Serum Calcium Concentrations Research Articles

Association between serum calcium levels and in-hospital mortality in sepsis: A retrospective cohort study

BackgroundThis study examines serum calcium levels and in-hospital mortality in patients with sepsis, a subject with contradictory findings in the existing literature. MethodsThis retrospective cohort study utilized data from the MIMIC-IV database, focusing on adult patients diagnosed with sepsis between 2008 and 2019. The serum calcium levels were taken as the highest value within the first 24 h of Intensive Care Unit (ICU) admission. We performed Cox proportional hazards regression analyses in multivariable-adjusted models to investigate the association between serum calcium levels and in-hospital mortality. Restricted cubic spline functions were used to assess the nonlinear relationship, and threshold effect analysis was conducted to identify potential inflection points. ResultsA total of 18,546 patients with sepsis were included in the study, and an in-hospital mortality rate of 16.9 % (3,126 out of 18,546) was obtained. Furthermore, a U-shaped relationship was observed between serum calcium concentrations and in-hospital mortality, with the lowest point at approximately 8.23 mg/dL. Hazard ratios were calculated as 0.75 (95 % CI: 0.67–0.85, P < 0.001) on the left side and 1.10 (95 % CI: 1.04–1.16, P < 0.001) on the right side of the inflection point. Sensitivity analyses corroborated these results. ConclusionThe research identified a U-shaped correlation between serum calcium concentrations and in-hospital mortality rates among patients with sepsis, underscoring the importance of serum calcium monitoring in this patient population upon hospital admission.

Acute pancreatitis and refractory hypercalcemia in the third trimester caused by parathyroid carcinoma

BackgroundHypercalcemia can be a rare contributor to acute pancreatitis (AP) in pregnancy. This is primarily due to primary hyperparathyroidism (PHPT), resulting from parathyroid carcinoma. We exhibited a case report to analyze the diagnosis and treatment during the onset of hypercalcemia-induced AP.Case presentationA 32-year-old primigravida presented with acute pancreatitis near full-term gestation. Following a cesarean delivery, there was a reduction in serum amylase and peripancreatic exudate, but her serum calcium concentrations persistently elevated over 4.0 mmol/L. Interventions to lower the hypercalcemia were only temporarily effective, until a high serum parathyroid hormone (PTH) concentration of 1404 pg/mL was detected. Ultrasound revealed a 31 mm × 24 mm hypoechoic oval nodule in the left lower lobe of the thyroid gland. She underwent a parathyroidectomy, resulting in a dramatic decrease in serum PTH level, from preoperative levels of 2051 pg/mL to 299 pg/mL just 20 minutes after removal. Similarly, her serum calcium declined from 3.82 mmol/L to 1.73 mmol/L within 24 hours postoperatively. The final histopathology suggested parathyroid carcinoma.ConclusionWhen refractory hypercalcemia is present, serum PTH levels should be measured to determine PHPT. Parathyroidectomy is the optimal strategy for alleviating hypercalcemia and clarifying the underlying pathology.

Research on cognitive impairment and potential risk factors in peritoneal dialysis patients: An observational study.

The objective of this study is to investigate the associated risk factors and their effects on cognitive impairment (CI) in patients undergoing peritoneal dialysis. A retrospective analysis was conducted on the basic information of 268 patients who underwent continuous ambulatory peritoneal dialysis (CAPD) at our hospital from January 2020 to September 2023. Cognitive function was assessed using the Montreal Cognitive Assessment Scale during their subsequent dialysis visits. Participants were categorized into a CI group and a cognitively normal group. Blood and other biological samples were collected for relevant biomarker analysis. Subsequently, we analyzed and compared the factors influencing CI between the 2 groups. The prevalence of CI among CAPD patients was 58.2%. Compared to the cognitively normal group, the CI group had a higher prevalence of alcohol consumption, lower levels of education, and reduced serum uric acid levels (P < .05). There was also a higher incidence of autoimmune diseases such as systemic lupus erythematosus in the CI group (P < .05). In terms of dialysis efficacy, the residual kidney Kt/V and residual kidney Ccr were significantly lower in the CI group compared to the cognitively normal group. In blood parameters, the CI group showed elevated total cholesterol levels and lower serum calcium concentrations (P < .05). Logistic regression analysis identified male gender, older age, lower educational attainment, hypercholesterolemia, and elevated high-sensitivity C-reactive protein levels as independent risk factors for CI in CAPD patients (P < .05). Additionally, in this patient cohort, dialysis duration and residual renal function were protective factors against CI (P < .05). CI is prevalent among PD patients. Elevated high-sensitivity C-reactive protein levels, male gender, older age, lower educational attainment, and hypercholesterolemia constitute an independent risk factor for CI in CAPD patients, whereas residual renal function acts as a protective element.

