Serum Calcium Values Research Articles

Biochemical changes in tuberculosis.

Introductiontuberculosis (TB) remains a global health issue with high morbidity and mortality rates especially in the developing countries. It is a multi-organ disease and can influence biochemical changes. This study sought to determine the influence of tuberculosis and its drug treatment on serum biochemical parameters in patients in Nigeria.Methodsit was a descriptive observational cohort study on 150 subjects whose blood samples were analyzed for serum albumin, serum sodium, and serum potassium. The subjects were grouped into 3: TB group= 50 new TB subjects not on treatment, F group= 50 TB subjects on treatment for 2/12 or more and C group= 50 non-TB control subjects. These biochemical variables were compared between the 3 groups.Resultsmale/female ratio was 1: 1.5, mean age 37.1±0.92 years, and range 18-65 years. The differences in mean values of serum albumin, calcium and sodium between the three groups were significant (p<0.001), whereas that of serum potassium was not significant (p=0.056). Those patients with new case TB had a significantly lower serum sodium, serum albumin and serum calcium than the control group and those on treatment, p<0.001. There was significant positive correlation between serum albumin and serum calcium (r=0.0.420, p<0.001) as well as serum sodium (r=0.310, p<0.001) in the study population. Similarly, the correlation between serum calcium and serum sodium was positive and significant (r=0.200, p=0.014). In contrast, the correlation between serum potassium and serum albumin and that between serum potassium and serum calcium was not significant.Conclusiontuberculosis with or without anti-tuberculous medications was associated with significant reduction in serum albumin, serum sodium and serum calcium in this study.

Microwave ablation versus radiofrequency ablation for primary hyperparathyroidism: a multicenter retrospective study

Objective To compare the clinical outcomes of microwave ablation (MWA) and radiofrequency ablation (RFA) in the treatment of primary hyperparathyroidism (pHPT). Method This retrospective study included 104 pHPT patients treated by MWA or RFA between January 2015 and March 2020 in four centers. The clinical outcomes including effectiveness and complications were compared between the two groups. Ablation cure was defined as the reestablishment of normal values of serum calcium and intact parathyroid hormone (iPTH) at least more than 6 months. Clinical cure was defined as the reestablishment of normal values of serum calcium and iPTH throughout the entire follow-up period. Results A total of 77 patients underwent MWA (mean age, 55.5 ± 16.4 years) and 27 underwent RFA (mean age, 58.9 ± 15.6 years). During the follow-up (median, 18.7 months in the MWA group; 12 months in the RFA group), no difference was observed between ablation cure rates (88.3% vs. 88.9%, p = 1.000), clinical cure rates (87.0% vs. 82.3%, p = .880), recurrent pHPT (5.2% vs. 3.7%, p = .447), persistent pHPT (11.7% vs. 11.1%, p = 1.000) and complication rate (9.1% vs. 3.7%, p = .677). A maximum diameter less than 0.7 cm was an independent prognostic factor of uncured pHPT in ablation (hazard ratio, 0.1; 95% confidence interval: 0.02, 0.54; p = .007). Major complication – voice change encountered in five patients (6.5%) in the MWA group and in one patient (3.7%) in the RFA group. Conclusion Both RFA and MWA are safe and effective techniques for patients with pHPT, with comparable clinical outcomes.

Hypoparathyroidism in pregnancy

Hypoparathyroidism is a disorder rarely observed during pregnancy. It poses a major challenge in managing a patient appropriately to prevent maternal and fetal complications. We report a case of a 21-year-old gravid woman, a diagnosed case of hypoparathyroidism. She was successfully treated with calcium and calcitriol before pregnancy. Dosage was adjusted according to serum calcium values, and she delivered a healthy baby with normal serum calcium level.

