Serum Calcium Measurements Research Articles

CHILDREN ON ANTI EPILEPTIC DRUGS HAVE LOW SERUM CALCIUM AND RAISED ALKALINE PHOSPHATASE LEVELS

Objective: Epilepsy is a common neurological disorder in children requiring long-term therapy using anti-epileptic drugs (AEDs). Chronic use of AEDs may impair bone health. This study aimed to determine the biochemical changes affecting bone metabolism in pediatric epileptic patients taking AEDs. Materials and Methods: This cross-sectional study was conducted in the Department of Pediatrics of Benazir Bhutto Hospital, Rawalpindi from January 2019 to July 2019. A total of 95 children were enrolled based on non-probability consecutive sampling technique. Bone metabolism was evaluated by measuring serum calcium and alkaline phosphatase levels in all the study participants. Data was entered on SPSS v 22 and descriptive statistics were applied. Results: Of 95 epileptic children, 50.53% (n=48) were male and 49.47% (n=47) were females taking AEDs (either carbamazepine, valproate sodium or phenobarbital), 47.37% (n=45) were between 2-6 years of age while 52.63% (n=50) were between 7-11 years of age (Mean age: 6.53±2.54 years). Mean calcium and alkaline phosphatase levels of patients were calculated as 7.94±2.3 mg/dl and 226.31±17.45 IU/L respectively. Frequency of hypocalcemia in patients taking AEDs was recorded in 67.37% (n=64) and 81.05% (n=77) had raised alkaline phosphatase levels. Conclusion: This study concludes that frequency of hypocalcemia and raised alkaline phosphatase levels in patients taking AEDs is higher and needs attention to address this issue while the magnitude recorded in this study is primary in local population which needs to be re-assessed through multi-center trials.

Association of Serum Calcium and Phosphate With Incident Cardiovascular Disease in Patients With Hypoparathyroidism

The pathophysiological basis for the increased incidence of cardiovascular disease in patients with chronic hypoparathyroidism is poorly understood. To evaluate associations between levels of albumin-corrected serum calcium, serum phosphate, and calcium-phosphate product with the odds of developing cardiovascular events in patients with chronic hypoparathyroidism with ≥1 calcitriol prescription, we conducted a retrospective nested case-control study of patients who developed a cardiovascular event and matched controls without an event. The primary outcome was the instance of cardiovascular events. An electronic medical record database was used to identify 528 patients for the albumin-corrected serum calcium analysis and 200 patients for the serum phosphate and calcium-phosphate product analyses. Patients with ≥67% of albumin-corrected serum calcium measurements outside the study-defined 2.00 to 2.25 mmol/L (8.0 to 9.0 mg/100 ml) range had 1.9-fold higher odds of a cardiovascular event (adjusted odds ratio, 95% confidence interval 1.89, 1.10 to 3.25) compared with patients with <33% of calcium measurements outside the range. Likewise, patients with any serum phosphate measurements above 0.81 to 1.45 mmol/L (2.5 to 4.5 mg/100 ml) had 3.3-fold higher odds (3.26; 1.24 to 8.58), and those with any calcium-phosphate product measurements above 4.40 mmol2/L2 (55 mg2/dL2) had 4.8-fold higher odds of a cardiovascular event (95% confidence interval 1.36 to 16.81) compared with patients with no measurements above these ranges. In adult patients with chronic hypoparathyroidism, a cardiovascular event was more likely in those with a higher proportion of albumin-corrected serum calcium measurements outside 2.00 to 2.25 mmol/L (8.0 to 9.0 mg/100 ml) or any serum phosphate and any calcium-phosphate product measurements above the normal population range.

Neurodevelopmental Abnormalities in Patients with Familial Hypocalciuric Hypercalcemia Type 3