Comparative effects of calcitriol and calcimimetic on bone health in renal insufficiency

AbstractCalcitriol and calcimimetics are used to treat hyperparathyroidism secondary to chronic kidney disease (CKD). Calcitriol administration and the subsequent increase in serum calcium concentration decrease parathyroid hormone (PTH) levels, which should reduce bone remodeling. We have previously reported that, when maintaining a given concentration of PTH, the addition of calcimimetics is associated with an increased bone cell activity. Whether calcitriol administration affects bone cell activity while PTH is maintained constant should be evaluated in an animal model of renal osteodystrophy. The aim of the present study was to compare in CKD PTH‐clamped rats the bone effects of calcitriol and calcimimetic administration. The results show that the administration of calcitriol and calcimimetic at doses that induced a similar reduction in PTH secretion produced dissimilar effects on osteoblast activity in 5/6 nephrectomized (Nx) rats with secondary hyperparathyroidism and in Nx rats with clamped PTH. Remarkably, in both rat models, the administration of calcitriol decreased osteoblastic activity, whereas calcimimetic increased bone cell activity. In vitro, calcitriol supplementation inhibited nuclear translocation of β‐catenin and reduced proliferation, osteogenesis, and mineralization in mesenchymal stem cells differentiated into osteoblasts. In conclusion, besides the action of calcitriol and calcimimetics at parathyroid level, these treatments have specific effects on bone cells that are independent of the PTH level.

Severe hypocalcemia in the emergency department: a retrospective cohort study of prevalence, etiology, treatment and outcome.

The aim of this study was to evaluate the prevalence of severe hypocalcemia in patients attending the emergency department. Symptoms, causes, treatment, and outcome of severe hypocalcemia as well as course of calcium concentrations were assessed. This retrospective case series included all adult patients with measurements of serum calcium concentrations presenting to the emergency department of the Bürgerspital Solothurn between January 01 in 2017 and December 31 in 2020. Medical record reviews were performed of all patients with severe hypocalcemia, defined by a serum calcium concentration < 1.9mmol/L, to assess clinical presentation and management. 1265 (3.95%) patients had a serum calcium concentration of < 2.1mmol/L of which 139 (11%) had severe hypocalcemia of < 1.9mmol/L. 113 patients had at least one measurement of albumin. Of these, 43 (3.4%) had an albumin-corrected serum calcium < 1.9mmol/L defining true, severe hypocalcemia. Hypocalcemia was identified and documented in 35% of all cases. The mean serum calcium concentration was 1.74 ± 0.14mmol/L. Calcium concentrations in malignancy-related hypocalcemia were similar to non-malignancy-related hypocalcemia. The main symptoms attributed to hypocalcemia were cardiac and neurologic. 12% of patients with severe hypocalcemia received intravenous and 23% oral calcium replacement. Active malignancy was the main cause of severe hypocalcemia in 28%, while in most cases, the main cause remained unclear. 41.9% of severely hypocalcemic patients reattended the emergency department for another episode of hypocalcemia within 1 year. Hypocalcemia is common in patients attending the emergency department, however, appears to be neglected frequently. The disorder is often a manifestation of severe disease, triggered by multiple causes. Calcium replacement was administered in less than half of the patients with severe hypocalcemia in this study. Due to frequent readmissions to the emergency department and a high mortality, increased awareness of the disorder and careful follow-up are desirable.

RETROSPECTIVE HEMATOLOGY AND SERUM BIOCHEMISTRY OF RING-TAILED LEMURS (LEMUR CATTA) ON ST. CATHERINES ISLAND, GEORGIA, USA.

