Tetany Research Articles

Tandem mass tag-based proteomics reveals the antiepileptic mechanism of steroidal saponins from Anemarrhena asphodeloides in Kainic acid induced epileptic rat model.

Epilepsy (EP) is one of the most common neurological diseases in the world. Anemarrhena asphodeloides Bunge. (AA), as a typical heat-cleaning medicine, has been proven to possess the antiepileptic effect in clinical and experimental studies. Anemarrhena asphodeloides steroidal saponins (AAS) are main components. However, the therapeutic effects and underlying mechanisms of AAS against EP are not been fully elucidated. In this study, 63 steroidal saponins were discovered in AAS by UPLC-Q-TOF/MS analysis. Pharmacological and behavioral analysis demonstrated that AAS could significantly lower the Racine classification and reduce the frequency of generalized spike rhythm the rate of tetanic seizures in kainic acid-induced epileptic rats. Hematoxylin and eosin and Nissl staining-indicated AAS could significantly improve hippocampal injury and neuron loss in epileptic rats. TMT proteomic analysis discovered 26 different expressed proteins (DEPs), which were identified as the rescue proteins. After bioinformatic analysis, Heat Shock Protein 90 Alpha Family Class B Member 1 (Hsp90ab1) and Tyrosine 3-Monooxygenase (Ywhab) were screened as key DEPs and verified by western blotting. AAS could significantly inhibited the up-regulation of Hsp90ab1 and Ywhab in EP rats; these two proteins might be the key targets of AAS in treating EP.

Клініко-патогенетичне значення правцевого токсину. Клінічний випадок

Правець — це серйозне, потенційно небезпечне для життя інфекційне захворювання, що виникає в результаті попадання в рану спор Clostridium tetani, розвиток якого обмежується поствакцинальним імунітетом. Даний збудник виробляє один з найсильніших токсинів — тетаноспазмін, що обумовлює клінічні прояви. Найбільш частими симптомами захворювання є тризм, дисфагія, сардонічна посмішка та тетанічні судоми на тлі тонічного напруження м’язів. Смерть, як правило, настає внаслідок дихальної або серцевої недостатності. Лікування зазвичай проводиться в умовах відділення інтенсивної терапії з метою запобігання розвитку потенційних ускладнень, що загрожують життю людини. Це наочно ілюструє наведений у статті клінічний випадок правця в нещепленої 6-річної дитини з добрим результатом. Тривалість захворювання становила 64 доби. Націлювання лікарів первинної ланки на забезпечення імунізацією груп ризику допоможе запобігти розвитку правця.

Clinical analysis of 14 cases of pseudohypoparathyroidism in children

Objective To analyze the clinical characteristics and treatment of pseudohypoparathyroidism(PHP) in children and to increase clinicians′understanding of this disorder. Methods From January 2008 to November 2018, a total of 14 PHP patients at our hospital were retrospectively analyzed, as regarding the clinical manifestation, laboratory examination and imaging data.The patients were further divided into two groups according to onset age: group A(under 1 year) and group B(over or equal to 1 year). The laboratory findings were compared between the two groups. Results Of the 14 patients(10 boys and 4 girls), the median age of onset was 12 years(range: 1 day to 16 years). Epilepsy is one of the most common manifestations of PHP.Laboratory findings include hypocalcemia(1.06-2.18mmol/L), hyperphosphatemia(2.1-3.5 mmol/L), and elevated concentrations of PTH(105.6-733.0 pg/ml). PTH levels were significantly lower in the group A than in group B(Z=2.07, P=0.042). Five patients were found to have calcifications in bilateral basal ganglia and cerebral parenchyma by head CT.All the patients were improved after treatment, which included calcium gluconate injection to control tetany, calcium supplement combined with vitamin D and/or calcitriol orally. Conclusion For children who presented frequent hypocalcemia tetany and calcifications in head CT, serum calcium, phosphorus, PTH levels should be further investigated to make a correct diagnosis.Calcium supplement combined with vitamin D or its metabolites is an effective therapy for PHP children. Key words: Pseudohypoparathyroidism; Tetany; Children