To evaluate the prevalence and degree of any neurodevelopmental abnormalities in children with familial hypocalciuric hypercalcemia type 3 (FHH3). A formal neurodevelopmental assessment was performed in children diagnosed with FHH3. The Vineland Adaptive Behavior Scales, which is a standardized parent report assessment tool for adaptive behavior, was used to assess communication, social skills, and motor function and to generate a composite score. Six patients were diagnosed with hypercalcemia between 0.1 and 8years of age. All had neurodevelopmental abnormalities in childhood consisting of either global developmental delay, motor delay, expressive speech disturbances, learning difficulties, hyperactivity, or autism spectrum disorder. Four out of the 6 probands had a composite Vineland Adaptive Behavior Scales SDS of<-2.0, indicating adaptive malfunctioning. Significant deficits were observed in the domains of communication (mean SDS: -2.0, P<.01), social skills (mean SDS: -1.3, P<.05), and motor skills (mean SDS: 2.6, P<.05). Individuals were equally affected across domains, with no clear genotype-phenotype correlation. All family members affected with FHH3 also described evidence of neurodevelopmental dysfunction, including mild-to-moderate learning difficulties, dyslexia, and hyperactivity. Neurodevelopmental abnormalities appear to be a highly penetrant and common feature of FHH3, and early detection is warranted to provide appropriate educational support. This case series also supports consideration of serum calcium measurement as part of the diagnostic work-up in any child presenting with unexplained neurodevelopmental abnormalities.

Post Total Thyroidectomy Hypocalcaemia and relation with the Age of the Patient

Objective: To find the magnitude of clinically overt hypocalcaemia post-total thyroidectomy and its relation with the age of the patient.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Combined Military Hospital, Bahawalpur Pakistan, from Jan 2017 to Dec 2019.&#x0D; Methodology: Sixty patients who were to undergo total thyroidectomy were included in the study in strict compliance with the inclusion and exclusion criteria. Patients were divided into two groups according to their ages. In Group-A, patients younger than 50 and Group-B, patients older than 50 years were included. All the patients were followed up by clinical examination for the development of clinically overt hypocalcaemia and confirmed by measurement of serum calcium.&#x0D; Results: Mean age of the patients was 42.75±13.05 years, with an age range of 20 to 68 years. Of all the patients, 14(23.3%) were male, and 46(76.7%) were females. Seven patients in Group-A developed post-thyroidectomy hypocalcaemia clinically,whereas, in Group-B, only one developed this condition. Clinical post-thyroidectomy hypocalcaemia developed more often in the younger age group and these results were statistically significant (p= 0.023).&#x0D; Conclusion: Clinically overt hypocalcaemia develops more often in younger patients after total thyroidectomy.Keywords: Biochemical hypocalcaemia, Clinical hypocalcaemia, Post thyroidectomy hypocalcaemia, Total thyroidectomy

Prevalence and Outcome of Post- thyroidectomy Hypocalcaemia: A Prospective Clinical Study

Aims: (1) To record the incidence of post-thyroidectomy hypocalcaemia. (2) To correlate blood calcium levels with symptoms of hypocalcaemia. (3) To find out the type of hypocalcaemia whether temporary or permanent. (4) To assess the risk factors for development of hypocalcaemia. Design: Prospective analysis of 50 consecutive patients undergoing thyroid surgeries. Materials &amp; Method: All patients undergoing any thyroidectomy in the department of general surgery were followed for a period of 3 months. The type of surgery, Histopathology and clinical diagnosis to predict the outcome of post-operative hypocalcaemia was validated. The influences of Patient factors, intra-operative identification of RLN and parathyroid were also observed. Results: The overall prevalence of hypocalcaemia was 28% of which 12 patients had temporary and 2 had permanent hypocalcaemia. Only 12 patients developed clinical symptoms. Hypocalcaemia typically ensues during the early post-operative period (24-48 hrs). Hypocalcaemia was significantly associated with the type of surgery (p=0.0293), Histopathology (p=0.0312) and clinical diagnosis (p=0.0008). Age, Sex and identification of RLN and Parathyroid did not play a significant role in predicting the outcome of post-operative hypocalcaemia. Conclusion: Hypocalcaemia either transient or permanent can be debilitating and lead to significant morbidity. Temporary hypocalcaemia is common after surgery for malignancies. Histopathology, clinical diagnosis and extent of surgical resection influence the outcome of hypocalcaemia. Early measurement of serum calcium and albumin levels can ensure early management and prevent complications of hypocalcaemia.