Patterns of calcium channel (TRPV6) expression in rabbit gut epithelium

&lt;p&gt;The present study was undertaken to explore the immunohistochemical localisation of TRPV6 calcium channels in rabbit gut epithelium that are actively involved in calcium absorption. To undertake the research, twelve apparently healthy adult female rabbits with a body weight between 1.0 to 1.5 kg were procured, acclimatised and divided into two groups: control and test. Both groups were kept on same feed along with exogenous calcium supplementation in test group animals only. The serum calcium level revealed that normally a high value of serum calcium is maintained in the rabbit as compared to other mammals, thus indicating that the homeostatic mechanism might be poorly developed. Immunohistochemistry and reverse transcription polymerase chain reaction analysis revealed that the caecum was the site of maximum calcium absorption in rabbit, followed by the duodenum and jejunum. The expression pattern of TRPV6 protein/mRNA was weaker in test group animals than in the control group, indicating that the channel was functional in low calcium concentration in the gut.&lt;/p&gt;

Effects of high levels of water soaked sweet orange peel meal on the Performance response and blood profile of West African dwarf goats

A total of sixteen West African grower bucks of about 7-10 months were used in a completely randomised design to assess the effect of feeding diets with high levels of water soaked sweet orange peel meal (WSSOPM) on the performance response and blood profile of West African dwarf goats. Collected sweet orange peels were soaked in water and drained after 24 hours. The peels were then sun-dried on concrete floors for 48hour and afterwards crushed into a meal using a feed milling machine. The WSSOPM was used to compound four(4) experimental diets containing 0%, 60%, 80% and 100% WSSOPM, these were designated treatment T1, T2, T3, and T4, respectively. Each treatment had four (4) replicate. The study lasted for 11weeks. Results showed that, the mean daily feed intake, mean daily weight gain and the feed conversion ratio of the goats did not show treatment effect (P&gt;0.05) among the treatments. The cost analysis showed that profitability increased with increasing levels of WSSOPM in the diets. The blood parameters measured did not show treatment effect, except the albumin values in which T2 (3.53g/dL) was higher than T1 (2.80 g/dL), T3 (2.68 g/dL) and T4(2.55 g/dL).The mineral indices measured showed variations (P&lt;0.05) in only potassium values, treatment effect was not apparent on the serum calcium, phosphorus, magnesium, sodium and zinc values. Water soaked sweet orange peel meal can be used to replace maize offal at 60%, 80% and 100 % in the diets of West African dwarf goats without negatively affecting both performance and blood indices.

A deep learning backcasting approach to the electrolyte, metabolite, and acid-base parameters that predict risk in ICU patients.

A powerful risk model allows clinicians, at the bedside, to ensure the early identification of and decision-making for patients showing signs of developing physiological instability during treatment. The aim of this study was to enhance the identification of patients at risk for deterioration through an accurate model using electrolyte, metabolite, and acid-base parameters near the end of patients' intensive care unit (ICU) stays. This retrospective study included 5157 adult patients during the last 72 hours of their ICU stays. The patients from the MIMIC-III database who had serum lactate, pH, bicarbonate, potassium, calcium, glucose, chloride, and sodium values available, along with the times at which those data were recorded, were selected. Survivor data from the last 24 hours before discharge and four sets of nonsurvivor data from 48-72, 24-48, 8-24, and 0-8 hours before death were analyzed. Deep learning (DL), random forest (RF) and generalized linear model (GLM) analyses were applied for model construction and compared in terms of performance according to the area under the receiver operating characteristic curve (AUC). A DL backcasting approach was used to assess predictors of death vs. discharge up to 72 hours in advance. The DL, RF and GLM models achieved the highest performance for nonsurvivors 0-8 hours before death versus survivors compared with nonsurvivors 8-24, 24-48 and 48-72 hours before death versus survivors. The DL assessment outperformed the RF and GLM assessments and achieved discrimination, with an AUC of 0.982, specificity of 0.947, and sensitivity of 0.935. The DL backcasting approach achieved discrimination with an AUC of 0.898 compared with the DL native model of nonsurvivors from 8-24 hours before death versus survivors with an AUC of 0.894. The DL backcasting approach achieved discrimination with an AUC of 0.871 compared with the DL native model of nonsurvivors from 48-72 hours before death versus survivors with an AUC of 0.846. The DL backcasting approach could be used to simultaneously monitor changes in the electrolyte, metabolite, and acid-base parameters of patients who develop physiological instability during ICU treatment and predict the risk of death over a period of hours to days.

Peripheral Giant Cell Granuloma of the Jaws as First Sign of Primary Hyperparathyroidism: A Case Series.

