsequent surveillance for other endocrine tumours. Objective: The aim of study was to compare the clinical, biochemical, radiological features and surgical outcome in patients with MPHPT versus SPHPT and to identify the predictors of MEN-1 among apparently sporadic hyperparathyroidism. Design: Ambispective cross-sectional study from 2015-2021. Participants: 251 subjects with SPHPT and 23 subjects with MPHPT. Setting: The endocrine clinic of All India Institute of Medical Sciences, New Delhi, India. Results: The classical symptoms of hyperparathyroidism (80.5% vs 47.8%, p<0.001), mean serum calcium (12.7 vs 11.8 mg/dl, p=0.01) and alkaline phosphatase (ALP) levels (p=0.03) were significantly seen higher in SPHPT than MPHPT. MEN-1 patients showed low bone mineral density (BMD) at lumbar spine (-1.52±1.44 vs -2.6±1.25, p=0.001) and femoral neck (1.13±1.37 vs-1.81±1.01, p=0.002) and higher prevalence of complicated nephrolithiasis (34.5 % vs 56.5%, p=0.03) for the age. BMD at their lumbar spine showed an inverse correlation with serum PTH (r=-0.51, p=0.01). Whereas the typical radiological features of hyperparathyroidism and severe skeletal manifestations including brown tumours and fractures were observed less in MEN-1 (44.8% vs 21.7% vs, p=0.02). The overall remission rate was 98.6% in SPHPT and 90% in MPHPT on long term follow up.Despite milder biochemical features, the frequency of hungry bone syndrome was not different from SPHPT (11.6% vs 15.8%, p=0.32). The transient and permanent hypoparathyroidism were more common in MPHPT group (24.4% vs 50%, p=0.01: 0.4% vs 15%, p=0.002).The factors strongly predictive of MEN-1 in multivariate analysis were ALP within the normal range (OR 4.2(95% CI 1.1-16.9), p=0.038), lower lumbar spine BMD (OR 0.47 (95% CI (0.28-0.76), p=0.003) and hyperplastic parathyroid gland on histopathology (OR 37.1(95% CI (9.9-138.6), p<0.001). The multivariate predictive model showed an excellent discrimination between two classes with area under curve in ROC was 0.91. Conclusions: MEN-1 associated PHPT have severe bone and renal involvement despite milder biochemical features, even in Indian settings, where there is a higher frequency of severe symptomatic sporadic hyperparathyroidism. MEN-1 should be suspected when, a discordant finding of severe degree of bone demineralisation at lumbar spine and in normal range of ALP, has observed among apparently SPHPT. Our model can assist in deciding on screening for MEN-1 as the family history and multiglandular involvement may be absent at the presentation, and delay in development of other endocrine tumours. Presentation: Saturday, June 17, 2023

Clinical profile and treatment outcomes among patients with sporadic and multiple endocrine neoplasia syndrome-related primary hyperparathyroidism.

Accurate demarcation between multiple endocrine neoplasia, type 1 (MEN1)- related primary hyperparathyroidism (MPHPT) and sporadic PHPT (SPHPT) is important to plan the management of primary parathyroid disease and surveillance for other endocrine and nonendocrine tumours. The objective of this study is to compare the clinical, biochemical and radiological features and surgical outcomes in patients with MPHPT versus SPHPT and to identify the predictors of MEN1 syndrome in PHPT. This was an ambispective observationalstudy involving 251 patients with SPHPT and 23 patients with MPHPT evaluated at the endocrine clinic of All India Institute of Medical Sciences, New Delhi, India between January 2015 and December 2021. The prevalence of MEN1 syndrome among patients with PHPT was 8.2% and a genetic mutation was identified by Sanger sequencing in 26.1% of patients with MPHPT. Patients with MPHPT were younger (p < .001), had lower mean serum calcium (p = .01) and alkaline phosphatase (ALP; p = .03) levels and lower bone mineral density (BMD) Z score at lumbar spine (p < .001) and femoral neck (p = .007). The prevalence of renal stones (p = .03) and their complications (p = .006) was significantly higher in MPHPT group. On multivariable analysis, factors predictive of MPHPT were hyperplasia on histopathology [OR 40.1, p < .001], ALP levels within reference range [OR 5.6, p = .02] and lumbar spine BMD [OR 0.39 per unit increase in Z score, p < .001]. Patients with MPHPT have more severe, frequent and early onset of bone and renal involvement despite milder biochemical features. A normal serum ALP, low BMD for age and gender at lumbar spine and histopathology evidence of hyperplasia are predictive factors for MEN1 syndrome in PHPT.