Serum Calcium, Magnesium and Creactive protein levels in female Metabolic Syndrome patients

Background: Metabolic syndrome (Mets) is a risk factor for cardiovascular, chronic lung, liver and kidney diseases. Hypercalcaemia, hypomagnesaemia and elevated C-reactive protein (CRP) produce various complications such as cardiac arrythmia, renal stones, atherosclerosis, Diabetes Mellitus, Obesity etc. Some researchers suggested that hypercalcaemia, hypomagnesaemia and elevated CRP occur in Metabolic syndrome patients. Objectives: To measure serum calcium, magnesium and CRP levels in Metabolic syndrome patients. Methods: This cross sectional study was conducted from March 2019 to July 2020 in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University(BSMMU), Shahbag, Dhaka. For this study, 30 female metabolic syndrome patients aged 25 to 45 year, from the Outpatient department of Endocrinology of BSMMU were selected. For comparison, 30 age and gender matched apparently healthy female subjects were control. Serum calcium and magnesium were measured by Colorimetric method and serum CRP was measured by Immunoturbidimetric method. Independent sample‘t’ test was performed for serum calcium and Mann-Whitney U test was performed for serum magnesium and CRP. Results: Mean serum calcium (p £0.05 and median value of serum CRP (p £0.01) were significantly higher, median value of serum magnesium was lower (p&gt;0.05) but not significant in Metabolic syndrome patients than that of control. Conclusion: This study may conclude that elevated serum calcium and CRP levels are associated with metabolic syndrome patients. J Bangladesh Soc Physiol. 2022, June; 17(1): 14-20

Acute Yellow Oleander Poisoning-Its Cardiotoxicity and Clinical Profile: A Study on Eastern India Population

Background: Yellow oleander/Cerebra thevetia/Pila kaner a plant widely cultivated in the plains in india is highlypoisonous. Kernels of the seeds contain glycosides thevetin, thevetoxin, cerberin, and peruvoside. Poisoningusually leads to gastrointestinal and cardiac toxicity.Aims and Objectives: Our aim was to determine the clinical profile of yellow oleander poisoning with specialemphasis on cardiac toxicity, neurotoxicity if any and outcome of management using currently available treatment.Materials and Methods: We studied 60 patients with yellow oleander poisoning prospectively admitted inHospital. A 12 lead electrocardiogram 3 min rhythm ECG strip and blood sample for measurement of electrolytes,Serum calcium, urea and creatinine and liver function tests were taken before treatment. ECG was also done inevery patient on 2nd day of admission and at the time of discharge. Serum cardiac glycosides could not be donedue to lack of facilities.Results: Toxic manifestations included were Gastrointestinal, cardiac toxicity in the form of cardiac arrhythmia butSome patients developed neurological symptoms in the form of tremor (6 patients -10%), ataxia( 8 patients-13.33%)at the end of first week, and focal seizure (only four patients-6.66%).Conclusion: In our study we found gastrointestinal symptoms(vomitting, loose motion with dehydration) andcardiological symptoms (sinus tachycardia, sinus bradycardia, AV block and nodal rhythm, ventricular ectopicsare more commonly present in Yellow oleander poisoning. Moreover we have found some Neurological symptomsin our study in the form of tremor,ataxia and focal seizures.

Prevalence and risk factors for vitamin D insufficiency in 6-12-month-old infants: a cross-sectional study in Southern Thailand

BackgroundVitamin D is an essential micronutrient for bone mineralization and bone growth in children. There have been few studies to date of vitamin D status in infants aged 6–12 months in Southeast Asian countries.AimTo examine the prevalence of vitamin D insufficiency (VDI, including vitamin D deficiency) in healthy infants and the risk factors for VDI in southern Thailand.MethodsA cross-sectional study was carried out in 120 healthy infants aged 6–12 months and their mothers. Blood samples were obtained for measurement of serum calcium, phosphate, alkaline phosphatase, albumin, parathyroid hormone and 25-hydroxyvitamin D (25OHD) levels. The mothers were interviewed for their infants feeding intake, sunlight exposure, type of dress, and sunscreen use. Chi-square and t-test were used to compare between groups for categorical and continuous variables, respectively. Pearson correlation was used to identify the relationship between serum levels of 25OHD of the infants and other biochemical variables of the infants and serum levels of maternal 25OHD. Logistic regression analysis was used to identify the factors associated with vitamin D status.ResultsThe prevalence of VDI in our study infants was high at 28.3%, all of whom were mainly breastfed infants. Subgroup analysis of the mainly breastfed infants found that the risk factors for VDI were maternal VDI and a short duration of sunlight exposure. The serum 25OHD levels of the mainly breastfed infants were significantly positively correlated with the maternal serum 25OHD levels (r = 0.49, p-value < 0.01) and with sunlight exposure duration (r = 0.40, p-value < 0.01).ConclusionsThe prevalence of VDI was high in 6–12-month-old infants, particularly those who were mainly breastfed from VDI mothers, and who had short durations of sunlight exposure. As breast milk contains adequate amounts of most important vitamins and growth factors, breastfeeding is still encouraged for infants with 400 IU vitamin D daily supplementation to prevent VDI.