Clinical analysis of 18 cases of pseudohypoparathyroidism

Objective To analyze the clinical characteristics of pseudohypoparathyroidism (PHP) inpatients in our hospital from January 2008 to December 2017 and to gain a better understanding of this disorder. Methods 18 inpatients diagnosed as sporadic PHP in our hospital were analyzed retrospectively, as regarding the clinical manifestation, laboratory examination and imaging data. Results 18 inpatients were diagnosed sporadic PHP consisting of 12 males and 6 females, with 13 adults and 5 child participants respectively. The medium age of onset was 14 (6-57), and the average age at diagnosis was (24.9±14.7) years old. Initial onset of symptoms reported were: 12 patients complained of tetany, 3 reported convulsions, 1 reported numbness, 1 reported dysnoesia, and 1 were asymptomatic. Among them: 3 patients were found to have short distal phalanx, 7 displayed a round face, and 3 out of 15 adults were less than 155 cm in height. 12 patients had a positive Trousseau sign, 1 had an ectopic calcification. 11 were found to have intercranial massive calcifications by head computed tomography. Serum calcium was reported at (1.58±0.11) mmol/L and parathyroid hormone was (359.5±146.6) pg/ml. 3 patients were discovered to have hypothyroidism, 2 had been misdiagnosed with epilepsy, and 1 with encephalitis. Conclusions Tetany and intracranial calcifications were the most common signs of PHP patients. A number of the PHP cases in this study lacked typical Albright′s Hereditary Osteodystrophy (AHO) appearance. The age of onset and duration of the disease varied somewhat in the different patient populations. The heterogeneity nature of the clinical manifestations of PHP makes it difficult to diagnose. It is therefore important to make accurate differential diagnosis of PHP to avoid misdiagnosis. (Chin J Endocrinol Metab, 2018, 34: 920-925) Key words: Pseudohypoparathyroidism; Hypocalcemia; Hypoparathyroidism

Nutritional Hypovitaminosis D Presenting as Tetany in an Infant

Nutritional Hypovitaminosis D Presenting as Tetany in an Infant

Wintersweet (Chimonanthus praecox) toxicity in four goats

CASE HISTORY: A one-year-old female goat presented with acute onset of recumbency, seizures and vocalisation approximately 5 hours after being given access to branch trimmings from a neighbour's garden. The plant from which the pruned branches came was subsequently identified as wintersweet (Chimonanthus praecox). Three other goats kept in the same paddock displayed similar clinical signs over a period of 4 hours following the initial presentation.CLINICAL FINDINGS: All four goats were ataxic, displayed tetanic seizures and were in lateral recumbency; they had dilated pupils and were hyperaesthetic, with elevated heart and respiratory rates. After symptomatic treatment, including sedation with diazepam, one of the three goats continued to deteriorate and was subjected to euthanasia. The remaining three goats recovered over 1–14 days with nursing care and physiotherapy.DIAGNOSIS: Toxicity due to ingestion of wintersweet, which contains the alkaloid calycanthine.CLINICAL RELEVANCE: Calycanthine is a central nervous system toxin, causing convulsions. Wintersweet shrubs are present in many New Zealand gardens. Practitioners should be aware that the seeds and flowers, and possibly the leaves, of this plant are highly toxic with signs of toxicity including ataxia, hyperaesthesia and seizures.

Analysis of diagnosis and treatment of 89 patients with primary hyperparathyroidism