Effect of antiepileptic drugs on bone metabolism in children using biochemical markers: a case control study

Background: Most epileptic patients are diagnosed and treated in childhood and adolescence and this period is crucial in attaining peak bone mass. Few studies are conducted on children showing long term effects of AEDs on bone metabolism. So, the present study was conducted to evaluate correlation of long-term uses of AEDs with changes in bone metabolism using biochemical marker. Methods: Total of 140 subjects divided into 70cases - Epileptic children aged 1 to 14 years who are on AEDs for at least 6months and 70 Controls- Children aged 1 to 14 years not on AEDs. Semi structured questionnaire was used to collect demographic data. Venous blood samples were collected and sent for laboratory investigations like Serum vitamin D, serum calcium, serum phosphorus, Parathyroid hormone and alkaline phosphatase levels. Results: Mean age of study population in cases was 7.74±4.43 years and in controls was7.65±3.72 years. Mean vitamin-D, calcium, phosphorus decreases while PTH and ALP increases with duration of treatment in epileptic children with a statistically significant difference between them (P&lt;0.05). Mean serum vitamin D level in cases and in controls was with no statistical significant difference between two groups. Mean serum calcium, phosphorus, parathormone and alkaline phosphatase levels in cases and controls all had a statistically significant mean difference between two groups. Serum vitamin-D, serum calcium, serum phosphorus was low in patients treated with enzyme inducing when compared to non-enzyme inducing drugs in epileptic children with a statistically significant difference between them (P&lt;0.05). Serum vitamin-D, serum calcium, serum phosphorus was high in patients on monotherapy when compared polytherapy in epileptic children with a statistically significant difference between them (P&lt;0.05). Conclusions: Present study shows that children on AEDs for longer duration had low bone mineral parameters when compared to normal children. The study emphasizes that mineral levels need to be monitored in epileptic patients as they are at a higher risk of falling and bone fractures.

Clinical and demographic aspects of Paget disease of bone: A multicentric study from Turkey.

Paget disease of bone (PDB) is a metabolic bone disease that has been rarely reported in the Eastern countries. This study aimed to evaluate the clinical and demographic characteristics of patients with PDB followed up at endocrinology clinics in Turkey. An invitation was sent to tertiary endocrinology clinics to complete a survey on the demographic, clinical, radiological, and laboratory parameters, as well as treatment modalities of patients with PDB. This study enrolled clinically and radiologically proven 185 patients with PDB from 18 endocrinology centers based in 10 cities of Turkey. This cohort of PDB had female preponderance (women/men: 105/80) with a mean age, during diagnosis, of 57±10 years. Most of the patients (59.6%) were symptomatic at diagnosis. Bone pain and headache were the predominant clinical symptoms. Polyostotic disease was observed in 67.5% (n=125) of patients. Frequently affected bones were skull (41.6%), pelvis (53.5%), spine (41%), and femur (25.4%). Moreover, 17 patients with skull involvement had hearing loss. Mean serum alkaline phosphatase (ALP) level (552±652 IU/L; range: 280-5762 IU/L) was over the normal reference cutoff with normal serum calcium levels. Intravenous bisphosphonates (zoledronic acid, 5 mg; pamidronate, 60-90 mg) were the most used drugs (75%) for the treatment of PDB. Most of the patients (87.1%) treated with intravenous bisphosphonates responded well, with a decrease in serum ALP level (117±114 IU/L) in the 12th month of therapy. Furthermore, 16 patients relapsed after the second year of therapy; 3 patients did not respond to the initial intravenous bisphosphonate treatment. The patients with PDB followed up by endocrinology clinics of Turkey exhibited polyostotic disease with classical clinical, radiological, and biochemical features and women's predominance with good response to intravenous bisphosphonate therapy.

Frequency of Vitamin D deficiency and its association with serum PTH levels in end stage renal disease patients.