Hypercalcemia in Individuals with Monoclonal Gammopathy of Undetermined Significance: Results from the Istopmm Study

Introduction Multiple myeloma (MM) is a malignancy of bone marrow plasma cells, characterized by monoclonal immunoglobulins in the blood or urine and associated organ dysfunction encapsulated in the CRAB criteria (hypercalcemia, renal impairment, anemia, and bone lesions). MM is always preceded by monoclonal gammopathy of undetermined significance (MGUS), an asymptomatic premalignant stage. MGUS is relatively common in the general population, with an age-adjusted prevalence of 3-6%, dependent on gender and race. No treatment is recommended for MGUS, but a regular follow-up to detect progression to MM is advised. This includes regular measurements of serum calcium to capture MM-associated hypercalcemia. Hypercalcemia in the general population is most commonly caused by hyperparathyroidism or non-MM malignancy. We are unaware of any systemic study designed to guide physicians on how to react to hypercalcemia in individuals with MGUS. The aim of this study was to examine the underlying causes of hypercalcemia in individuals with MGUS and which diagnostic factors along with hypercalcemia are indicative of MM in order to guide the approach to hypercalcemia in individuals with MGUS in the clinic. Methods The ongoing Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) study is a population-based screening study for MGUS and a randomized trial of follow-up strategies. In total, 80,759 Icelanders aged 40 years and above enrolled in the study, and 75,422 were screened for MGUS using serum protein electrophoresis (SPEP) and a free light chain assay. Two-thirds of those who screened positive for MGUS were randomized to active follow-up at the study´s clinical research center. Participants who were in active follow-up in the study between April 1. 2017, and March 1. 2022, and had albumin-corrected serum calcium levels ≥ 2.55 mmol/L or serum ionized calcium levels ≥ 1.40 mmol/L were identified. The medical records of the participants were reviewed in collaboration with a senior endocrinologist to establish the persistence of hypercalcemia and underlying diagnosis. If MM was found as the cause of the hypercalcemia, then other CRAB features present at diagnosis were also recorded. In addition, the characteristics of the study cohort were compared with individuals without hypercalcemia who were in active follow-up in iStopMM using Student's t-test and Fisher exact test. Results Of the 2,546 individuals with MGUS in active follow-up, 191 (7.5%) had at least one elevated serum calcium measurement, of whom 93 had persistent hypercalcemia (48.7%) (Figure 1A). Thus, more than half had transient hypercalcemia. Individuals with hypercalcemia were more likely to be female (68% vs. 45%; p < 0.001) and were older than those without hypercalcemia (median age 73 vs. 70 years; p < 0.001). Primary hyperparathyroidism was found to be the most common cause of persistent hypercalcemia (56%), with malignancies other than MM following as the second most common cause (16%). In 18 cases (19%), the cause of hypercalcemia was not identified (Figure 1B). However, MM was ruled out in every case according to iStopMM protocols. MM was found in 3 participants with persistent hypercalcemia (3%); all had bone lesions and other concurrent CRAB features. Conclusion In this nationwide screening study, based on 75,422 individuals, we examined hypercalcemia in 2,546 individuals with MGUS and found that it was rarely associated with MM. Additionally, we found no cases of isolated hypercalcemia in MM. Importantly, more than half of hypercalcemia cases were transient, and when persistent, the underlying causes among individuals with MGUS were similar to those in the general population. Based on these results, we conclude that hypercalcemia, particularly isolated hypercalcemia, is not a strong indicator of MGUS progression and is most often caused by other underlying diseases. Thus, in the absence of other CRAB features, hypercalcemia in MGUS should be approached in the same way as in patients without MGUS. Measurements of serum calcium should be repeated, and hyperparathyroidism should be ruled out before undertaking further assessments for possible malignancy, including MM. These findings contribute to a more evidence- and value-based approach to the care of individuals with MGUS. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Association of Calcium and Phosphate Levels with Incident Chronic Kidney Disease in Patients with Hypoparathyroidism: A Retrospective Case-Control Study.