Objective To summarize the clinical manifestations, diagnosis and treatment of the primary hyperparathyroidism(PHPT). Methods The clinical data of 89 patients with PHPT admitted during 1991 to 2013 were retrospectively analyzed. Results The mean age of the 89 patients was(44.7±15.8)years(13-86 years), male to female ratio was 1∶2.1. 79% of the 89 patients were symptomatic. 62% of the 89 patients had been misdiagnosed. 52% had been misdiagnosed as kidney stones or bone diseases(fracture, tumor, and metabolic bone disease). The remaining subjects had been misdiagnosed as peptic ulcer, rheumatoid arthritis or pancreatitis. The median serum parathyroid hormone(PTH)level in 88 patients was 697.3 pg/ml(26.4-5 000.0 pg/ml, n=88), the mean serum calcium level was(3.03±0.56)mmol/L(n=88). The 24 h urine calcium was(10.02±4.73)mmol/24 h(n=36). The sensitivity of localization of the parathyroid lesions with technetium-99mmethoxy-isobutyl-isonitrile(99mTc-MIBI)was 96%, being higher than ultrasound(71%), CT(71%), and MRI(72%)(P<0.05, respectively). 79 cases had been treated surgically. The median serum PTH level was 748.2 pg/ml(46.1-5 000.0 pg/ml)before surgery, 79.9 pg/ml(11.35-838.0 pg/ml)15 minutes after surgical removal of the lesions(P<0.05 vs preoperative)and 22.9 pg/ml(2.3-1 203.0 pg/ml)on the first postoperative day(P<0.05 vs preoperative). Serum calcium was(3.03±0.56)mmol/L before surgery, (2.25±0.37)mmol/L on the first postoperative day(P<0.05 vs preoperative)and(2.08±0.36)mmol/L on the second postoperative day(P<0.05 vs preoperative). After the operation, 42 cases(53%)had perioral and limb numbness, 2 cases(3%)had hoarseness of voice and bucking while drinking, 1 case(1%) had tetany. All these symptoms were improved after calcium supplementation. 67 patients(85%)had been diagnosed as parathyroid adenoma pathologically, 7 patients(9%)as hyperplasia, 3 patients(4%)as cysts, and 2 patients(3%)as carcinoma. Among 67 cases of adenomas, 62 cases had a single parathyroid adenoma, 1 case with multiple parathyroid adenomas, and 4 cases with ectopic parathyroid adenomas. The ectopic lesions were located below the thyroid, in the rib cage, left mediastinum, and above the sternum. Conclusions The majority of domestic PHPT was symptomatic. Delayed diagnosis of PHPT is still very frequent. The clinical presentations of PHPT are variable, determination of serum calcium and PTH level simultaneously is the keypoint for early identification and diagnosis of PHPT. The clinician should be familiar with the various clinical manifestations of PHPT and thus enhance understanding of pathogenesis of the disease. 99mTc-MIBI scintigraphy remained the first choice of preoperative imaging localization of the parathyroid lesions, followed by ultrasound, CT, and MRI. Surgical removal of the lesions is effective and safe. (Chin J Endocrinol Metab, 2015, 31: 300-305) Key words: Primary hyperparathyroidism; Diagnosis; Treatment

Marble bone disease and the Anaesthesiologist.

Sir, Osteopetrosis is an uncommon genetic disease encountered by anaesthesiologists and is rarely reported.[1] The various associated anatomical and physiological alterations are challenging. We report the successful management of a 35-year-old female with the condition, scheduled for revision surgery for malunion of femur under combined spinal-epidural block (CSE). Pre-operatively, difficult airway, atlantoaxial dislocation (AAD) and significant bony sclerosis of entire vertebral column were identified [Figure 1]. Figure 1 Vertebral column sclerosis The patient had received general anaesthetic 4 years before for fracture of the shaft of the femur. The fracture had malunited resulting in deformity, and a redo interlocking nail femur was planned. Patient was explained the need and the procedure of fibreoptic guided awake intubation, in case of failure of regional anaesthesia. The patient was 36 kg in weight, 138 cm tall with short limbs, frontal bossing, macrocephaly with no mental retardation, receding mandible and irregular dentition. Airway assessment revealed a high arched palate, restricted neck extension and a modified Mallampati airway grade 2b. Difficult intubation was anticipated. In view of AAD, advanced airway gadgets to prevent neck movements during laryngoscopy and intubation were kept ready. Substantial sclerosis of vertebral bodies was noticed in spine radiographs with almost fused spine in the lumbar region, thereby increasing the technical difficulty in performing the neuraxial blockade. The patient was pre-medicated with injection pantoprazole 40 mg and alprazolam 0.25 mg. The patient was verbally assured and could be comfortably positioned sitting for the neuraxial block. Needle through needle technique was used for CSE. Block was performed by paramedian approach in L2-L3 intervertebral space and was successful in the first attempt. Bupivacaine 0.5% heavy (10 mg) with fentanyl 12.5 μg was deposited intrathecally. The epidural catheter was fixed at 7 cm mark (space identified by loss of resistance to air at 2 cm from the skin). A sensory analgesia up to T10 dermatome was achieved. The patient was carefully positioned with adequate padding of pressure points. Tranexamic acid 10 mg/kg intravenous was administered during surgery. A fixed dose continuous epidural infusion containing bupivacaine 0.125% with fentanyl 1 μg/ml was started at 5 ml/h at the end of surgery for post-operative analgesia. Patient exhibited stable haemodynamics during surgery. The epidural catheter was removed on 3rd post-operative day. The patient did not exhibit any signs of post-operative neurological deterioration. Osteopetrotic patients[2] vary greatly in their presentation and severity. The simplest form is osteopoikilosis, noticed as incidental finding of osteopetrosis on radiographs. Autosomal recessive variant has a neonatal onset with fractures, short stature, compressive neuropathies, hypocalcaemia, tetanic seizures, pancytopenia, mental retardation, skin and immune system involvement and renal tubular acidosis. The onset of primarily skeletal manifestations such as fractures, osteoarthritis of hip joint and osteomyelitis of the mandible at adolescence is typical of autosomal dominant variant. Common findings are cranial nerve compressions manifesting as visual and hearing loss, nutritional anaemia, thrombocytopaenia, brittle and osteomyelitic bones (more prone to bleed), hypocalcaemic seizures with secondary hyperparathyroidism and muscular hypotonia. Judicious use of transfusions is warranted as significant immunosuppression is a feature of this disease. Nasal space is reduced by bony encroachments with disturbed facial anatomy complicating nasal intubation. Fibreoptic guided awake oral intubation is preferred if general anaesthesia is contemplated.[3] The anaesthetic options are limited and technically difficult with both airway and spine involved in the disease process. The osteopetrotic bones are difficult to drill and surgical time can escalate. We were able to successfully place a central neuraxial block in our patient, but this may not always be the best anaesthetic. Hence, pre-operative identification of anaesthetic complexities is essential to plan safe perioperative course.