Annual health records were retrospectively analyzed for a colony of ring-tailed lemurs (Lemur catta) inhabiting St. Catherines Island, Georgia, USA to establish baseline hematological and serum biochemical parameters and determine sex- and age-related differences. Summarized complete blood count and serum biochemistry panel results are presented for 85 blood samples collected from 54 lemurs at annual health exams during 1998-2003. Within each of four age classes (infant, <1 yr; juvenile, 1-5 yr; adult, ≥ 6 yr), data were stratified and summarized based on sex. Lemur age was a significant positive predictor of mean corpuscular hemoglobin; absolute concentrations of neutrophils, monocytes, and band cells; serum concentrations of blood urea nitrogen (BUN), creatinine, globulins, lipase, and total protein; and gamma-glutamyl transferase (GGT) activity. Lemur age was a significant negative predictor of albumin:globulins ratio; alkaline phosphatase (ALP) activity; and serum concentrations of calcium, cholesterol, glucose, magnesium, phosphorus, potassium, and triglycerides. Neutrophil proportions increased with aging and lymphocyte proportions decreased with aging, particularly in females. Recent steep population declines of wild ring-tailed lemurs make their successful husbandry and medical care an increasingly pressing concern. These biomedical data will aid in clinical diagnosis and treatment of lemurs in human care, and support conservation efforts for this species.

Serum metabolic profiling in pregnant Holstein cows 3 weeks prior to parturition using two-dimensional gas chromatography time-of-flight mass spectrometry.

This preliminary study explored potential serum biomarkers for predicting the onset of milk fever (MF), a bovine parturient disease with hypocalcemia. We conducted two-dimensional gas chromatography mass spectrometry-based metabolomics in 8 and 17 pregnant Holstein cows that did and did not develop MF 3 weeks later, respectively. In principal component analysis (PCA) applied to a dataset containing 1,498 metabolites, serum metabolites exhibited highly similar chemical profiles between cows with and without MF. PCA with a limited dataset of metabolites containing fatty acids, which had significantly different values between the groups and/or correlation coefficients of >0.5 for the serum calcium concentration, distinguished the two groups. These suggest the possibility of developing serum biomarkers for predicting bovine MF.

Valproate intercalated in layered double hydroxides: Synthesis, characterization, release kinetics and biocompatibility studies

Layered double hydroxides (LDHs) are biocompatible materials with excellent anion exchange properties, making them suitable for use as drug carriers by incorporating the drug in its anionic form within their layered structure. In this study, an LDH was synthetized through ion exchange with valproate (VAL), an anticonvulsant drug, using an LDH with nitrate as the parent material. The resulting LDH-VAL sample underwent a comprehensive multi-technique characterization using XRD, TG-DSC, TEM, SEM, EDS, FTIR, XPS and zeta potential measurements. Dissolution kinetics and VAL release kinetics in an ample range of pH (3–9), along with biological assays to test biocompatibility, were also performed. All techniques confirmed the successful intercalation of the drug into the LDH structure, displacing all the nitrate ions of the parent material and increasing the basal spacing d003 from 8.8 Å to 18.3 Å. VAL release in NaCl and physiological buffer solutions was incongruent with LDH dissolution, clearly indicating that VAL release was controlled by an ion exchange process. In 0.9 % NaCl solutions, 90–100 % of VAL was released with only 15–20 % of LDH dissolution, and in buffer solutions 100 % of VAL was released with, at the most, 30 % of LDH dissolution. Biological assays, including lactate dehydrogenase activity, serum calcium concentration and histological analysis of blood samples, confirmed that the prepared LDH-VAL is a biocompatible material with a potential use as a nanodrug carrier.

Supplementation of the Combination of Quercetin and Vitamin E Alleviates the Effects of Heat Stress on the Uterine Function and Hormone Synthesis in Laying Hens.