To assess the frequency of Vitamin D Deficiency and its association with serum Parathormone (PTH) levels in End stage renal disease patients in a tertiary setup. This cross sectional study was conducted in the Department of Nephrology, Liaquat National Hospital from January to December 2016 and comprised patients with End stage renal disease on maintenance haemodialysis. Sample size of 113 at 8% prevalence was calculated inflated to 150. Participants were selected through purposive sampling technique. Numerical variables were expressed as mean ± SD (standard deviation) while categorical variables were expressed as frequency and percentages. To determine association between Vitamin D and serum Parathormone (PTH) levels chi-square test was applied. Association of serum alkaline phosphatase levels with both Vitamin D levels and PTH levels was analyzed using chi-square test. SPSS 20 was used for data analysis. P-value <0.05 was taken as significant. Of the 150 participants, 33 were drop outs, 63(53.8%) were males and 54(46.2%) were females. The overall mean age was 52.47±15.21 years. Of all, hypertension as a comorbidity was present in 64(54.7%), Diabetes mellitus was present in 8(6.8%) and cardiovascular disease in 7(6%). Among the biochemical markers, mean serum vitamin D levels were 18.6±13.6ng/ml, mean Serum PTH levels were 253.8±227.2pg/ml, mean serum alkaline phosphatase levels were 143.7±125.4μg/L, mean serum phosphorus levels were 4.81±3.46mg/dl and mean serum calcium levels were 21.41±114.4mg/dl. Among the study participants, 67(57.3%) were found to be Vitamin D deficient. Both low and normal vitamin D was associated with High PTH (P <0.001) Other significant associations noted were that of High Alkaline Phosphatase with High PTH levels and a normal Vitamin D level (P<0.001). Our study revealed more than half of our participants were Vitamin D deficient and an association was found between Normal Vitamin D levels and high serum PTH levels with associated high alkaline phosphatase levels.

PARATHYROID HORMONE AND BIOCHEMICAL METABOLIC BONE MARKERS IN PATIENTS WITH β-THALASSEMIA MAJOR IN MISAN PROVINCE / IRAQ

Beta-thalassemia is a heterogeneous group of hereditary blood disorders characterized by defects in the synthesis of the β- chains of hemoglobin, resulting in variable phenotypes ranging from severe anemia to clinically asymptomatic individuals. This study aims to assess the serum PTH, vitamin D, calcium, phosphorus, alkaline phosphatase, and magnesium levels in β-thalassemia major patients. A total of 50 (30 male and 20 female) patients with β- thalassemia major with ages range 11- 16 years and an equal number of sex-matched healthy adolescents as a control group were included in this study. A total of 52% of patients were lived in an urban area, and there was no significant difference between patients and the control group regarding residency. Male patients showed low statistically significant (P 0.05) mean serum PTH, vitamin D, and calcium levels, but mean serum phosphorus and alkaline phosphatase levels were significantly higher (P 0.05) as compared to the male control group. However, female patients had low, but without statistical significant (P&gt;0.05) mean serum PTH level, whereas vitamin D and calcium levels were highly significant (P 0.05) reduced. The phosphorus and ALP levels were highly significantly (P 0.05) increased as compared to female controls. Regarding β- thalassemia major group, the current study showed male patients had non-significant (P 0.05) higher levels of PTH, calcium, phosphorus, and ALP. In contrast, vitamin D level was non-significantly (P 0.05) low in male patients as compared to female patients. Mean serum level of PTH had a negative correlation with phosphorus, but it had a positive association with vitamin D, calcium, ALP, and magnesium. In conclusion, this study demonstrated that β-thalassemia major patients have a markedly deranged biochemical metabolic bone profile. Regular monitoring of PTH and biochemical mineral profile is also recommended.

SUN-345 Use of Anti-FGF23 Monoclonal Antibody in the Treatment of Children and Adolescents with X-Linked Hypophosphatemic Rickets

Background: X-linked hypophosphataemia is the most common heritable form of rickets in children, disorder caused by mutations in PHEX, leading to elevated secretion of FGF23, renal phosphate wasting with consequent hypophosphataemia, diminish synthesis of 1,25(OH)2 vitamin D, rickets/osteomalacia, and disproportionate short stature. Conventional treatment with oral phosphate supplementation and active vitamin D heals rickets, prevents progressive growth failure, but in a substantial proportion of patients treatment is unsuccessful and/or associated with adverse effects. Since 2018, burosumab, a human monoclonal antibody against FGF23, was approved for the treatment of X-linked hypophosphataemia.Aim: We report a pilot experience on the efficacy and safety of treatment with burosumab in children and adolescents with X-linked hypophosphataemia (XLH). Methods and patients: Eight XLH patients (5 males) (5 pre pubertal and 3 Tanner IV) with an age range from 2.9 to 16.2 years, were recruited, 6/8 had family history of XLH, the remaining two were confirmed with molecular study. All discontinue conventional therapy at least 7 days before treatment with Burosumab which was administered every 2 weeks SC for 6 months, at a starting dose of 0.8 mg/kg/dose. Growth velocity, Thacher Rickets Severity Score, fasting serum calcium (mg/dl), phosphorus (P)(mg/dl), alkaline phosphatase (ALP)(IU/L), PTH (pg/dl), 25OH Vitamin D (ng/ml) and tubular phosphate reabsorption (TPR) (X±SD) were evaluated at basal, 3, and 6 months of treatment. Results: All patients had normal 25OH2 Vitamin D: 35.3±8.6 ng/ml at the start of therapy and had significantly improvement of serum P: basal 2.2±0.51, 3 months: 3.24±0.43 and at 6 months 3.01±0.38 mg/dl (p<0.005). The mean serum ALP level decreased from 686.9±410.8 to 535.8±302.4 and 402.5±106.7 IU/L (p<0.05) respectively. TPR normalized during treatment: 67.3±9, 86±3.1, and 86.9±6.1 %(p<0.001). The severity of rickets, as well, showed a significant improvement: 4.0±2.0, 2.3±1.2, and 1.0±0.8 (p<0.005), respectively. The non-pubertal children increased their growth velocity from 3.7±1.2 cm/yr to 7.0±1.4, and 7.9±2.0 cm/yr (p<0.05) respectively. Serum calcium and PTH levels did not show any significantly variation. Mild adverse events such as local reactions and headaches were observed. Conclusions: 1) Treatment with burosumab restores phosphate metabolism, 2) Growth and the Thacher Rickets Severity Score improved during treatment, 3) all patients showed a good safety profile with only minor adverse events. This is the first report of children with XLH treated with burosumab in Latin-America.