Validity of early parathyroid hormone assay as a diagnostic tool for sub-total thyroidectomy related hypocalcaemia.

To determine the validity of early (one hour postoperatively) parathyroid hormone (PTH) assay (² 10 pg/ml), keeping gold standard as the serum ionic calcium level, for predicting sub-total thyroidectomy-related hypocalcaemia and to calculate the sensitivity and specificity of latent signs of tetany. Cross-sectional validation study. Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad from August 2008 to August 2010. Patients undergoing sub-total thyroidectomy were included by convenience sampling. PTH assay was performed 1 hour post sub-total thyroidectomy. Serum calcium levels were performed at 24 and 48 hours, 5th day and 2 weeks after surgery. Cases that developed hypocalcaemia were followed-up for a period of 6 months with monthly calcium level estimation to identify cases of permanent hypocalcaemia. Symptoms and signs of hypocalcaemia manifesting in our patients were recorded. Data was analyzed through SPSS version 10. 2 x 2 tables were used to calculate sensitivity and specificity of PTH in detecting post-thyroidectomy hypocalcaemia. Out of a total of 110 patients included in the study, 16.36% (n=18) developed hypocalcaemia including 1.81% (n=2) cases of permanent hypoparathyroidism. The sensitivity of one hour postoperative PTH assay as a predictive tool for post-thyroidectomy related hypocalcaemia was 94.4% while its specificity was 83.6% with 53% positive predictive value and 98.7% negative predictive value. One hour post sub-total thyroidectomy PTH assay can be helpful in predicting post sub-total thyroidectomy hypocalcaemia. Moreover, it can be useful in safe discharge of day-care thyroidectomy patients.

Clinical study on gasless video-assisted endoscopic thyroidectomy by infraclavicular wall

Objective To evaluate the clinical value of gasless video-assisted endoscopic thyroidectomy by infraclavicular wall.Methods 15 cases received gasless video-assisted endoscopic thyroidectomy by infraclavicular wall.13 cases underwent total thyroidectomy,2 cases underwent subtotal thyroidectomy.All 15 cases were protected recurrent laryngeal nerve and parathyroid by inspecting during the operation.Results All 15 patients were cured without hoarse and tetany,and the flaps without hematomas and extravasated blood.Conclusion Gasless video-assisted endoscopic thyroidectomy by infraclavicular also can reach the principle demand by the tradional opening way.As the supremacy way of aesthetic and hidden,it can be used to the patients who want high request on faces. Key words: Thyroidectomy; Endoscopy