Chickens are sensitive to heat stress because their capacity to dissipate body heat is low. Hence, in chickens, excessive ambient temperature negatively influences their reproductive performance and health. Heat stress induces inflammation and oxidative stress, thereby rendering many reproductive organs dysfunctional. In this study, we evaluated the effects of the supplementation of dietary quercetin and vitamin E on the uterine function, eggshell quality via estrogen concentration, calcium metabolism, and antioxidant status of the uterus of laying hens under heat stress. The ambient temperature transformation was set at 34 ± 2 °C for 8 h/d (9:00 am-5:00 pm), which was followed by 22 °C to 28 °C for 16 h/d. Throughout the experiment, the relative humidity in the chicken's pen was at 50 to 65%. A total of 400 Tianfu breeder hens (120-days-old) were randomly divided into four dietary experimental groups, including basal diet (Control); basal diet + 0.4 g/kg quercetin; basal diet + 0.2 g/kg vitamin E; and basal diet + the combination of quercetin (0.4 g/kg) and vitamin E (0.2 g/kg). The results show that the combination of quercetin and vitamin E significantly increased the serum alkaline phosphatase levels and the antioxidant status of the uterus (p < 0.05). In addition, the combination of quercetin and vitamin E significantly increased the concentrations of serum estrogen and progesterone, as well as elevated the expression of hypothalamic gonadotropin-releasing hormone-1 and follicular cytochrome P450 family 19 subfamily A member-1 (p < 0.05). We also found that the calcium levels of the serum and uterus were significantly increased by the synergistic effects of quercetin and vitamin E (p < 0.05), and they also increased the expression of Ca2+-ATPase and the mRNA expression of calcium-binding-related genes in the uterus (p < 0.05). These results are consistent with the increased eggshell quality of the laying hens under heat stress. Further, the combination of quercetin and vitamin E significantly increased the uterine morphological characteristics, such as the height of the uterine mucosal fold and the length of the uterine mucosa villus of the heat-stressed laying hens. These results collectively improve the uterine function, serum and uterine calcium concentration, eggshell strength, and eggshell thickness (p < 0.05) in heat-stressed laying hens. Taken together, we demonstrated in the present study that supplementing the combination of dietary quercetin and vitamin E alleviated the effects of heat stress and improved calcium metabolism, hormone synthesis, and uterine function in the heat-stressed laying hens. Thus, the supplementation of the combination of quercetin and vitamin E alleviates oxidative stress in the eggshell gland of heat-stressed laying hens, thereby promoting calcium concentration in the serum and eggshell gland, etc., in laying hens. Hence, the combination of quercetin and vitamin E promotes the reproductive performance of the laying hens under heat stress and can also be used as a potent anti-stressor in laying hens.

Population based screening for osteoporosis in men among 40 and 80 years in the brazilian state of Roraima"

The main objective of this study was to conduct population screening for osteoporosis in men between the ages of 40 and 80 in the Boa Vista, the capital of the Brazilian state of Roraima. The population study conducted in this study was basically based on the Fracture Risk Assessment Tool (FRAX®) nomogram model proposed by the World Health Organization (WHO). Specifically, the current work focuses on (i) analyzing the serum concentrations of calcium, vitamin D and total testosterone in relation to the risk of bone event by the FRAX® nomogram and (ii) correlating cardiovascular risk by calculating Framingham score with the FRAX® nomogram. This cohort, and cross-sectional study involves both quantitative and qualitative data obtained in the field from 380 patients. The data obtained were compared to the pre-existing data collected through different bibliography. For the sampling, a cluster method was utilized. Patients with immediate need of health services were referred to the state hospital of Coronel Mota, Boa Vista. This project was approved by the Ethical Committee (number: 50207115.7.0000.5301). While commuting to work or travel around found to be the major reason of the fractures, we observed that older people and people who were involved in physical activities inside a gymnasium had considerably high at risk of fractures. FRAX and TBS femur score (Trabecular Bone Score) was higher for people with fractures. People having lumbar osteopenia and femur osteopenia had higher risk of TBS femur fractures while people having lumbar osteoporosis had higher risk of TBS (femur and hip) as well as FRAX femur factures. All the data obtained in this study were analyzed using SPSS version 21 and a p value of ≤0.05 was considered as statistically significant. Key risk factors for fracture include increased age, physical activities in a gymnasium, lumbar and femur osteopenia and lumbar osteoporosis.

