Serum Calcium Values Research Articles

COMPARATIVE STUDY BETWEEN CALCIUM CHANNEL BLOCKER AND PROGESTERONE THERAPY IN PREVENTION OF RECURRENT PRETERM LABOR

Background: Preterm labor (PTL) is the leading cause of perinatal and neonatal morbidity and mortality and strongly related to the developmental and neurological disabilities later in life. Objective: To compare between calcium channel blocker and progesterone in the prevention of Preterm Labor in patients with history of recurrent spontaneous preterm labor. Patients and Methods: A comparative clinical study was done at Al-Hussein Hospital on one hundred pregnant women with history of previous spontaneous preterm labors were selected in this study, and randomly arranged into two groups: calcium channel blocker group (A), and progesterone group (B). Results: There was no statistically significant difference between all groups as regards age, parity and number of previous preterm labors, There was a statistically significant difference between the progesterone group and the calcium group as regards GA at delivery, with higher percentage of lower GA at delivery among the progesterone group (35.61 weeks) compared to the calcium group (37.11 weeks), There was a statistically significant difference between the progesterone group and the calcium group as regards mean values of birth weight with higher percentage of lower birth weight among the progesterone group (2.37 kg) compared to the calcium group (2.93 kg), There was a statistically significant difference between the progesterone group and the calcium group as regards mean values of five minutes APGAR Score with higher percentage of lower five minutes APGAR Score among the progesterone group (7.66) compared to the calcium group (8.57), There was no statistically significant difference between all groups as regards the mode of delivery. There was a statistically significant difference between the progesterone group and the calcium group as regards NICU admission with higher percentage of NICU admission among the progesterone group (40%) compared to the calcium group (17.1%), There was a statistically significant difference in different studied groups before and after progesterone administration as regards mean values of serum progesterone, There was a statistically significant difference in different studied groups before and after progesterone administration as regards mean values of serum calcium. Conclusion: The use of calcium channel blocker and progesterone reduced the rate of preterm labor, prolonged gestational age at delivery, reduced the frequency of uterine contractions, and improved the symptoms of preterm labor in women with history of recurrent spontaneous preterm labors. Calcium channel blocker was more superior on progesterone as regards prevention of recurrent preterm labor.

Exogenous intoxication by non-prescribed use of vitamin D, a case report

BackgroundThis case report, unlike the current literature related to vitamin D intoxication, aims to highlight the risk of self-medication, and how publicity boosts the acquisition of vitamins for different purposes, increasing consumption with no professional indication or supervision. This practice can pose a serious health risk to the population.Case presentationOur patient, a brazilian retired 64-year-old female, presented to the emergency service with post-prandial food vomiting of undigested content and stabbing abdominal pain with worsening during palpation. Concomitantly, onset of sporadic frontal headache, fatigue, hyporexia, weight loss of 18 kg in the same period, severe pruritus, musculoskeletal pain in the limbs and nocturia. The physical examination showed hypertension (160/80 mmHg) and itchy macules in the lower limb. Initially, the main diagnostic hypotheses were multiple myeloma, hyperparathyroidism and pancreatitis secondary to hypercalcemia, osteolytic neoplasms and other neoplasms that present with hypercalcemia. However, blood count, parathyroid hormone, chest X-ray, immunoglobulins, myelogram and bone marrow biopsy were not compatible with these diagnoses. Meanwhile, 25 OH vitamin D dosage and diluted vitamin D test confirmed the diagnosis of hypervitaminosis D. Hypercalcemic crisis was managed with vigorous hydration (50 ml/kg in 2 h), furosemide, bisphosphonates and blood pressure control with amlodipine and atenolol. Subsequently, the patient was discharged from the outpatient clinic with complete remission of symptoms, weight gain, serum calcium values of 10.76 mg/dL and ionizable calcium values of 6.52 mg/dL.ConclusionOur report summarizes the possible consequences of using a vitamin compound without supervision of a competent professional, as these substances are mistakenly considered non-toxic. To add, little information is available about the supplements’ metabolism and their biological effects. Therefore, It is difficult to diagnose intoxication. This case report shows that even the self-administration of a product designed to bring health benefits can become a risky behavior. These vitamin and mineral supplements are supposed to bring patient empowerment and reduce government spending in health-care, but indeed represent a significant public health concern due to possible overdose and drug interactions.