The Role of Urinary Magnesium in Dogs’ Rickets Diagnosis

Indifferently of animal species (including humans) in magnesium deficiencies usually wehave one drop of this mineral from bone tissue. This phenomenon is more intense in young animalsand is directly correlated with severity of magnesium deficits. The total number of clinical cases was15 dogs, belong of German Sheppard, Dobermann, Great Dane, Siberian Husky breeds with clinicalsymptoms of rickets and with ages between 6 to 9 mounts.Group I has included patients with moderate signs of rickets and the group II has includedpatients with more severe form . Our biochemical analysis was: serum Calcium (SCa), serumMagnesium (SMg), erythrocyte Magnesium (EMg), an inorganic Phosphate (inorg.P), serumCreatinine (SCr) and Alkaline Phosphatase (AP); from urine we determine : urinary Magnesium(UMg), urinary Creatinine (UCr) and Magnesium excretion fraction (MgEF). Median values of sericand erythrocytes Magnesium in both groups were below reference values, but in group 2 were lowerthan in group 1. Dismagnesiemia is followed by one abrupt decreses in magnesiuria and reduction ofexcretion fraction of magnesium. This mean that global magnesium reserve is dropping andmagnesium activity in cell is deficencity. Rickets osteodistrophia can be associated with slowhipomagnesium tetany.

Seizures and severe nutrient deficiencies in a puppy fed a homemade diet

An 8-month-old male Saint Bernard developed tetanic seizures and hyperthermia during evaluation of bilateral osteochondritis dissecans of the shoulder joints. Further investigation revealed that the dog was receiving an unbalanced homemade diet. Preliminary evaluation of the dog revealed bilateral signs of pain and mild muscle wasting in the shoulder joint areas. Serum biochemical analysis revealed severe hypocalcemia, hyponatremia, hypochloremia, hyperphosphatemia, vitamin D deficiency, and taurine deficiency. Diffuse osteopenia was identified on radiographs of the mandible and long bones, confirming bone demineralization. Analysis of the homemade diet revealed that the dog's diet was severely deficient in a variety of nutrients. The dog responded positively to treatment for hypocalcemia, hyperthermia, and seizures. The dog's diet was changed to a complete and balanced canine diet formulated for growth. Body weight and body condition were monitored, and dietary intake was adjusted to achieve optimal body condition during growth. After initial evaluation, serial monitoring of serum calcium and taurine concentrations revealed that values were within reference limits and the dog had no further clinical signs associated with dietary deficiency. Findings in this puppy highlight the risks associated with feeding an unbalanced homemade diet during growth and the importance of obtaining a thorough dietary history from all patients. For owners who elect to feed a homemade diet, it is critical to have the homemade diet carefully formulated by a veterinary nutritionist to avoid severe nutrient imbalances, especially in young, growing dogs.

Minimally invasive endoscopic thyroidectomy via an anterior chest approach for early papillary thyroid cancer

To evaluate the feasibility and safety of endoscopic thyroidectomy via anterior chest approach for early papillary thyroid cancer (T1N0M0). From July 2004 to December 2010, 91 patients with early papillary thyroid cancer underwent minimally invasive endoscopic thyroidectomy via anterior chest approach. The clinical and pathologic characteristics of patients, operation types, operative time, postoperative hospital stay time, and postoperative complications were analyzed retrospectively. All 91 operations were successfully performed endoscopically. There was no case conversed to open surgery. The mean tumor size was (0.96 ± 0.71) cm. The operation types included unilateral lobectomy (41 cases), unilateral subtotal lobectomy (3 cases), ipsilateral lobectomy and contralateral subtotal lobectomy (42 cases), and bilateral total thyroidectomy (5 cases). Central compartment node dissection was carried out in 39 cases with the tumor diameter less than 1.0 cm and in 29 cases with the tumor diameter of 1.0 - 2.0 cm. The mean operating time was (99 ± 17) min, the mean bleeding volume was (18 ± 12) ml, and the mean post-operative hospital stay time was (3 ± 1) days. Temporary recurrent laryngeal nerve (RLN), paresis occurred in 2 cases and recovered within 1 to 2 months after the surgery. One patient showed permanent RLN paralysis. Two patients showed temporary hypoparathyroidism. No patient showed post-operative seroma and tracheal injury. There was no case with injury to the superior laryngeal nerve. No further complications, such as irritating cough, tetany, and emphysema developed after the operation. With the anterior chest wall approach, all patients had no surgical scar on the neck and thus they were satisfied with the cosmetic outcomes. All patients were disease free by follow-up of 7 to 85 (58.4 ± 17.2) months. Minimally invasive endoscopic thyroid surgery through anterior chest approach is a feasible and safe method for the treatment of early papillary thyroid cancer. This technique had better cosmetic results and the long-term effect of this technique needs further evaluation.