Peripheral giant cell granulomas (PGCG) associated with hyperparathyroidism (HPT) are rare clinical entities. The aim of this study is to report on 21 PGCGs of the oral cavity as the first clinical sign of unknown primary HPT (PHPT) referred to the Complex Operating Unit of Odontostomatology of Aldo Moro University of Bari from 2009 to 2019. Surgical treatment consisted in conservative enucleation of the lesion, if possible, with contextual bone rim osteoplasty with piezosurgical tools and following histological examination. After histological diagnosis of PGCG, PHPT screening was performed dosing parathyroid hormone and serum calcium. In all the patients haematological investigation demonstrated elevated values of parathyroid hormone and serum calcium ruling out an unknown PHPT. Specifically, after endocrinological evaluation, patients showed PHPT related to: parathyroid adenoma (13), parathyroid hyperplasia (two, one of which occurred in a intra-thyroidal parathyroid), and parathyroid carcinoma (1) and were scheduled for surgical treatment. Considering that PGCGs could represent the first clinical sign of an undiagnosed PHPT and the screening of PHPT is a non-invasive and cheap exam, in case of histological diagnosis of a giant cell lesion, both central and peripheral, especially in patients with synchronous or history of methacronous giant cell lesions, parathyroidal screening should be mandatory.

Serum calcium slope is a predictor of post-thyroidectomy hypocalcemia

Background: Hypocalcemia is a common complication following thyroidectomy. The effects of hypocalcemia can range from simple numbness to life-threatening seizures. Barring stridor, haemorrhage and hypocalcemia, other complications of thyroidectomy are not seriously morbid and hence patients can be sent home. This study sought to determine whether early postoperative calcium levels can predict hypocalcemia following thyroidectomy, to help decide on early discharge.Methods: This was a prospective cohort study, conducted between July 2016 and June 2017 among 80 consecutive patients who underwent total thyroidectomy in our department. Serum calcium values were obtained pre-operatively and at 6 and 24 hours post-operatively. Serum calcium slopes were calculated and the receiver operating characteristic curve constructed to evaluate the accuracy of risk prediction.Results: The mean total calcium levels of patients with hypocalcemia were significantly lower than the levels of the normocalcemic group. The slope of change between total calcium measurements at 6 and 24 hours in patients with hypocalcemia was found to be significantly steeper than the slope in the case of normocalcemic patients.Conclusions: It is possible to predict post-thyroidectomy hypocalcemia based on the characteristics of the early post-operative serum calcium slope. On the basis of the slope’s features, all patients except those at risk can be safely discharged home early. This can cut down on the patients’ total cost of treatment as well as save unnecessary wastage of health resources.

Survival and analysis of predictors of mortality in patients undergoing replacement renal therapy: a 20-year cohort

Backgroundoptimal management of end-stage renal disease (ESRD) in hemodialysis (HD) patients should be more studied because it is a serious risk factor for mortality, being considered an unquestionable global priority.Methodswe performed a retrospective cohort study from the Nephrology Service in Brazil evaluating the survival of patients with ESRD in HD during 20 years. Kaplan-Meier method with the Log-Rank and Cox’s proportional hazards model explored the association between survival time and demographic factors, quality of treatment and laboratory values.ResultsData from 422 patients were included. The mean survival time was 6.79 ± 0.37. The overall survival rates at first year was 82,3%. The survival time correlated significantly with clinical prognostic factors. Prognostic analyses with the Cox proportional hazards regression model and Kaplan-Meier survival curves further identified that leukocyte count (HR = 2.665, 95% CI: 1.39–5.12), serum iron (HR = 8.396, 95% CI: 2.02–34.96), serum calcium (HR = 4.102, 95% CI: 1.35–12.46) and serum protein (HR = 4.630, 95% CI: 2.07–10.34) as an independent risk factor for the prognosis of survival time, while patients with chronic obstructive pyelonephritis (HR = 0.085, 95% CI: 0.01–0.74), high ferritin values (HR = 0.392, 95% CI: 0.19–0.80), serum phosphorus (HR = 0.290, 95% CI: 0.19–0.61) and serum albumin (HR = 0.230, 95% CI: 0.10–0.54) were less risk to die.Conclusionsurvival remains low in the early years of ESRD treatment. The present study identified that elevated values of ferritin, serum calcium, phosphorus, albumin, leukocyte, serum protein and serum iron values as a useful prognostic factor for the survival time.