Reasons for the increased incidence of chronic kidney disease (CKD) in patients with chronic hypoparathyroidism are poorly understood. This study evaluated associations between levels of albumin-corrected serum calcium, serum phosphate, and calcium-phosphate product and the odds of CKD development in patients with chronic hypoparathyroidism. A retrospective nested case-control study of adult patients with chronic hypoparathyroidism who had ≥1 prescription for calcitriol who developed CKD and matched controls who did not develop CKD were selected from the IBM® Explorys electronic medical record database. Patients. The study included a cohort of 300 patients for the albumin-corrected serum calcium analysis and 80 patients for the serum phosphate and calcium-phosphate product analyses. Measurements. We examined associations between albumin-corrected serum calcium, serum phosphate and calcium-phosphate product levels, and the risk of devloping CKD (defined as ≥2 outpatient estimated glomerular filtration values <60 mL/min/1.73 m2 occuring ≥3 months apart or ≥1 diagnostic code for CKD stages 3-5). Individuals who had ≥67% of albumin-corrected serum calcium measurements outside, above, or below the study-defined range (2.00-2.25 mmol/L [8.0-9.0 mg/dL]) had 3.5-, 2.9-, and 2.7-fold higher odds of developing CKD (adjusted odds ratios [95% CI]: 3.46 [1.82-6.56], 2.85 [1.30-6.28], and 2.68 [1.16-6.15]), respectively, compared with patients who had <33% of albumin-corrected calcium measurements in those ranges. There was no association between developing CKD and having any serum phosphate measurements or any calcium-phosphate product measurements above normal population ranges. In adult patients with chronic hypoparathyroidism, a higher proportion of albumin-corrected calcium measurements outside of the 2.00-2.25 mmol/L (8.0-9.0 mg/dL) range was associated with higher odds of developing CKD.

LBODP017 Unusual Presentation Of Brown Tumors In Tertiary Hyperparathyroidism: A Case-based Review

Abstract Brown tumor (BT) is a rare non-neoplastic skeletal manifestation of untreated tertiary hyperparathyroidism (THPT) that is associated with renal osteodystrophy in patients with End-Stage Renal Disease (ESRD). Nearly half of patients with ESRD have Osteitis Fibrosa Cystica (OFC) of varying severity, which is the most common form of renal osteodystrophy. BT represents the extreme form of OFC. As a result of frequent monitoring of bone profile and the expansion of pharmacological therapy, the disease is increasingly being diagnosed in its early stages; however, some are still seen at an advanced stage. Depending on the tumor size, the management will range from a conservative approach with supportive parathyroidectomy to a comprehensive surgical removal. Here, we report a rare case of an extensive BT of the pelvis in a patient with ESRD and THPT who was also found to have coincidental papillary thyroid cancer following total thyroidectomy and parathyroidectomy with a postoperative complication of hungry bone syndrome. She then underwent prophylactic intramedullary nail fixation for an impending fracture in the right femur. This case report highlights the importance of considering BT as a differential diagnosis of lytic bone lesions and that measuring serum calcium, phosphorus, and parathyroid hormone as part of the initial evaluation is essential to identify the correct diagnosis. Multidisciplinary team approach with frequent follow-up is crucial to allow early diagnosis and prevent unnecessary surgical interventions. Presentation: No date and time listed

PSAT198 Atypical Parathyroid Adenoma is an Unusual Cause of Primary Hyperparathyroidism