FAHR syndrome presented with tetany: Case Report

Fahr sendromu serebellum, talamus ve bazal ganglionlarda kalsiyum ve fosfor metabolizma bozuklugu sonucu olusan kalsinozisle seyreden norodejeneratif bozukluklarla karakte- rize beyin tomografisi ile kalsiyum ve cesitli minerallerin birikiminin gosterilebilecegi nadir gorulen bir hastaliktir. Tetaniden noropsikiyatrik semptomlara kadar genis bir klinik seyir gosterebilir. Tanisinda Beyin tomografisi kullanilmakta olup tedavisi cogu zaman semptomatik ve kalsiyum metabo- lizma bozuklugunun duzeltilmesi seklindedir. Ani noropsiki- yatrik semptomlar gorulen, kalsiyum metabolizma bozuklu- gu olup, sebebi anlasilamayan norolojik semptomlar gelisen hastalarda Fahr sendromu ayirici tanida mutlaka hatirlanma- si gerekmektedir. Fahr syndrome is a rarely seen disease which is preceded with calcinosis that consists as a result of Ca and P metabo- lism disorder at cerebellum thalamus and basal ganglia. It is characterized by neurodegenerative disorder. Deposition of Ca and several minerals can be seen at cranial ct. It has wide clinical course that indicates tetany to neuropsychiatric symptoms. Cranial CT is used at diagnosis of Fahr synd. treatment is usually symptomatic and includes correction of Ca metabolism disorder. Fahr syndrome must be considered at differential diagnosis of patients who has Ca metabolism disorder, suddenly developed neurological symptoms.

Infantile malignant osteopetrosis: a rare cause of neonatal hypocalcemia

Infantile malignant osteopetrosis (IMO; OMIM 259700) is a rare inherited bone disease characterized by reduced or dysregulated activity of osteoclasts, resulting in generalized osteosclerosis. The disease usually presents within the first few months of life with anemia, hepatosplenomegaly, frontal bossing, nystagmus, blindness, deafness, and bone fractures. Children with IMO are at risk of developing hypocalcemia, with attendant tetanic seizures. We report the case of a baby boy who presented with neonatal hypocalcemia. Skeletal radiographs demonstrated sclerotic bones and a dense base of the skull with typical "space alien" face confirming the diagnosis of IMO. Pancytopenia developed at 2 months of age. Visual evoked potential showed severe bilateral optic nerve damage. Genetic mutation study revealed a new mutation in exon 13 of the TCIRG1 gene. Neonatal hypocalcemia can occur as result of IMO, which is easily missed out by clinicians. This causes delay in establishing the diagnosis and starting necessary treatment. Therefore, osteopetrosis should be kept in mind as a rare cause of neonatal hypocalcemia.

Pregnancy in Inherited Hypokalemic Salt-Losing Renal Tubular Disorder

The management of inherited hypokalemia has improved and the issue of pregnancy has become important. Between 1992 and 2010, five Italian women with the clinical diagnosis of Gitelman syndrome gave birth to a total of six newborns. Pregnancy was uneventful in four women but was complicated by tiredness and tetanic seizures in the fifth woman. Drug management included potassium chloride in four cases and magnesium and amiloride in one case each. The six neonates were born at term (n=4) or near term (n=2), with a body weight that was appropriate for gestational age. The children, aged between 6 weeks and 18 years, were healthy and neurodevelopmentally and somatically normal at the last follow-up. Women with hypokalemia can become pregnant and the disorder may be managed without negative effect on the fetus.