Hypocalcemia with Immune Checkpoint Inhibitors: The Disparity among Various Reports.

Immune-related adverse events affecting parathyroid function are rarely reported with immune checkpoint inhibitors (ICPIs). Activating calcium-sensing receptor antibodies causing autoimmune hypoparathyroidism with nivolumab was recently reported. KEYNOTE-189 and CHECKMATE-067 trials reported a 21–29% hypocalcemia event rate, but the etiology of hypocalcemia was not reported. A chart review was performed to study patients receiving ICPI from 2015 to 2018 at multiple sites affiliated with Saint Vincent Hospital. The study population was divided into two groups based on the presence or absence of calcium altering conditions or medications. True hypocalcemia incidence was calculated after correcting calcium for albumin from the initiation of ICPI to their last follow-up. Group 1 (n = 83) includes patients with no calcium altering conditions or medications. Group 2 (n = 98) includes patients on calcium supplements (n = 17), vitamin D (n = 44), bisphosphonates (n = 24), >stage IIIB chronic kidney disease (CKD) (n = 5), and bone metastasis (n = 38). Hypocalcemia events in Group 1 vs. Group 2 were 8.4% and 19.3%, respectively. Our entire study demonstrated 26.8% vs. 1.1% of Grade I vs. II hypocalcemia events. However, after correcting the calcium for albumin, hypocalcemia incidence was 0.56% (n = 1). No further workup was done to investigate the etiology as that patient passed away. Our data suggest that the true hypocalcemia incidence after using albumin-corrected calcium values is very low in patients receiving IPCI, even in the presence of calcium altering factors. The percentage of patients with hypocalcemia is much higher and similar to the KEYNOTE-189 and CHECKMATE-067 trials when serum calcium values without albumin correction are used. Thus, the higher reported incidence of hypocalcemia in these trials is likely due to the reporting of serum calcium without albumin correction.

P1398EFFECTS OF CONVERTING FROM CINACALCET TO ETELCALCETIDE

Abstract Background and Aims Secondary hyperparathyroidism is a common problem in patients undergoing chronic hemodialysis and its treatment includes vitamin D analogs and calcimimetics which act upon the calcium-sensing receptor. Etelcalcetide was introduced as an intravenous calcimimetic easy to administer at the end of the hemodialysis session with improved adherence. Hypocalcemic episodes have raised some concerns although this side effect is not unanimously described. As an institutional policy most patients from 2 hemodialysis units were switched from cinacalcet to etelcalcetide between July 2017 and January 2018. We aimed at evaluating the impact of this conversion upon laboratory values and ongoing medication. Method We collected data from patients in 2 hemodialysis units including monthly serum values of calcium, phosphorus, hemoglobin and albumin, quarterly parathormone (PTH) values from 3 months previous to conversion until 3 months post-conversion as well as the calcimimetic dose during the same time frame. Descriptive statistics concerning mean and median values of the previous 3 and next 3 months following conversion were used. A paired sample t-test was performed to compare values before and after conversion. Results Of the approximately 200 patients, 22 were on cinacalcet and were switched to etelcalcetide. These had a mean age of 66.9 years and included 9 women and 8 diabetics. Mean PTH value before conversion was 728±391 (range 371-1900pg/mL) and did not differ significantly from that after conversion 717±330 (p=0.9). No significant statistical difference between values before and after conversion was found for serum calcium (9.3±0.5 vs 9.2±0.6; p=0.43), phosphorus (5.4±0.8 vs 5.1±1.0; p=0.15), albumin (4.1±0.2 vs 4.1±0.2; p=0.83) and hemoglobin (11.3±0.8 vs 11.4±0.9; p=0.50). The mean number of hypocalcemic values during the 3 months before and after conversion was identical (0.6±1 vs 0.6±0.9; p=0.86). The median cinacalcet dose on the month before conversion was 30mg/day (IQR 22.5) and the median etelcalcetide dose at conversion was 2.5mg three times per week (IQR 1.9). The conversion factor was 27mg cinacalcet: 1mg etelcalcetide, because even patients on high cinacalcet doses were initially started at low etelcalcetide doses. However, at 3 months following conversion, the median etelcalcetide dose was 8.75 (IQR 7.5). The doses of erythropoiesis-stimulating agents (ESA), vitamin D analogues and phosphorus binders were not significantly affected. Conclusion Switching from cinacalcet to etelcalcetide in all patients on hemodialysis in a particular institution did not change laboratory values or increased the number of hypocalcemic measurements. The etelcalcetide dose was adjusted up for the first 3 months and the mean PTH value did not change significantly. Treatment with ESA, vitamin D analogues and phosphorus binders remained unchanged after conversion. Secondary hyperparathyroidism is a chronic condition and etelcalcetide provides a useful means to control it with an easy administration regimen.