Different elemental infant formulas show equivalent phosphorus and calcium bioavailability in healthy volunteers

Retrospective chart reviews have reported hypophosphatemia associated with elemental formula use in infants and children with systemic disease involving multiple diagnoses. The present study aims to evaluate the bioavailability of phosphorus from 2 commercial elemental formulas and to test our hypothesis of bioequivalence of the 2 products in healthy volunteers receiving gastric acid-suppressive medication. A single-center, double-blind, randomized, cross-over study was conducted in healthy volunteers with esomeprazole-induced hypochlorhydria. After a standardized low phosphorus meal followed by overnight fasting, subjects consumed 1 gram of phosphorus in a single oral dose of 1217 kcal of Product A (Neocate) or Product B (Elecare). The alternate product was given following a 1-week washout period. Blood and urine were collected at baseline and different time-points for up to 6 hours after product consumption. Area-under-the-curve (AUC) and peak values (Cpeak) for serum phosphate and calcium and urinary creatinine-corrected phosphate and calcium were assessed for bioequivalence of Products A and B. Results show that the geometric mean ratio (GMR) and 90% CI for serum phosphate were 1.041 (0.998-1.086) and 1.020 (0.963-1.080) for AUC0-360 and Cpeak, respectively, meeting the predetermined criteria for bioequivalence. Urinary creatinine-corrected phosphate followed a similar pattern after intake of Product A and B, but did not reach bioequivalence criteria (GMR: AUC70-370 = 1.105 (0.918-1.330); Cpeak = 1.182 (1.040-1.343)). Serum calcium concentrations (GMR: AUC0-360 = 1.002 (0.996-1.009); Cpeak = 0.991 (0.983-0.999)) and urinary creatinine-corrected calcium excretion (GMR: AUC70-370 = 1.117 (1.023-1.219); Cpeak = 1.157 (1.073-1.247)) demonstrated bioequivalence of the products. In conclusion, both elemental infant formulas showed equivalent serum phosphorus and calcium bioavailability in healthy volunteers even if combined with treatment with acid-suppressive medication.

Low serum calcium levels on admission independently predict mortality in patients with acute myocardial infarction

Abstract Background Serum calcium levels were reported to be associated with risk of cardiovascular diseases. The aim of this study was to analyze the association between serum calcium levels and all-cause mortality in patients with acute myocardial infarction (AMI). Methods A total of consecutive 3886 AMI patients with serum calcium data available were included in this analysis. The baseline characteristics, including clinical and laboratory parameters were collected. Patients were classified into 4 equally-sized groups based on serum calcium values (≤2.15, 2.16–2.23, 2.24–2.31, ≥2.32 mmol/L). Serum calcium tests were finished within 12 hours after admission. Patients were followed up for a median of 2.0 years (interquartile range 0.6–4.0). The primary endpoint was all-cause mortality. Results Compared to upper quartiles of serum calcium groups, subjects in the lowest quartile group (≤2.15 mmol/L) were older, lower body mass index (BMI), had lower levels of LDL-C and albumin, but higher level of NTproBNP. During a median follow-up period of 2.0 years, all-cause death occurred significantly more in the lowest quartile group (19.8%, 11.9%, 8.0% and 9.2% among the 4 groups from lowest to highest quartile, p&amp;lt;0.001 for trend). After adjusting for potentially confounding variables, the Cox analysis revealed that low serum calcium levels independently predict subsequent all-cause mortality (OR=0.36, 95% CI: 0.18–0.73), and identified that older age, lower BMI, smoking, and higher levels of creatinine were also independently associated with increased risk of mortality. Conclusion Low serum calcium levels on admission independently predict mortality in patients with AMI. Further studies are required to determine whether calcium supplementation could improve outcomes in AMI patients with hypocalcemia. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Beijing Natural Science Foundation (no. 7194253);Scientific Research Common Program of Beijing Municipal Commission of Education (KM201910025017)

Hypocalcemia in Elderly Population in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

As the medical facilities are improving, the life expectancy is increasing which has led to rapid rise in elderly population. The epidemiology of many diseases in elderly has been modified, including calcium imbalance. This study aims to know the prevalence of hypocalcemia in elderly population visiting a tertiary care center of Kathmandu. A descriptive cross-sectional study was conducted in a tertiary care center of Kathmandu from March to July 2020 after obtaining ethical clearance (Ref: 2003202007). Total 402 participants at or above 60 years of age groups visiting outpatient departments were included in the study by convenience sampling method excluding those under vitamin D and calcium supplements. Serum total calcium level was measured using standard routine method and corrected with albumin. The serum calcium value less than 8 mg/dl was considered as hypocalcemia in accordance with the reference range of our laboratory. Data analysis for calculation of frequency and proportion was done in Statistical Package of Social Sciences. The prevalence of hypocalcaemia in elderly was found to be 97 (24.1%). Out of 286 participants of age group 60-74 years, hypocalcemia was seen in 75 (26.2%) and among 116 participants of age group >74 years, 22 (19%) were hypocalcemic. Among 181 male participants, 44 (24.3%) had hypocalcemia and out of 221 female participants, 53 (24%) had hypocalcemia. The finding of present study suggests that hypocalcemia is common among elderly which can be life threatening. Therefore, regular monitoring of serum calcium is recommended for this age group.