Hypercalcemia Etiologies in Pediatric Patients: An Informative Narrative Review

Background: Hypercalcemia, although less prevalent, is a critical diagnosis in pediatric patients, consisting of numerous etiologies that differ significantly from those in adults. In children, congenital causes are more prevalent. The differential diagnosis of hypercalcemia encompasses a broad spectrum of etiologies; however, up to 90% of all cases are diagnosed with either primary hyperparathyroidism or malignancy. Primary hyperparathyroidism predominates in ambulatory patients, while malignancy is more common among critically ill hospitalized patients. Objectives: This review addresses several important issues related to calcium metabolism and hypercalcemia: a) Overview of Calcium Metabolism b) Factors affecting serum total and ionized calcium concentration c) Clinical manifestations and importance of Hypercalcemia in pediatric patients d) Overview of the causes of Hypercalcemia in pediatric patients e) Overview of Hypercalcemia management Methods: A literature search was conducted for articles published from 2000 to 2024 using PubMed, Scopus, Web of Science, Cochrane, and Embase databases. The keywords used were: CALCIUM, Calcium metabolism disorders, hypercalcemia, Parathyroid hormone, Vitamin D, and acid-base imbalance. Results: This study provides a review of calcium metabolism and factors affecting total and ionized calcium concentrations, along with a definition of hypercalcemia, classification of its severity, its clinical manifestations, and a comprehensive overview of hypercalcemia etiologies categorized into parathyroid hormone (PTH)-related and unrelated causes. An overview of its management is also included. Conclusions: Hypercalcemia is an important disorder in both pediatric and adult patients. Before initiating a workup for hypercalcemia, it is crucial to understand the physiology of calcium and the factors affecting its serum concentrations. The etiologies of hypercalcemia in pediatric patients have a wide spectrum of differential diagnoses; primary hyperparathyroidism and malignancies account for 80-90% of all hypercalcemia cases found in clinical practice. Genetic and syndromic causes are usually more prevalent in pediatrics due to the nature of these conditions. Managing hypercalcemia requires two simultaneous approaches: first, measures aimed at lowering serum calcium concentrations and second, a workup for the underlying cause.

Fostering healthy aging through selective nutrition: A long-term comparison of two dietary patterns and their holistic impact on mineral status in middle-aged individuals—A randomized controlled intervention trial in Germany

Aging is associated with a decline in physiological functions and an increased risk of age-related diseases, emphasizing the importance of identifying dietary strategies for healthy aging. Minerals play a crucial role in maintaining optimal health during aging, making them relevant targets for investigation. Therefore, we aimed to analyze the effect of different dietary pattern on mineral status in the elderly. We included 502 individuals aged 50–80 years in a 36-month randomized controlled trial (RCT) (NutriAct study). This article focuses on the results within the two-year intervention period. NutriAct is not a mineral-modulating-targeted intervention study, rather examining nutrition in the context of healthy aging in general. However, mineral status might be affected in an incidental manner. Participants were assigned to either NutriAct dietary pattern (proportionate intake of total energy consumption (%E) of 35–45 %E carbohydrates, 35–40 %E fats, and 15–25 %E protein) or the German Nutrition Society (DGE) dietary pattern (proportionate intake of total energy consumption (%E) of 55 %E carbohydrates, 30 %E fats, and 15 %E protein), differing in the composition of macronutrients. Data from 368 participants regarding dietary intake (energy, calcium, magnesium, iron, and zinc) and serum mineral concentrations of calcium, magnesium, iron, copper, zinc, selenium, iodine, and manganese, free zinc, and selenoprotein P were analyzed at baseline, as well as after 12 and 24 months to gain comprehensive insight into the characteristics of the mineral status. Additionally, inflammatory status - sensitive to changes in mineral status - was assessed by measurement of C-reactive protein and interleukin-6. At baseline, inadequate dietary mineral intake and low serum concentrations of zinc and selenium were observed in both dietary patterns. Throughout two years, serum zinc concentrations decreased, while an increase of serum selenium, manganese and magnesium concentrations was observable, likely influenced by both dietary interventions. No significant changes were observed for serum calcium, iron, copper, or iodine concentrations. In conclusion, long-term dietary interventions can influence serum mineral concentrations in a middle-aged population. Our findings provide valuable insights into the associations between dietary habits, mineral status, and disease, contributing to dietary strategies for healthy aging.

Evaluation of the thiazide challenge test to differentiate primary from hypercalciuria-related hyperparathyroidism.