Paget's Disease of Bone in Tunisia: A Study of 69 Patients.

Context:Paget's disease of bone is a common bone disease with a striking variation in its incidence and characteristics in different parts of the world. It is uncommonly reported in African patients.Aims:Given the lack of studies describing the characteristics of patients with Paget's disease of bone in North Africa, we aimed to describe demographic, clinical, biochemical, and imaging characteristics, as well as treatment outcomes of Tunisian patients with Paget's disease of bone.Subjects and Methods:This bicentric and retrospective study included patients with Paget's disease of bone. Clinical, laboratory, radiological profile, and response to treatment were analyzed.Results:Sixty-nine patients were identified. The mean age was 64.9 ± 11.6 years and 52.2% were women. One patient reported a positive family history. Seven patients were asymptomatic. Bone pain was the most common presenting symptom. Eight patients had a history of malignancy. In three patients, Paget's disease of bone was diagnosed as part of a metastatic workup. Monostotic disease was found in half of the cases. The most commonly involved sites were pelvis (43.5%), femur (21.7%), and spine (21.7%). The mean serum alkaline phosphatase level at presentation was 591 U/L (68–8380). Two patients received salmon calcitonin (2.8%) and 47 patients (68.1%) received bisphosphonates. After a mean follow-up of 55 months (2–240 months), bone pain improved in 43.1% of patients and the serum alkaline phosphate levels had normalized in 22 of them (43.1%). During follow-up, there was no malignant transformation.Conclusions:In this series of Tunisian patients, Paget's disease of bone had a female predominance and was usually monostotic. The clinical and radiological presentations were similar to the European series.

Burosumab Therapy in Children with X-Linked Hypophosphatemia

BackgroundX-linked hypophosphatemia is characterized by increased secretion of fibroblast growth factor 23 (FGF-23), which leads to hypophosphatemia and consequently rickets, osteomalacia, and skeletal deformities. We investigated burosumab, a monoclonal antibody that targets FGF-23, in patients with X-linked hypophosphatemia.MethodsIn an open-label, phase 2 trial, we randomly assigned 52 children with X-linked hypophosphatemia, in a 1:1 ratio, to receive subcutaneous burosumab either every 2 weeks or every 4 weeks; the dose was adjusted to achieve a serum phosphorus level at the low end of the normal range. The primary end point was the change from baseline to weeks 40 and 64 in the Thacher rickets severity total score (ranging from 0 to 10, with higher scores indicating greater disease severity). In addition, the Radiographic Global Impression of Change was used to evaluate rachitic changes from baseline to week 40 and to week 64. Additional end points were changes in pharmacodynamic markers, linear growth, physical ability, and patient-reported outcomes and the incidence of adverse events.ResultsThe mean Thacher rickets severity total score decreased from 1.9 at baseline to 0.8 at week 40 with every-2-week dosing and from 1.7 at baseline to 1.1 at week 40 with every-4-week dosing (P<0.001 for both comparisons); these improvements persisted at week 64. The mean serum phosphorus level increased after the first dose in both groups, and more than half the patients in both groups had levels within the normal range (3.2 to 6.1 mg per deciliter [1.0 to 2.0 mmol per liter]) by week 6. Stable serum phosphorus levels were maintained through week 64 with every-2-week dosing. Renal tubular phosphate reabsorption increased from baseline in both groups, with an overall mean increase of 0.98 mg per deciliter (0.32 mmol per liter). The mean dose of burosumab at week 40 was 0.98 mg per kilogram of body weight with every-2-week dosing and 1.50 mg per kilogram with every-4-week dosing. Across both groups, the mean serum alkaline phosphatase level decreased from 459 U per liter at baseline to 369 U per liter at week 64. The mean standing-height z score increased in both groups, with greater improvement seen at all time points with every-2-week dosing (an increase from baseline of 0.19 at week 64) than with every-4-week dosing (an increase from baseline of 0.12 at week 64). Physical ability improved and pain decreased. Nearly all the adverse events were mild or moderate in severity.ConclusionsIn children with X-linked hypophosphatemia, treatment with burosumab improved renal tubular phosphate reabsorption, serum phosphorus levels, linear growth, and physical function and reduced pain and the severity of rickets. (Funded by Ultragenyx Pharmaceutical and Kyowa Hakko Kirin; ClinicalTrials.gov number, NCT02163577; EudraCT number, 2014-000406-35).