Serum Calcium and Serum Alkaline Phosphatase Levels and their Correlations with Disease Activity in Patients with Rheumatoid Arthritis

Rheumatoid Arthritis is a systemic autoimmune disease, characterized by chronic synovial inflammationleading to joint destruction and bone erosion. Metabolic changes have been studied in rheumatoid arthritis,with several studies reported decrease in serum calcium, and increase in serum alkaline phosphatase inrheumatoid arthritis patients in comparison to healthy individuals. This study has been undertaken toevaluate serum calcium and serum alkaline phosphatase levels in patients with rheumatoid arthritis, andtheir correlation with disease activity. A total of 100 patients with rheumatoid arthritis were enrolled in thestudy and compared with 50 healthy controls (46 female: 4 male) matched for age and sex. No significantdifferences have been noticed in mean values of serum calcium, corrected calcium, and serum alkalinephosphatase in patients with rheumatoid arthritis and healthy controls. The mean values of serum calcium,corrected calcium and serum alkaline phosphatase levels were slightly higher with moderate and high diseaseactivity in comparison to low disease activity in patients with rheumatoid arthritis, but the differences didnot reach the statistical significance.

English

BACKGROUND Role for macronutrient supplementation in preventing pre-eclampsia is now backed with evidence which is evolving rapidly. We wanted to study and compare serum calcium and serum magnesium levels in pre-eclamptic women and women with normal pregnancy. METHODS 30 women with normal pregnancy and 30 women with preeclampsia were included in the study. Their serum calcium and magnesium levels were estimated using colorimetry. RESULTS Serum calcium levels in normotensive patients was found to be 9.3 ± 0.95 mg / dL and in preeclamptic patients, it was 8.3 ± 0.85 mg / dL. Serum magnesium levels were found to be 1.94 ± 0.24 mg / dL and 1.57 ± 0.125 mg / dL in normal and pre-eclamptic women respectively. These values were affected by age, parity, BMI, socio-economic status, and nutrition before and during pregnancy. CONCLUSIONS Low values of maternal serum calcium along with magnesium are related to preeclampsia which might have an association in this disease. We also realised that evaluation of base-line levels of serum calcium and magnesium are necessary during early pregnancy. Constant monitoring of blood pressure is also essential. Adequate intake of macronutrients is essential for maintaining health of both mother and child. Hence, measurable and realistic efforts must be made along these lines. Nutrition is a key concern in pregnant women and is pivotal in ensuring health in this vulnerable group. KEYWORDS Pre-Eclampsia, Serum Calcium, Serum Magnesium, Pregnancy, Macronutrients

BIOCHEMICAL, HISTOPATHOLOGICAL AND IMMUNOHISTOCHEMICAL EVALUATION OF ALTERATIONS IN BLOOD AND TIBIAL BONE TISSUES OF OVARIECTOMIZED RATS IN THE ACUTE PHASE