Hypoalbuminaemia associated hypocalcaemia with overt clinical features: A case report

Hypocalcaemia is defined as serum calcium level less than 9.0 mg/100 ml (2.25 Mmol/l). It is often only being considered as a differential diagnosis in the paediatric unit, where it is usually included as part of routine investigations, especially in children with clinical problems such as convulsions, seizure, apathy, muscles weakness, tetany, suspected vitamin D deficiency or maternal hypercalcaemia. In adult patients however, hypocalcaemia is often neglected (especially in private health facilities) except in specialties such as rheumatology, neurology, nephrology and intensive care unit. In this report, neurological manifestations (paraesthesia, delirium, seizure and coma) were presented by the patient. Both anthropometric and biochemical parameters were evaluated in this patient and the results were used to evaluate the patients clinical presentation. The findings revealed that there was malnutrition, which manifested biochemically as hypoalbuminaemia and hypocalcaemia. Calcium replacement therapy satisfactorily returned this patient to stable clinical state, the therapy was done parenterally but gradually. Surprisingly, this patient showed overt clinical features of hypocalcaemia against the popular belief that hypoalbumineamic hypocalcaemia does not have a physiological significance. This report emphasizes the need to include serum calcium estimations in our routine investigations in clinical practice on one hand, and on the other hand, it appears to disagree with the overemphasized rarity of physiologically significant hypocalcaemia due to hypoalbuminaemia. Key words: Hypocalcaemia, hypoalbuminaemia, overt clinical features.

Osteopetrosis

Osteopetrosis ("marble bone disease") is a descriptive term that refers to a group of rare, heritable disorders of the skeleton characterized by increased bone density on radiographs. The overall incidence of these conditions is difficult to estimate but autosomal recessive osteopetrosis (ARO) has an incidence of 1 in 250,000 births, and autosomal dominant osteopetrosis (ADO) has an incidence of 1 in 20,000 births. Osteopetrotic conditions vary greatly in their presentation and severity, ranging from neonatal onset with life-threatening complications such as bone marrow failure (e.g. classic or "malignant" ARO), to the incidental finding of osteopetrosis on radiographs (e.g. osteopoikilosis). Classic ARO is characterised by fractures, short stature, compressive neuropathies, hypocalcaemia with attendant tetanic seizures, and life-threatening pancytopaenia. The presence of primary neurodegeneration, mental retardation, skin and immune system involvement, or renal tubular acidosis may point to rarer osteopetrosis variants, whereas onset of primarily skeletal manifestations such as fractures and osteomyelitis in late childhood or adolescence is typical of ADO. Osteopetrosis is caused by failure of osteoclast development or function and mutations in at least 10 genes have been identified as causative in humans, accounting for 70% of all cases. These conditions can be inherited as autosomal recessive, dominant or X-linked traits with the most severe forms being autosomal recessive. Diagnosis is largely based on clinical and radiographic evaluation, confirmed by gene testing where applicable, and paves the way to understanding natural history, specific treatment where available, counselling regarding recurrence risks, and prenatal diagnosis in severe forms. Treatment of osteopetrotic conditions is largely symptomatic, although haematopoietic stem cell transplantation is employed for the most severe forms associated with bone marrow failure and currently offers the best chance of longer-term survival in this group. The severe infantile forms of osteopetrosis are associated with diminished life expectancy, with most untreated children dying in the first decade as a complication of bone marrow suppression. Life expectancy in the adult onset forms is normal. It is anticipated that further understanding of the molecular pathogenesis of these conditions will reveal new targets for pharmacotherapy.

Symptoms and management of tetany

Tetany is a series of symptoms characterized by painful muscle cramp that derives from enhanced neuromuscular excitability due to hypocalcemia, hypomagnesemia or alkalosis. In a broad sense, tetany includes associated sensory disturbance. Typical symptoms of tetany include carpopedal spasm, laryngospasm and generalized seizure. Chvostek and Trousseau signs are provocative tests for diagnosis of latent tetany. Many diseases including endocrine disorders like hypoparathyroidism and alkalosis by hyperventilation can cause tetany. Infusion of calcium or magnesium is effective as an acute therapy for tetany. However, subsequent diagnosis and treatment of underlining diseases are mandatory.

Duranta erecta poisoning in nine dogs and a cat

Four incidents of Duranta erecta (golden dewdrop, Sheena's Gold, Geisha Girl) poisoning affecting nine dogs and a cat produced drowsiness, hyperaesthesia and tetanic seizures in all affected animals with evidence of alimentary tract irritation (vomiting, gastric and intestinal haemorrhage, diarrhoea, melaena) in five dogs and the cat. Fruits and leaves were seen to be eaten by affected animals. Therapy was successful in three of the dogs. Repeated diazepam doses and, in some cases, additional pentobarbitone or propofol anaesthesia, were successful in controlling seizures.