Abstract Background Atypical parathyroid adenomas (APA) are considered tumors of uncertain malignant potential and have a biochemical and clinical phenotype that is generally more aggressive than typical parathyroid adenomas (PA). Low incidence as an etiology of primary hyperparathyroidism (PHPT) presents a challenge in understanding the pathological features and natural history of APA. We present a case of PHPT due to an APA and review the published literature for these tumors. Case A 37 year-old male was referred for evaluation of hypercalcemia, with serum calcium level 13.6 mg/dL (8.6-10.3). Repeat serum calcium measurement was 12.7 mg/dL, and two measurements of intact PTH were 870 pg/mL and 919 pg/mL (12-88), respectively. The patient's laboratories raised concern for parathyroid carcinoma (PC), but there was no palpable neck mass and no enlarged parathyroid glands were visualized on ultrasonography. Parathyroid scintigraphy was notable for faint but persistent Tc-99 m sestamibi uptake in the left inferior neck. Additional preoperative evaluation revealed significantly reduced bone mineral density in the distal third of the radius (0.638 g/cm2, Z-score -3.2), silent nephrolithiasis of the right kidney, and vitamin D deficiency (25-OH vitamin D 13.4 ng/dL, 30-100). An unequivocally enlarged (175 mg, 2.5 cm in largest diameter) left inferior parathyroid gland was removed, with the remaining glands unremarkable by inspection. Extensive nuclear atypia and cellular pleomorphism indicated an APA, and invasive features of PC were absent. One month after surgery, serum calcium improved to 10.2 mg/dL and intact PTH was 40 pg/mL. Conclusions APA account for 1-2% of PHPT cases. This patient's case has several features that distinguish it from a PA including degrees of preoperative hypercalcemia and intact PTH elevation, low vitamin D level, significantly reduced bone density in the distal third of the radius, nephrolithiasis, relatively young age, and male gender. Fibrous bands, pseudocapsular invasion, and trabecular growth pattern are the most common histologic features of APA, but nuclear atypia and cellular pleomorphism are well established diagnostic criteria. APA may be biochemically similar to PC but are distinguished from PC by the absence of gross invasion into adjacent anatomic structures, distant metastases, and vascular or perineural invasion. Additionally, CDC73 mutations are present in nearly all cases of PC but not in APA. Over 90% of patients with APA are successfully treated by parathyroidectomy. Careful follow up of APA patients is recommended, though there are no specific guidelines regarding a minimum satisfactory duration of postsurgical monitoring. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Short Term Hospital Outcome of Intracerebral Hemorrhage on The Basis of Admission Serum Calcium Level

(1) Background: Spontaneous intracerebral haemorrhage (ICH) accounts for approximately 15% of all strokes and is a leading cause of disability, with a one-month mortality rate of 40%. Whereas factors predicting short-term mortality are well known, data regarding long-term outcome are scarce and imprecise. Only a few studies revealed association of serum calcium level with outcome of stroke particularly ischaemic stroke but data regarding intracerebral hemorrhage is very limited. Therefore, to reveal the short-term hospital outcome of intracerebral hemorrhage patient on the basis of admission serum calcium level is the objective of the study. Methods: This study was a hospital based observational study and conducted at the Department of Neurology, Neurosurgery and Medicine in Dhaka Medical College Hospital. People who were suffering from intracerebral haemorrhage and were admitted in the department of Neurology, Neurosurgery and Medicine were approached for inclusion in the study according to inclusion and exclusion criteria. Ethical issues were ensured properly. After written informed consent history and physical examination were done. Diagnosis was confirmed by researcher with the aid of CT scan. Total 365 consecutive samples were collected and incompletion of data was considered exclusion of the study. Following radiological confirmation blood were drawn to measure serum calcium level with maintaining all aseptic precautions. For analysis patients’ corrected serum calcium level were divided into three tertiles: T1 = &lt;2.20 mmol/l, T2 = 2.20 to 2.40 mmol/l and T3 = &gt;2.40 mmol/l. The principal investigator interviewed each patient individually and in case of unconscious patient; history was collected from attendant of the patient. All these were registered, documented and analyzed in the statistical program Statistical Package for Social Science (SPSS) version 20.0. Results: Out of a total of 365 patients, Mean age of the population was 58.43(±12.33).................

Hypercalcemia - Diagnosis and Management

Hypercalcemia - Diagnosis and Management Abstract. The diagnostic workup of hypercalcemia requires a thorough patient history, a focused clinical examination as well as a step-by-step laboratory diagnostic approach. In order to detect the exact aetiology of hypercalcemia an accurate measurement of serum calcium in correlation with the parathyroid hormone level is therefore essential. Primary hyperparathyroidism and malignancy-related hypercalcemia are responsible for about 90% of all hypercalcemia cases. Therefore, these two pathologies should always be considered in the diagnostic approach. The therapeutic procedure is based on the aetiology and severity of the hypercalcemia.