AMAÇ: Menopoz sonrası meydana gelen osteoporoz, kemik kütlesinde azalma ve kemik dokunun yapısında bozulma ile sonuçlanır. Ovariektomi sonrası, osteoporoz bulgularına rastlanmakta ve kemik yıkımı kemik oluşumundan fazla olduğundan kemik kaybına neden olmaktadır. ADAMs transmembran proteinleri ekstrasellüler matriksin yeniden yapılandırılmasında ve embriyonik gelişim, hücre göçü, adezyon, anjiyogenez olmak üzere birçok fizyolojik süreçte rol alırlar. Çalışmamızın amacı, ovariektomi oluşturulan sıçanlarda kan ve kemik dokusunda akut dönemde meydana gelen değişikleri biyokimyasal, histopatolojik ve immünohistokimyasal yöntemlerle araştırmaktır.GEREÇ VE YÖNTEM: Sağlıklı ve dişi 20 adet erişkin Wistar albino sıçan kontrol (n:10) ve bilateral ovariektomi uygulanan grup (n:10) olmak üzere 2 gruba ayrıldı. Anestezi altında yumurtalık rahim boynu kısmından 2 cm'lik kesi yapılarak, iki dorsolateral insizyon ile uterus apeksinden çift taraflı yumurtalıklar ipek iplikle çıkarıldı. Ovariektomi den 1 hafta sonra, deney hayvanları feda edildi. Serum östrojen, kalsiyum ve alkalin fosfat değerlerini ölçmek için her hayvandan kan örnekleri alındı, tibia kemikleri çıkarılarak formalin çözeltisine alınarak tespit edildikten sonra, dekalsifiye etme işlemine tabi tutuldu ve rutin histolojik işlemlerin ardından parafin blokları hazırlandı, yarı-ince kesitleri alınarak histopatolojik incelemeler için Hematoksilen Eozin boyası ile boyandı. İmmünohistokimyasal analiz için, antijen retrival işlemini uygulamak üzere sitrat tamponuna alındıktan sonra hidrojen peroksit ile muamele edildi. Kesitlere anti-ADAMTS-1 primer antikoru uygulandı, ışık mikroskobunda değerlendirildi.BULGULAR: Kontrol grubunda radiyal tarzda dağılmış havers kanalları ve volkman kanalları izlenirken, kollajen lifler birbirine paralel ve düzenliydi. Ovariektomi grubunda ise kemik matriksinde dejeneratif değişiklikler, lamelli kemik yapısında bozulma izlendi. ADAMTS-1 ekspresyonu açısından, kontrol grubu osteoblast ve osteosit hücrelerinde ve kemik matriksindeki ince kollajen liflerde ekspresyon pozitifti. Ovariektomi grubunda, dejeneratif alanda yer alan osteoklast hücrelerinde ADAMTS-1 ekspresyonunda artış, osteon yapılarında, endotel hücrelerinde ADAMTS-1 pozitif ekspresyonu izlendi. Kanda östrojen değerleri açısından, ovariektomi grubunda kontrol grubuna göre anlamlı bir düşüş gözlendi. Kalsiyum değerlerinde ise kontrol ve ovariektomi gruplarının değerleri birbirine yakındı. Alkalen fosfataz değerlerinin ovariektomi grubunda yükseldiği görüldü(p=0,01).SONUÇ: Çalışmamız sonucu elde ettiğimiz veriler ışığında, osteoporoz tedavisine ADAMTS-1 proteinlerinin dahil edilmesinin yeni tedavi yöntemlerini destekleyebileceği düşüncesindeyiz.

Clinical Characteristics of Mineral Bone Disease Among Patients with Chronic Kidney Disease in Southern, Nigeria

Mineral bone disease (MBD) is a common complication in patients with chronic kidney disease (CKD). The objective of this study is to determine the characteristics of CKD-MBD among adult patients with CKD in South-South, Nigeria. One hundred and fifty consecutive consenting chronic kidney disease patients who fulfilled the inclusion criteria for this study were recruited. Patients had a detailed clinical assessment, biochemical and radiological evaluations for CKD-MBD. Biochemical investigations included serum calcium, phosphate, parathyroid hormone (PTH) and alkaline phosphatase while the radiological investigations included X-ray of the skull, spine, wrist and phalanges. The age range of the patients was 22-80 years, with a mean of 45.1 (±11.9) years. There were 90 males and 60 females with male to female ratio of 1.5:1. Symptoms suggestive of CKD-MBD in the study population were bone pain and pruritus occuring in 34.9% and 12.0% of the CKD-MBD patients. Other symptoms presented by the patients included leg swelling in 126 (84%), frothiness of urine in 123 (82%), vomiting in 109 (72.7%), facial puffiness in 102 (68%), haematuria in 18 (12%) and chest pain in 73 (48.7%) of the patients. The mean values for serum PTH, serum calcium, serum phosphate, alkaline phosphatase and caxpo4 product among the CKD-MBD patients were 205.06±112.6 pg/ml, 2.56±0.73mmol/l, 1.63±0.63mmol/l, 109.26±65.57IU/L and 4.07±1.28mmol2 /l2 respectively. There was hypercalcaemia in 44.6%, hypocalcaemia in 26.0%, hypophosphataemia in 12.0% and hyperphosphataemia in 29.3% of the patients. High alkaline phosphatase was observed in 36.0% while 8.7% had low alkaline phosphatase. There was high calcium x phosphate product in 34.0% of the patients. Radiological features in keeping with CKD-MBD was present in only 6% of those with CKD-MBD. Hypercalcemia is the major biochemical abnormalilty in patients with CKD-MBD in our environment.