A case series of benign transient hyperphosphatasemia from a pediatric endocrinology reference health facility in Turkey.

IntroductionBenign transient hyperphosphatasemia (BTH), even a known condition, is not very well managed by primary care physicians. The diagnostic criteria for BTH were alkaline phosphatase (ALP) levels above 3-5 times greater than the age adjusted upper limit of normal among children under 5 years with no evidence of liver or bone disease whose ALP values resolved within 4 months.MethodsThis study involved 15 patients aged 0-5 years, who were referred to the pediatric endocrinology clinic for elevated ALP levels. They were diagnosed with BTH. We examined demographic and biochemical parameters including ALP and ALP isoenzymes, liver enzymes, calcium, phosphate, and parathormone (PTH) levels to rule out liver or bone disease as a cause for hyperphosphatasaemia.ResultsOf 15 patients 7 were male and 8 were female. Mean age was 2.45 ± 1.09 (range 1.2-4.6) years. Mean serum ALP level was 2315 ± 1028 IU/L (1102-4662), while liver enzymes, calcium, phosphate, PTH and vitamin D3 levels were in normal ranges. The mean normalization period of ALP was 2.4 ± 1.1 (0.5-4) months, and all were normal at the end of 4 months without any treatment.ConclusionThis study and literature knowledge related to BTH has shown that being aware of BTH is very important for a primary care physician. Paediatricians can conveniently manage the differential diagnosis and follow up this period of elevated ALP.

Vitamin D status in children with autoimmune thyroiditis

Background: Deficiency of 25 hydroxyvitamin D has been linked with predisposition to autoimmune disorders. Also, vitamin D has been found to be a causal factor in many autoimmune diseases. Objective of the study was to investigate vitamin D status in children with autoimmune thyroiditis attending endocrinology OPD at a tertiary centre in southern India.Methods: It is a case control study done in which 75 children (70 female, 5 male) with age and sex matched healthy controls were chosen. Free thyroxine, TSH, anti TPOAb, anti TGAb, 25 hydroxyvitamin D, serum calcium, phosphorus, alkaline phosphatase levels were estimated in both cases and control subjects. Children with anti TPO or anti TG positivity were divided into four groups based on their level of antibody titers.Results: The mean age in cases was 9.8±0.34 years. 25(OH)D levels were significantly lower in cases (15.07±1.14 ng/ml) compared to controls (17.82±1.13 ng/ml) (p&lt;0.0006). Mean serum calcium levels in cases (9.35±0.16 mg/dl) were significantly lower when compared to controls (9.73±0.14 mg/dl) (p&lt;0.0005). Similarly mean serum alkaline phosphatase level in cases (184.97±11.10 IU/L) were significantly elevated when compared with controls (122.37±6.82 IU/L) (p&lt;0.0001). However, there was no significant difference in serum phosphorus levels between cases (4.42±0.10 mg/dl) and controls (4.43±0.14 mg/dl) (p=0.83). There was no significant difference in vitamin D level among the groups in both anti TPO (p&lt; 0.283) and anti TG (p&lt;0.148).Conclusions: The significant decrease in vitamin D levels in cases signifies that 25(OH)D may be an independent causal factor related to the autoimmunity in thyroid diseases.