Estimation of Serum Calcium Level in the Patients of Hypertension

Background: Hypertension is one of the leading progressive cause of mortality and morbidity in developed as well as developing countries all over the world. Intracellular and extracellular ions of the body regulate the hemostasis of blood pressure. Objective: To estimate the serum calcium level in the patients of newly diagnosed cases of hypertension with normotensive set of subjects. Methodology: This case comparative study was conducted at the medical OPD of Bilawal Medical College and LUMHS Hospital Hyderabad and Jamshoro. 100 subjects were chosen and divided into two groups: 50 normotensive as a control group and 50 hypertensive as a case study group. Selection of samples was done on the basis of the non-probability technique. A sphygmomanometer was used to measure blood pressure, and a kit method was used to measure serum calcium levels. The statistical analysis of the data was carried out by SPSS version 22 by applying the student t test. Results: The mean age of control group subjects was 44 ± 6 years and control group was 42 ± 7 years. The mean systolic Blood pressure of control group was 110 ± 5 mmHg, while in case study group it was 140 ± 10 mmHg. The mean Diastolic blood pressure of control group was 80 ± 5 mmHg, while in case study group it was 105 ± 5 mmHg. The mean serum calcium level in control group was 9.82 ± 0.68 mg/dl and in case study group it was 8.45 ± 0.47 mg/dl. There was significant (p &lt;0.05) difference of serum calcium level was observed in case study group (hypertensive subjects group). Conclusion: This study concluded that disturbance in intracellular calcium levels can be one of contributory factor in the pathogenesis of essential hypertension. Keywords: Essential Hypertension, Serum Calcium, Intracellular Calcium, Blood Pressure.

CKD-MBD biomarkers and CKD progression: an analysis by the joint model.

Biomarkers of chronic kidney disease-mineral and bone disorder (CKD-MBD) have been implicated in CKD progression in follow-up studies focusing on single measurements of individual biomarkers made at baseline only. The simultaneous relationship between the time trend of these biomarkers over the course of CKD and renal outcomes has never been tested. We applied the joint model (JM) to investigate the longitudinal relationship between repeated measurements of CKD-MBD biomarkers and a combined renal endpoint (estimated glomerular filtration rate reduction>30%, dialysis or transplantation) in 729 stage 2-5 CKD patients over a 36-month follow-up. In the survival submodel of the JM, the longitudinal series of parathyroid hormone (PTH) values was directly and independently related to the risk of renal events [hazard ratio (HR) (1 ln increase in parathyroid hormone (PTH) 2.0 (range 1.5-2.8), P<.001)] and this was also true for repeated measurements of serum phosphate [HR (1mg/dl) 1.3924 (range 1.1459-1.6918), P=.001], serum calcium [HR (1mg/dl) 0.7487 (range 0.5843-0.9593), P=.022], baseline fibroblast growth factor 23 [HR (1 pg/ml) 1.001 (range 1.00-1.002), P=.045] and 1,25-dihydroxyvitamin D [HR (1 pg/ml) 0.9796 (range 0.9652-0.9942), P=.006]. Repeated measurements of serum PTH, calcium and phosphate as well as baseline FGF23 and 1,25-dihydroxyvitamin D are independently related with the progression to kidney failure in a cohort of stage 2-5 CKD patients. This longitudinal study generates the hypothesis that interventions at multiple levels on MBD biomarkers can mitigate renal function loss in this population.

A clinical study of the hemodynamic and metabolic effects of Zone 3 REBOA for sacral and pelvic tumor resections

BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) is a key procedure in sacral and pelvic tumor resection that provides hemorrhage control. However, few studies have been performed to capture the effects of REBOA in a nonshock condition and provide a detailed description of the changes occurring with prolonged occlusion time. This study aimed to examine the hemodynamic and metabolic effects of Zone 3 REBOA for sacral and pelvic tumor resections following different periods of REBOA.MethodsIn total, 121 patients who underwent surgical tumor resections of the pelvis and/or the sacrum with the use of aortic balloon occlusion were prospectively enrolled from October 2020 to December 2021. All cases were divided into Group A (occlusion time ≤ 60 min, n = 57) and Group B (occlusion time ≥ 90 min, n = 64). Physiologic parameters were continuously recorded, and laboratory specimens were obtained at regular intervals.ResultsBalloon inflation resulted in a significant increase in SBP from 106 to 120 mmHg and decreased to 96 mmHg immediately following balloon deflation. With the application of REBOA, the median blood loss was only 1200 ml (range, 400–7900). When deflating the REBOA, the arterial pH was lower than baseline (7.36 vs. 7.41, p < 0.01), the arterial lactate concentration increased from 0.9 to 1.4 mmol/L (p < 0.01), serum potassium measurements increased from 3.99 to 4.12 mmol/L, serum calcium measurements decreased from 2.31 to 2.04 mmol/L, and blood creatinine decreased from 64 to 60 µmol/L. The operating time of Group B was longer than that of patients in Group A, and the patients in Group B needed more blood units to be transfused. Although laboratory measurements, including pH, potassium, calcium, and blood creatinine, were at the same level in two groups comparison, the lactate was significantly higher in Group B after deflation (p = 0.01).ConclusionsThe results of this study showed that acceptable hemodynamic and metabolic stability can be attained when the occlusion time of REBOA is more than 90 min, although the long duration of occlusion caused relatively higher lactate levels.