Diagnostic and treatment delay in primary hyperparathyroidism. A pending issue

IntroductionPrimary hyperparathyroidism (PHPT) remains underdiagnosed among patients with hypercalcemia, potentially causing increased morbidity. ObjectiveTo identify in surgically operated patients the presence of overlooked hypercalcemia and patients with criteria for surgery (CFS) for PHPT at least one year prior to referral to Endocrinology, and to determine whether this diagnostic delay leads to increased morbidity. MethodsAn observational study was carried out in 116 consecutive patients. We evaluated electronic medical records registered at least 12 months prior to referral and divided them in four groups: hypercalcemia with CFS (group 1), hypercalcemia without CFS (group 2), normocalcemia (group 3), and cases without previous biochemical evaluation (group 4). ResultsA total of 84 patients (72.4%) had a previous measurement of serum calcium at a time interval of ≥12 months. Sixty-six (56.9%) had hypercalcemia and 43 of them (37%) had ≥1 CFS, with an average delay of 57 months in receiving proper evaluation. Almost half of the calcemia measurements in group 1 had been made in the emergency room. Patients from group 1 were younger, and had a greater frequency of nephrolithiasis and renal impairment than patients in group 4. The serum calcium values at referral were similar in both groups and higher than the values found in patients from the other two groups. DiscussionIn patients with PHPT and CFS, referral to an endocrinologist is made with an average delay of almost 5 years. The identified causes of this delay, which conditions more kidney disease, are unrecognized hypercalcemia and/or unawareness of the surgical criteria, while calcium elevations promote referral. Interventions are needed to avoid this delay in the diagnosis and resolution of PHPT.

Intraoperative Detection of Hyperplastic Parathyroid Gland With Positron Emitter 18F-Fluorocholine and Handheld Probe

We present the first intraoperative detection of a hyperplastic parathyroid gland with a positron emitter F-fluorocholine and handheld probe, with the estimation of the absorbed dose to the surgeon and surgical staff. Intraoperative positron emitter detection enabled the resection of a small parathyroid gland, resulting in normal postoperative values of PTH and serum calcium in a 69-year-old woman. Calculated whole-body dose to the surgical staff and surgeons' fingers is well below the annual limits for exposed workers and the general public. Intraoperative F-FCH detection with handheld probe is a safe and feasible method for localizing small parathyroid glands.

Hypocalcemia with immune checkpoint inhibitors: The disparity among various reports.

e15153 Background: Immune-related adverse events affecting parathyroid function are rarely reported with immune checkpoint inhibitors (ICPI). Activating calcium-sensing receptor antibodies causing autoimmune hypoparathyroidism with nivolumab was recently published by Piranavan et al. KEYNOTE-189 and CHECKMATE-067 trials reported a 21-29% hypocalcemia event rate. The purpose of our study is to identify the hypocalcemia incidence in patients receiving ICPI at a single institution with multiple sites. Also, we aimed to investigate hypoparathyroidism as the etiology in these patients, if hypocalcemia was detected. Methods: A chart review to study patients receiving ICPI from 2015 to 2018 at multiple sites affiliated with Saint Vincent Hospital. The study population was divided into two groups based on the presence or absence of calcium altering conditions or medications. True hypocalcemia incidence was calculated after correcting calcium for albumin from the initiation of ICPI to their last follow-up. Results: Group 1 (N = 83) includes patients with no calcium altering conditions or medications. Group 2 (N = 98) includes patients on calcium supplements (N = 17), vitamin D (N = 44), bisphosphonates (N = 24), > stage IIIB CKD (N = 5), and bone metastasis (N = 38). Hypocalcemia events in Group 1 vs. Group 2 were 8.4% and 19.3%, respectively. Our entire study demonstrated 26.8% vs. 1.1% of Grade I vs. II hypocalcemia events. However, after correcting the calcium for albumin, hypocalcemia incidence was 0.56% (N = 1). No further workup was done to investigate the etiology as that patient passed away. Conclusions: Our data suggest that the true hypocalcemia incidence after using albumin-corrected calcium values is very low in patients receiving IPCI, even in the presence of calcium altering factors. The percentage of patients with hypocalcemia is much higher and similar to the KEYNOTE-189 and CHECKMATE-067 trials when serum calcium values without albumin correction are used. Thus, the higher reported incidence of hypocalcemia in these trials is likely due to the reporting of serum calcium without albumin correction.