Association of Obesity with Forearm Fractures, Bone Mineral Density and Fracture Risk (FRAX®) During Postmenopausal Period

Objective: The aim of this study was to investigate the association among obesity with bone mineral density (BMD) and subsequent fracture risk among postmenopausal women with a previous forearm fracture. Materials and Methods: The study enrolled obese (n=40) and normal-weight (n=40) postmenopausal women who had a previous forearm fracture. BMD measurements were obtained using a GE-LUNAR DPX dual energy X-ray absorptiometry scan for all subjects. FRAX® fracture risk scores were calculated taking into account former fractures and current risk factors of the subjects. Both groups were compared with respect to their BMD values, T scores, FRAX® risk scores and frequency of previous fractures. Results: No difference was observed between groups with regard to mean age, mean age of menopause onset and mean serum calcium, phosphorus and alkaline phosphatase levels (p>0.05 for all). Statistically, obese patients showed highly significantly greater mean BMD values at lumbar spine (L1-L4) and femoral neck in comparison to subjects with normal body weight (p=0.000 for all). Obese patients had a lower 10-year probability of a major osteoporotic fracture on average as determined by FRAX® fracture risk score compared to that in normalweight subjects (p<0.05). Also, obese group had a lower 10-year probability of a hip fracture versus normal-weight subjects (p<0.01). Both groups were found to have a similar frequency of previous fractures. Conclusion: Although obese patients in this study had greater BMD values and lower FRAX® risk scores, the probability of subsequent fractures predicted for the obese group was not lower when compared to that predicted for normal-weight group. It should be kept in mind that obesity may not necessarily be protective against fractures and treatment algorithms based solely on BMD might be inadequate to predict future fracture risk.

Effect of stevia sweetener consumption as non-caloric sweetening on body weight gain and biochemical’s parameters in overweight female rats

Recently, non nutritive sweeteners that can substitute for sucrose (high in calorie) cause increased the prevalence of overweight children and adults. Non-caloric or low caloric sweeteners as tools for making healthful food choices have been introduced to satisfy consumer demand. The aim of this study was to evaluate the effect of stevia sweetener as a substitute sucrose at different doses (25, 250, 500 and 1000mg/kg b. wt/day) for twelve weeks on the weight management and on several hematological and biochemical parameters of female rats. The results showed significant improvement and ameliorated reduction in final bodyweight, body weights gain (%) (BWG) and feed efficiency ratio (FER) in the stevia sweetener groups compared with the control. Stevia sweetener at 500mg/kg b. wt/day helps in weight loss of rats, decrement in the total cholesterol, triglycerides and low-density lipoprotein concentration, increment in the high-density lipoprotein and no significant differences in mean serum alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), or acid phosphatase (ACP) levels as compared to the control rats, which may be considered as therapeutic beneficial. Also, this dose may be considered as a safe dose for people with diabetes, especially the many individuals who need to lose weight to help control their blood glucose levels.

Association between Serum Alkaline Phosphatase Level and Cerebral Small Vessel Disease.

BackgroundSerum alkaline phosphatase (ALP) is a marker of vascular calcification. A high serum ALP level is associated with an increase in cardiovascular events, and predicts poor functional outcome in patients with stroke. We investigated whether serum ALP was associated with cerebral small vessel disease (cSVD) and large cerebral artery stenosis (LCAS).MethodsWe evaluated vascular risk factors, brain magnetic resonance images (MRIs), and MR angiograms from 1,011 neurologically healthy participants. The presence of silent lacunar infarction (SLI) and moderate-to-severe cerebral white matter hyperintensities (MS-cWMH) were evaluated as indices of cSVD on brain MRIs. Findings of extracranial arterial stenosis (ECAS) or intracranial arterial stenosis (ICAS) were considered to be indices of LCAS on MR angiograms.ResultsSubjects with SLI (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.27–3.42; p = 0.004) and MS-cWMH (OR: 1.48; 95% CI; 1.03–2.13, p = 0.036) were significantly more likely to have ALP levels in the third tertile (ALP ≥ 195 IU/L) than the first tertile (ALP ≤ 155 IU/L), after adjusting for cardiovascular risk factors. The mean serum ALP level was significantly higher in patients with SLI or MS-cWMH compared to patients without those findings. After adjustment for confounding factors, the multivariate model found that the statistical significance of serum ALP remained when the presence of SLI (OR: 1.05 per 10 IU/L increase in ALP; 95% CI: 1.02–1.08; p = 0.003) or MS-cWMH (OR: 1.03 per 10 IU/L increase in ALP; 95% CI: 1.00–1.06; p = 0.025) were added to the model. There were no differences in the proportions of patients with LCAS, ICAS, and ECAS across the serum ALP tertiles.ConclusionsOur study of neurologically healthy participants found a positive association between serum ALP level and indicators of cSVD, but no association between serum ALP level and the indicators of LCAS.