Vitamin D and calcium, together and separately, play roles in female reproductive performance

Vitamin D (VD) deficiency reduces the chances of successful fertilization; however, it remains to be validated whether this effect is dependent or not on calcium. To address this question, we generated several situation using a mouse model in which VD content was either increased or decreased in a normo or hypocalcemia context. After the measurement of serum 25-hydroxyvitamin D2, calcium and phosphorus levels, an analysis was carried out in terms of oocytes maturation as well as reproductive performance. VD overdose, despite the fact that it resulted in an increased number of mature oocytes, reduced developmental competence and offspring survival. VD deficiency (VDD), on the contrary, reduced the number and percentage of mature oocytes, blastocyst rate, as well as fertility rate and offspring survival. Hypo-calcemia when VD levels were normal, had a similar effect than VDD. The effects of VDD were reversed by a diet that corrected calcium level. Therefore, both VD overdose (in a context of normal calcium level) VD deficiency as well as hypo-calcemia have an effect on female reproductive function. In conclusion, although closely related, VD and calcium act in part independently of each other in defining the “optimum” for female reproductive performance.

COMPARATIVE STUDY OF SERUM CALCIUM AND MAGNESIUM LEVELS IN WOMEN WITH PRE ECLAMPSIA AND NORMOTENSIVE PREGNANT WOMEN

Objectives: The objective of the study is to establish a relation between serum calcium and magnesium levels with severity of pre-eclampsia and to compare the levels with normotensive pregnant women. Materials And Methods: 200 women with pre-eclampsia and 200 normotensive pregnant women were included in this hospital based, cross sectional study; serum calcium and magnesium levels were measured and data was analysed. The serum calcium concentration wasResults: signicantly lower in pre-eclamptic cases as compared to normotensive controls. (7.903±0.292 Vs 9.227±0.598 mg/dl, p &lt; 0.001). Serum magnesium concentration was signicantly lower in severe preeclampsia cases as compared to mild preeclampsia. (7.67±0.32 Vs 7.991±0.22 mg/dl, p&lt;0.001). Measurements of serum calcium and magnesium among women at risk may be used toConclusion: predict onset and severity of pre-eclampsia.

Unexpected Benefits in Single Institution Experience With Successful Implementation of a Standardized Perioperative Protocol in Pediatric Thyroidectomy.

Introduction:To illustrate how quality improvement can produce unexpected positive outcomes.Methods:We compared a retrospective review of perioperative management and outcomes of baseline 122 pediatric total thyroidectomies to 121 subsequent total thyroidectomies managed by an Electronic Medical Record protocol in a large, free-standing children’s healthcare system. Process measures included serum calcium measurement 6−12 hours postoperatively; parathyroid hormone measurement 6 hours postoperatively; preoperative iodine for Graves disease, and postoperative prophylactic calcium carbonate administration. In addition, we completed 4 Plan-Do-Study-Act (PDSA) cycles, focusing on implementation, refinement, usage, education, and postoperative calcitriol administration. The primary outcome included transient hypocalcemia during admission.Results:All perioperative process measures improved over PDSA cycles. Measurement of postoperative serum calcium increased from 42% at baseline to 100%. Measurement of postoperative PTH increased from 11% to 97%. Preoperative iodine administration for Graves disease surgeries improved from 72% to 94%. Postoperative calcium carbonate administration increased from 36% to 100%. There was a trend toward lower rates of severe hypocalcemia during admission over the subsequent PDSA cycles starting at 11.6% and improving to 3.4%. With the regular review of outcomes, surgical volume consolidated among high-volume providers, associated with a decrease in a permanent hypoparathyroid rate of 20.5% at baseline to 10% by the end of monitoring.Conclusions:In standardizing care at 1 large pediatric institution, implementing a focused quality improvement project involving the perioperative management of transient hypocalcemia in total thyroidectomy pediatric patients resulted in additional, unanticipated improvements in patient care.