treatment of primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism due to idiopathic hypercalciuria (SHPT-IH) is markedly different. Robust diagnostic tools to differentiate between both entities are however lacking. evaluate the thiazide challenge test (TCT) in clinical practice, its aid in clinical decision making, evaluate the accuracy (sensitivity, specificity) and potentially useful parameters of the TCT. monocentric observational retrospective cohort study from January 2017 to November 2023. outpatient, Ghent University Hospital (Belgium). 25 adult patients with hypercalciuria, elevated parathyroid hormone (PTH), and high-normal or elevated serum calcium that underwent a TCT. TCT. serum, urinary biochemical parameters before and after testing, clinical and imaging outcomes, treatment, and follow-up. patients with a TCT-based working diagnosis of PHPT show greater increases in albumin-adjusted calcium and total serum calcium concentration than patients with SHPT-IH (+0,11 ± 0,10 vs. + 0,0071 ± 0,10mmol/l; p = 0,025 and +0,14 ± 0,12 vs. + 0,012 ± 0,15mmol/l; p = 0,024 respectively). The TCT-based working diagnosis of PHPT has a sensitivity of 81,8%, a specificity of 77,8% and a likelihood ratio of 3,68 of estimating a correct final diagnosis.Urinary calcium excretion, PTH, calcium-phosphorous ratio, PTH-inhibition rate, and parathyroid function index do not differ significantly in patients with PHPT compared to those with SHPT-IH. the TCT aids in discriminating patients with PHPT from those with SHPT-IH based on a rise in serum calcium. Other parameters are not different between both groups. Larger prospective trials are necessary to further define the diagnostic potential of the TCT, its most appropriate biochemical outcome variables, and decision cut-offs.

Correlation between CRAB Symptoms and Antioxidant Enzyme Activity in Patients with Multiple Myeloma

To investigate the relationship between clinical indicators of CRAB symptoms and antioxidant enzyme activity in patients with multiple myeloma (MM). The activity of catalase (CAT), glutathione peroxidase (GPX), and superoxide dismutase (SOD) in the bone marrow supernatants of 44 patients with MM and 12 patients with non-malignant hematological diseases was detected by colorimetric assay, and then the differences in the activity of antioxidant enzymes between the two groups were compared. Furthermore, the relationship between the activity of antioxidant enzymes in the MM group and the levels of serum calcium, serum creatinine (Scr), hemoglobin (Hb), alkaline phosphatase (ALP) as well as bone lesions were analyzed. The antioxidant enzyme activity was lower in MM patients compared with the control group (P < 0.05). When the concentrations of serum calcium and ALP were higher than the normal levels, Hb was lower than 85 g/L, and there were multiple bone lesions, the activity of CAT, SOD and GPX was significantly declined (P < 0.05); When the concentration of Scr≥177 μmol/L, the activity of GPX was significantly declined (P < 0.05). Regression analyses showed that CAT, SOD and GPX were negatively correlated with serum calcium (r =-0.538, r =-0.456, r =-0.431), Scr (r =-0.342, r =-0.384, r =-0.463), and ALP (r =-0.551, r =-0.572, r =-0.482). The activity of antioxidant enzymes, including CAT, SOD and GPX, were decreased in patients with MM and they were negatively correlated with some clinical indicators of CRAB symptoms (such as serum calcium, Scr, and ALP), which suggests that promoting the activity of antioxidant enzymes may be beneficial to treat the CRAB symptoms of the patients with MM.

Content of macro- and microelements in rats with experimental autoimmune thyroiditis and under the influence of lemna minor

The aim was to study the effect of aqueous extract and 30 % alcohol tincture of Lemna minor frond (AELM and TLM) on the content of macro- and microelements in rats with experimental autoimmune thyroiditis. Materials and methods. The effect of AELM and TLM was studied in a model of experimental autoimmune thyroiditis in rats, induced by immunization with human thyroid antigen. The serum levels of total thyroxine, total triiodothyronine, antibodies to thyroglobulin, antibodies to thyroperoxidase, and concentrations of macro- and microelements were studied. Results. The development of experimental autoimmune thyroiditis led to a decrease in the content of total thyroxine and antibodies to thyroperoxidase in the blood serum, an increase in the content of antibodies to thyroglobulin and a decrease in the concentrations of sodium, chlorine, potassium phosphorus, zinc, copper, iron and magnesium. It was found that the use of AELM and TLM against the background of autoimmune thyroiditis led to the restoration of T4 and elemental balance in rats, which was manifested in an increase in the content of sodium, chlorine, phosphorus, magnesium, zinc, iron, copper and calcium in the blood serum. It was also shown that TLM had a more powerful effect on the normalisation of the content of such elements as chlorine, potassium, copper and zinc. The obtained effect of AELM and TLM on the content of macro- and microelements in the blood serum of animals with experimental AIT can be explained by their positive effect on the functional activity of the thyroid gland. The studied extract and tincture may also affect other physiological and biochemical processes due to the content of macro- and microelements and other biologically active substances, which requires further research. Conclusions. Administration of AELM and TLM to rats with experimental AIT contributed to lowering the level of Anti-TG and restoring the thyroid and elemental status in the animals' blood serum. The obtained research data allow us to recommend AELM and TLM as a regulator of the elemental status of the body in case of changes in thyroid function

Do large parathyroid adenomas increase the risk of severe hypercalcemia?