Zinc Supplementation in Preterm Neonates and Neurological Development, A Randomized Controlled Trial.

To assess the effect of zinc supplementation on neuro-development and growth of preterm neonates. Referral neonatal unit of a teaching hospital. Open-labeled Randomized controlled trial. 100 preterm neonates. Participants randomized to receive oral zinc (study group) or not (controls). Primary: Neuro-development status at 40 weeks post conceptional age and at 3 month corrected age using Amiel-Tison neurologic assessment. Secondary: anthropometry and serum alkaline phosphatase at 3 months corrected age. At 40 weeks post-conceptional age, greater number of zinc supplemented infants demonstrated alertness and attention pattern normal for their age (P=0.02). Higher number of controls showed signs of hyper-excitability at 40 week post-conceptional age (P=0.001) and 3 months corrected age (P=0.003). At 3 month corrected age, mean serum alkaline phosphatase level was significantly higher in the study group compared to controls. Zinc supplementation till 3 month corrected age in preterm breastfed infants improves alertness and attention pattern; and decreases signs of hyperexcitability, and proportion with abnormal reflexes.

Increased serum alkaline phosphatase levels correlate with high disease activity and low bone mineral density in patients with axial spondyloarthritis

ObjectivesRecent studies report an association between serum alkaline phosphatase (ALP) levels and inflammation. The present study examined the relationship between ALP and disease activity, bone mineral density (BMD), and radiological damage in axial spondyloarthritis (SpA). MethodsA total of 115 patients who fulfilled the ASAS axial SpA criteria were enrolled. Serum ALP, bone-specific ALP (BALP), serum cross-linked telopeptide of type-I collagen (sCTX), and inflammatory markers were measured. Clinical parameters, BMD, grade of sacroiliitis, and the modified Stoke AS Spinal Score (mSASSS) were also assessed. The Ankylosing Spondylitis Disease Activity Score (ASDAS) was also calculated. The associations between serum ALP, disease activity score, BMD, and radiologic damage were evaluated. ResultsThe mean serum ALP level was 77 ± 26U/l. Serum ALP levels increased in 14 patients (13%). Serum ALP levels increased along with ASDAS-CRP after adjusting for age and sex (p = 0.004), and were significantly correlated with ASDAS-ESR and ASDAS-CRP (p = 0.001 and p < 0.001, respectively), negatively correlated with BMD in the lumbar spine and femoral neck (p = 0.003 and 0.046, respectively), and positively correlated with sacroiliitis grade and the mSASSS (p < 0.001 and p < 0.002, respectively). BALP and sCTX were not associated with disease activity or BMD. Multivariate analysis showed that serum ALP was independently associated with ASDAS-CRP (p = 0.010). ConclusionsIncreased serum ALP levels were associated with high disease activity, low BMD, and higher structural damage scores in SpA patients.

English

Rheumatoid arthritis is a chronic systemic autoimmune disorder causing inflammation of the synovial joints leading to joint destruction as well as a variety of extra articular features. In this present study, serum Adenosine deaminase and Alkaline phosphatase levels were studied in patients of rheumatoid arthritis. Thirty patients in the age group of 30-60 years of both sexes and equal number of age and sex matched healthy controls were included in this study. In rheumatoid arthritis patients, serum Adenosine deaminase levels were high, the mean serum Adenosine deaminase levels were 60 ± 9.55 and in controls the mean Adenosine deaminase levels were 21 ± 3.04. The p value was significant at p < 0.001. We conclude that serum Adenosine deaminase can be used as a marker for cell mediated immunity to monitor disease activity in rheumatoid arthritis. Serum Alkaline phosphatase was found to be raised in rheumatoid arthritis, the mean serum Alkaline phosphatase levels were 291.63 ± 35.84 in patients of rheumatoid arthritis when compared to healthy controls (196.73 ± 32.71).The p value was significant at p<0.001. The present study has focused on investigating the serum total Alkaline phosphatase levels in Rheumatoid Arthritis Patients and The findings have indicated a raised serum Alkaline phosphatase in patients of rheumatoid arthritis when compared to healthy controls thereby suggesting the role of serum Alkaline phosphatase as a marker of disease activity in rheumatoid arthritis.

Influence on quality of life from an early cinacalcet prescription for secondary hyperparathyroidism in dialysis.