Evaluation for Primary Hyperparathyroidism in Patients Who Present With Nephrolithiasis

The incidence of primary hyperparathyroidism (PHP) is likely underestimated. Nephrolithiasis may indicate PHP with indication for parathyroidectomy. We sought to determine the proportion of patients with an index diagnosis of nephrolithiasis that have serum calcium levels measured, parathyroid hormone (PTH) levels measured if hypercalcemic, and time to referral for definitive management if PHP is diagnosed. A single-institution retrospective review was performed of adult patients presenting with nephrolithiasis between July 1, 2016 and December 31, 2018. Exclusion criteria included currently admitted patients, prior nephrolithiasis, congenital or acquired urinary tract anomalies, and patients on calciuretics. Records were assessed for serum calcium and PTH measurement, as well as referrals. Univariate statistical analysis was performed. Of 1782 patients with nephrolithiasis screened, 968 met inclusion criteria. Patients were 49.8% female, 88.9% white. Mean age was 53y. Within this cohort, 620 (64.0%) patients had a calcium measured, with a mean elapsed time from presentation of 27d (interquartile range [IQR] 0-8). Twelve patients (1.58%) with calcium measured were hypercalcemic and eight (66.7%) had PTH measured with a mean elapsed time from presentation of 183d (IQR 72-310), all had elevated or non-suppressed PTH. Five (62.5%) were referred to surgeons with mean elapsed referral time of 270d (IQR 95-492). Many with index nephrolithiasis are not assessed for hypercalcemia or hyperparathyroidism. Patients with serum calcium and PTH values indicating PHP diagnosis may have significant delay to parathyroidectomy. Targeted interventions with electronic health record alerts or automated reflex testing may improve care in this domain.

Clinical value of intact parathyroid hormone levels on the first day after total thyroidectomy on prediction for permanent hypoparathyroidism

Objective: To examine the value serum calcium and intact parathyroid hormone (iPTH) levels measured on the first day after total thyroidectomy on prediction for permanent hypoparathyroidism. Methods: Totally 546 patients with thyroid cancer and benign thyroid lesions who underwent total thyroidectomy at Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University from February 2008 to December 2018 were analyzed retrospectively. There were 158 males and 388 females aging (50.9±13.2) years (range: 19.0 to 79.2 years). Serum calcium and iPTH levels were collected before surgery, on the first day and 6 months after surgery. Logistic regression was used to analyze the correlation between each data and the occurrence of permanent hypoparathyroidism after surgery.The area under the receiver operating characteristic curve was used to evaluate the predictive power of iPTH for postoperative occurrence of permanent hypoparathyroidism. Results: Among the 546 cases of total thyroidectomy, 22 cases of permanent hypoparathyroidism occurred, with an incidence of 4.0% (22/546). Multivariate analysis showed that iPTH levels on the first day after total thyroidectomy (OR=2.932, 95%CI: 1.129 to 7.616, P=0.027) and serum calcium levels (OR=2.584, 95%CI: 1.017 to 6.567, P=0.046) were independent prognosis factors for postoperative permanent hypoparathyroidism. When the threshold value of iPTH at 24 hours after total thyroidectomy was 5.51 ng/L, the AUC was 0.956 (95%CI: 0.936 to 0.972, P=0.000), sensitivity was 100%, specificity was 85.1%, positive predictive value was 22%, negative predictive value was 100%. When the threshold value of serum calcium at 24 hours after total thyroidectomy was 1.93 mmol/L, the AUC was 0.733 (95%CI: 0.694 to 0.770, P=0.000), sensitivity was 63.6%, specificity was 78.1%, positive predictive value of 10.8% and negative predictive value of 98.1%. Conclusions: Serum iPTH and calcium levels on the first day after total thyroidectomy were related to the occurrence of permanent hypoparathyroidism postoperatively. The predictive value of iPTH level is higher than that of serum calcium level.