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; Primary hyperparathyroidism (PHPT) is mainly caused by parathyroid adenoma (PA). Rare variants of PA, weighing &gt;2.0–3.5 g are called “large” or “giant” adenomas and account for about 1.5% of all PA.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; The aim of this study was to compare normal-sized and large parathyroid lesions identifying risk factors for severe hypercalcemia.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Materials and methods:&lt;/b&gt; 27 patients with PHPT and parathyroid lesion ≥2.0 cm3 (study group) were compared with 73 patients with PHPT and lesion &lt; 2.0 cm&lt;sup&gt;3&lt;/sup&gt; (control group). In both groups, the majority were women (81.5% – study group, 90.5% – control group, gender ratios 4.4:9.1, respectively). The patients were examined preoperatively and postoperatively: PTH, creatine, calcium, and phosphate serum and urine concentrations, and calcidiol serum levels were assessed. Preoperative ultrasonography (US) was performed.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; Patients with larger parathyroid lesions had signifficantly higher PTH and calcium serum concentrations and lower serum phosphate and calcidiol concentrations. There were no statistically significant differences in the concentration of creatine in serum and urine, calciuria, or tubular reabsorption of phosphorus (TRP). US relatively underestimated the parathyroid volume by about 0.3–0.4 mL (10% in larger lesions and 43% in smaller ones).&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; Due to higher PTH and calcium levels, larger parathyroid adenomas may constitute a higher risk of severe hypercalcemia. In general, US underestimated the parathyroid volume.&lt;/br&gt;

Association of Serum Calcium Levels of Preterm Neonates at Birth with Calcium Intake from Foods and Supplements by Bedridden Women during Pregnancy.

Bone calcium turnover is aggravated in pregnant women recommended to bed rest. In the present cross-sectional study, we aimed to clarify whether preterm neonates would benefit from calcium supplementation during pregnancy. Forty-two mothers (37.5 ± 6.7 years), recommended bed rest at home, and 42 preterm neonates (24-37 weeks gestational age) were enrolled. Neonates' serum calcium was quantified at birth. Mothers' calcium intake from foods and supplements during pregnancy was assessed. Serum 25-OH-D was measured in both mothers and neonates at birth. Results showed that mothers' calcium intake from foods was significantly lower than the recommended daily reference value (p < 0.001), while total calcium intake including supplements was close to the calcium reference value of 1000 mg/day (p = 0.648). Neonates' serum calcium concentration was significantly higher in mothers receiving calcium supplementation during pregnancy compared to mothers who did not (p < 0.001). A significant association between neonates' serum calcium levels and mothers' calcium supplementation was evident, even when adjusted to mothers' age, pre-pregnancy BMI, gestational age, and neonates' birth weight (beta = +0.460, p = 0.025). A statistically significant correlation between neonates' and mothers' serum 25-OH-D levels was found (r = 0.891, p < 0.001). In conclusion, calcium status in preterm neonates, born by bedridden women, could be enhanced after calcium supplementation during gestation.

Continuous Subcutaneous Delivery of rhPTH(1-84) and rhPTH(1-34) by Pump in Adults With Hypoparathyroidism.

Continuous subcutaneous infusion of recombinant parathyroid hormone (rhPTH) through a pump has been proposed as a therapeutic alternative for patients with chronic hypoparathyroidism who remain symptomatic or hypercalciuric on conventional treatment (calcium and active vitamin D) or daily injections of rhPTH(1-84) or rhPTH(1-34). However, the real-world evidence of the outcome of this novel therapy is limited. We report the clinical and biochemical outcomes of 12 adults with hypoparathyroidism (11 women, age 30-70 years, and 1 man, age 30 years) from 3 different clinical sites in the United States who were transitioned from conventional therapy to daily injections of rhPTH(1-84) or rhPTH(1-34) and then switched to continuous administration of rhPTH(1-84)/rhPTH(1-34) via pump therapy. In most patients, mean serum calcium concentrations increased while on PTH pump therapy compared with both conventional therapy (in 11 patients) and single/multiple daily rhPTH injections (in 8 patients). Despite this, 10 patients had lower median 24-hour urinary calcium levels while on PTH pump therapy compared with prior therapy (mean ± SD difference: -130 ± 222 mg/24 hours). All patients reported a qualitative decrease in hypocalcemic symptoms while receiving pump therapy. Three patients had pod failure at least once, and 1 patient developed an infusion site reaction. In this case series of 12 patients with chronic hypoparathyroidism treated with rhPTH(1-84)/rhPTH(1-34) administered via a pump, improvement in clinical and biochemical parameters were observed in the majority of the patients. Our observations indicate benefits of pump administration of rhPTH that warrant further investigation.