The goal of this study is to compare patient-reported quality of life (PRQOL) evolution between two groups of end-stage renal disease patients with secondary hyperparathyroidism (SHPT). The first with a cinacalcet prescription within 3 months after a diagnosis of SHPT (early group) and a second group of patients with a later or no cinacalcet prescription (nonearly group). From 2009 to 2012, we conducted a multicenter pharmaco-epidemiologic study in Lorraine region (France) including all consecutive patients on maintenance dialysis for at least 3 months with a diagnosis of SHPT (PTH > 500 pg/ml or first cinacalcet prescription). PRQOL was estimated using the Kidney Disease Quality Of Life-Short Form questionnaire, at baseline and at 6 and 12 months follow-up. Change in PRQOL was compared between the groups and adjusted with a propensity score. We included 124 patients: 44 in the early group and 80 in the nonearly group. The mental component summary score was lower in the early group, at baseline (43.6 ± 6.6 vs 46.6 ± 7.6; p = 0.030), and at the follow-up assessment (42.6 ± 6.9 vs 45.7 ± 7.9; p = 0.033). We found no difference between the groups in change in PRQOL, for all dimensions, even after adjustment with the propensity score. Mean serum alkaline phosphatase levels were normal in both groups at baseline (80.9 ± 32.5 vs 95.1 ± 39.6; p = 0.41). Cinacalcet prescription immediately following diagnosis of SHPT does not seem to be associated with better PRQOL evolution at 1 year. Mean serum alkaline phosphatase levels suggest that physicians should consider waiting for another PTH assay result before starting cinacalcet in case of a PTH rise.

Comparison of Metabolic Parameters Between Obese Normotensive and Obese Hypertensive Individuals—A Study of the NHANES Cross‐Sectional Data 2011–2012

It has been suggested that obesity-related hypertension is a separate entity that requires a new and defined approach. 1 Obesity is associated with adipocyte dysfunction, changes in cytokines, and free fatty acids that leads to oxidative stress and vascular inflammation culminating in hypertension. 1 Some studies have shown that the increase in waist circumference may increase the risk of hypertension even after cessation of smoking, making abdominal obesity a distinct and independent risk factor for the development of hypertension. 2 However, few studies have compared the different variables between obese normotensive and obese hypertensive individuals. We analyzed the cross-sectional data from the Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES) survey for 2011–2012. 3 We categorized the survey population into normal body mass index (BMI 6.5% (definition of diabetes according to the American Diabetes Association) between the groups (P=.76). The baseline characteristics of the two groups are given in the Table. There were no differences in the mean serum total cholesterol, triglycerides, sodium, calcium, alkaline phosphatase, creatinine, uric acid, or lactate dehydrogenase levels between the groups; however, there were significant differences in the waist circumference and direct high-density lipoprotein levels between the groups. The mean waist circumference in cm was 105.8 (13.7) in the obese-normotensive group and 109.9 (14.1) in the obese-hypertensive group (P<.01). Direct measurement of high-density lipoprotein in mg/dL was 52.65 (14.3) in the obese-normotensive group and 50.38 (12.3) in the obese-hypertensive group (P=.01).

Bone mineral density in patients with predialysis chronic kidney disease

Background: There is limited data available especially in Indian Population about prevalence of reduced bone mineral density (BMD) and various factors associated with it in CKD patients not on dialysis. Material: This study included 75 adult patients. Patients were divided into three groups depending upon GFR. Serum creatinine, albumin, calcium, phosphate (PO4), alkaline phosphatase, iPTH and Vitamin D were measured at baseline. BMD was measured by dual energy X-ray absorptiometry. Results: There were 51 male and 24 female patients. The mean serum phosphate, alkaline phosphatase and iPTH levels increased steadily as CKD progressed. On the other hand, mean corrected serum calcium and Vitamin D levels decreased progressively in group A, B and C. The mean serum PTH values in group A, B and C were 137.16 ± 109.85, 265.02 ± 132.03 and 328.14 ± 119.23 pg/mL, respectively and there was significant increase in mean PTH level from group A to group C (p < 0.05). The mean level of vitamin D showed a trend of declination from group A to C (p < 0.05). Z-score for group A, group B and group C was 1.11 ± 2.39, 0.87 ± 2.66 and −0.92 ± 1.59, respectively. Similarly, T score for the three groups were 0.47 ± 2.34, −0.4 ± 2.00 and −1.524 ± 1.42. Both T-score and Z-score positively correlated with GFR. There was negative correlation between Z-score and iPTH, and positive correlation with Vitamin D. Conclusion: Reduced bone density was seen early in the course of CKD as estimated from reduced BMD levels, increased prevalence of osteoporosis and increased fracture risk and it worsened with the progression of CKD.