Carotid-femoral pulse wave velocity is significantly increased in newly diagnosed hypertensive patients with primary hyperparathyroidism and significantly related with serum calcium level.

Primary hyperparathyroidism (PHP) is a rare cause of secondary hypertension (HT), but in patients with PHP, HT is very common and 20-80% of patients have HT. The aim of this study was to evaluate the change in carotid-femoral pulse wave velocity (CF-PWV) in hypertensive patients with PHP, and was to determine the clinical, laboratory, and echocardiographic parameters associated with CF-PWV. The study included 83 newly diagnosed hypertensive patients with PHP and 83 patients with newly diagnosed essential HT without PHP. All patients underwent echocardiography and CF-PWV measurements. In patients with PHP, blood urea nitrogen, hs-CRP, uric acid, serum and urine calcium, parathyroid hormone level, CF-PWV value, LV wall thickness, LVMI, aortic and left atrium (LA) diameter, and presence of LVH and CF-PWV > 10m/s were higher, and serum phosphorus levels were lower. Serum calcium, LA diameter, and LVMI values were closely correlated with CF-PWV. In the ROC analysis, the AUROC was calculated as 0.825 for calcium level to determine the patients with increased CF-PWV. When the serum calcium value was taken as 10mg/dL, it was determined with CF-PWV > 10m/s were 79.5% sensitivity and 78.2% specificity. CF-PWV significantly increases in newly diagnosed hypertensive patients with PHP and significantly related to serum calcium level. To protect against target organ damage, high serum calcium levels should be monitored as well as blood pressure in hypertensive patients with PHP.

Effect of Mineral Supplementation on the Macromineral Concentration in Blood in Pre- and Postpartum Blackbelly Sheep.

Simple SummaryThe objective of this study was to determine the effect of mineral supplementation on the serum concentration of calcium, phosphorus, and magnesium in pre- and postpartum Blackbelly sheep throughout three successive lambing periods under free grazing conditions in the Ecuadorian Amazon Region. The field work was carried out between January 2015 and February 2018 using 20 Blackbelly females. The flock was randomly divided into two groups: Group 1 (G1), who were fed forage plus a supplementation (Pecutrin® Mineral supplement plus vitamins A, D3, and E. Bayer HealthCare); and Group 2 (G2), who were fed forage only without mineral supplementation. In this study, we showed that Blackbelly sheep raised under free grazing conditions (G2) had very low serum calcium values, and supplementation was unable to improve them. Meanwhile, phosphorus and magnesium values were below the required levels, but after supplementation (G1), they exceeded the minimum threshold. Mineral supplementation in the rearing of sheep in grazing systems is necessary during the entire production cycle, but it must be done taking into account the soil–plant–animal relationship, specifically for the Amazonian Region systems.The objective of this study was to determine the effect of mineral supplementation on the serum concentration of calcium, phosphorus, and magnesium in pre- and postpartum Blackbelly sheep throughout three successive lambing periods under free grazing conditions in the Ecuadorian Amazon Region. The field work was carried out between January 2015 and February 2018 using 20 Blackbelly sheep belonging to the Centre for Research, Postgraduate Studies and Conservation of Amazon Biodiversity, Ecuador. The flock was randomly divided into two groups: Group 1 (G1) was fed with forage plus a supplementation (Pecutrin® Mineral supplement plus vitamins A, D3, and E. Bayer HealthCare) and Group 2 (G2) was fed only with forage without mineral supplementation. Three blood samples from the coccygeal vein were taken from each sheep 30 days before lambing, 30 days after, and 60 days after lambing. Concerning the average of calcium, significant differences were found at different times inside each group and also between them (p < 0.0001 in both cases). As for the phosphorus, significant differences were found between the means of the groups for all times from 30 days after the second lambing season (p < 0.05). It was observed that the groups differed significantly in terms on the average of magnesium (considering a significance level of 0.05) 30 days before the first lambing and at all times measured from the 30 days after the second lambing (p < 0.005). In this study, we showed that Blackbelly sheep raised under free grazing conditions in the Ecuadorian Amazon Region had very low serum calcium values, and supplementation was unable to improve them. Meanwhile, phosphorus and magnesium levels were below the required values, but after supplementation, they exceeded the minimum threshold. Mineral supplementation in the rearing of sheep in grazing systems is necessary during the entire production cycle, but it must be done taking into account the soil–plant–animal relationship specifically for the Amazonian Region systems.