Vitamin D and behavioral disorders in older adults: results from the CLIP study

ObjectivesVitamin D is involved in brain health and function. Our objective was to determine whether vitamin D deficiency was associated with behavioral disorders in geriatric patients. DesignThe observational cross-sectional CLIP (Cognition and LIPophilic vitamins) study. The report followed the STROBE statement. SettingGeriatric acute care unit in a tertiary university hospital in France for 3 months at the end of winter and beginning of spring. Participants272 patients ≥65 years consecutively hospitalized or seen in consultation. MeasurementsParticipants were separated into two groups according to vitamin D deficiency (i.e., serum 25-hydroxyvitamin D ≤25 nmol/L). Behavior was assessed using the reduced version of the Neuropsychiatric Inventory Scale (NPI-R) score and subscores. Age, sex, BMI, education level, comorbidities, MMSE and GDS scores, use psychoactive drugs and vitamin D supplements, and serum concentrations of calcium, parathyroid hormone, TSH and estimated glomerular filtration rate (eGFR) were used as potential confounders. ResultsParticipants with vitamin D deficiency (n = 78) had similar NPI-R score (17.4 ± 20.3 versus 17.2 ± 16.1, p = 0.92) but higher (i.e., worse) subscore of agitation and aggressiveness (2.0 ± 3.3 versus 1.2 ± 2.4, p = 0.02) and higher (i.e., worse) subscore of disinhibition (0.99 ± 2.98 versus 0.38 ± 1.42, p = 0.02) than those without vitamin D deficiency (n = 194). In multiple linear regressions, vitamin D deficiency was inversely associated with the subscore of agitation and aggressiveness (β = 1.37, p = 0.005) and with the subscore of disinhibition (β = 0.96, p = 0.008). ConclusionVitamin D deficiency was associated with more severe subscores of agitation and aggressiveness and of disinhibition among older adults. This provides a scientific basis to test the efficacy of vitamin D supplementation on behavioral disorders in older patients with vitamin D deficiency.

Portulaca oleracea leave extract enhanced renal function via enhancing urea and creatinine clearance in wistar rats

Portulaca oleracea is rich in several minerals, vitamins, and antioxidant components, which has made it widely used in the management of hepato-renal disorders. In this study, we aimed to establish the safety or otherwise effect of Portulaca oleracea on renal function in albino Wistar rats concerning its numerous uses in traditional medicine as a vegetable for humans and as animal feed. The rats were grouped into experimental and control groups of ten (10) rats each. The experimental group was fed with 200 mg/kg of portulaca oleracea extract incorporated into the diet, while the control group was fed with normal feed for 4 weeks. Blood samples were collected for analysis. The data obtained was analyzed using a student t-test. The result of the test showed that creatinine from the experimental group (0.28 ± 0.03 mg/dL, p = 0.002) showed a significant decrease when compared with the control group (0.37 ± 0.02 mg/dL) at p<0.05. Urea from the experimental group (28.57 ± 2.77 mg/dL, p = 0.002) showed a significant decrease as compared to the control group (37.175 ± 2.27 mg/dL). Sodium (174.66 ± 5.38 mEq/L, p = 0.007), potassium (13.07 ± 0.48 mEq/L, p = 0.016) and calcium (9.94 ± 1.05 mEq/L, p = 0.043) of portulaca group showed significant increase when compared with their respective control values (143.19 ± 4.70; 9.22 ± 3.10; 8.52 ± 0.83mEq/L) at p<0.05. It could therefore be concluded that Portulaca oleracea extract at a dose level of 200 mg/kg has a beneficial effect on renal function by enhancing creatinine and Urea clearance and improving serum sodium, potassium and calcium concentration.