Identifying early postoperative serum parathyroid hormone levels as predictors of hypocalcaemia after total thyroidectomy: A prospective non-randomized study.

There is no clear cut-off value of serum parathyroid hormone (PTH) or calcium in which patients are at risk for hypocalcemia after total thyroidectomy. We evaluated the usefulness of serum calcium and PTH concentration measurements after total thyroidectomy in predicting late-occurring hypocalcemia. A prospective, single-center, non-randomized longitudinal cohort study of 143 patients undergoing thyroidectomy between August 2019 and December 2019 with serum calcium and PTH levels sampled 1 h after surgery and on the first and fifth postoperative day. Hypocalcemia was defined as serum calcium levels < 2.14 mmol/L regardless of clinical symptoms. Normal PTH range was 1.6-6.9 pmol/L. The primary outcome measure was presence of hypocalcemia on the first and fifth postoperative day, analyzed by a logistic regression model. The PTH cut-off value for prediction of hypocalcemia was identified using a ROC curve comparing all three time points using the Youden J index. Out of 143 patients, 52 (36.4%) had hypocalcemia on the fifth postoperative day. Advanced age, concomitant neck dissection and serum PTH levels < 2.9 pmol/L 1 h after surgery and on the first postoperative surgery day were associated with a high risk of hypocalcemia on the first and fifth postoperative day and need for higher doses of calcium supplements (P < 0.0001, AUC 0.748, 95% CI 0.669-0.817, with 76.92% sensitivity and 71.43% specificity). Serum PTH level measured immediately postoperatively and on the first postoperative day is a reliable predictor of postoperative hypocalcemia with important clinical implications.

Efficacy of Ultrasound-guided Radiofrequency Ablation of Parathyroid Hyperplasia: Single Session vs. Two-Session for Effect on Hypocalcemia

To evaluate safety and efficacy of one- vs. two-session radiofrequency ablation (RFA) of parathyroid hyperplasia for patients with secondary hyperparathyroidism (SHPT) and to compare the outcome of both methods on hypocalcemia. Patients with secondary hyperparathyroidism underwent ultrasound guided RFA of parathyroid hyperplasia. Patients were alternately assigned to either group 1 (n = 28) with RFA of all 4 glands in one session or group 2 (n = 28) with RFA of 2 glands in a first session and other 2 glands in a second session. Serum parathyroid hormone (PTH), calcium, phosphorus and alkaline phosphatase (ALP) values were measured at a series of time points after RFA. RFA parameters, including operation duration and ablation time and hospitalization length and cost, were compared between the two groups. Mean PTH decreased in group 1 from 1865.18 ± 828.93 pg/ml to 145.72 ± 119.27 pg/ml at 1 day after RFA and in group 2 from 2256.64 ± 1021.72 pg/ml to 1388.13 ± 890.15 pg/ml at 1 day after first RFA and to 137.26 ± 107.12 pg/ml at 1 day after second RFA. Group 1’s calcium level decreased to 1.79 ± 0.31 mmol/L at day 1 after RFA and group 2 decreased to 1.89 ± 0.26 mmol/L at day 1 after second session RFA (P < 0.05). Multivariate analysis showed that hypocalcemia was related to serum ALP. Patients with ALP ≥ 566 U/L had lower calcium compared to patients with ALP < 566 U/L up to a month after RFA (P < 0.05). Group 1’s RFA time and hospitalization were shorter and had lower cost compared with Group 2. US-guided RFA of parathyroid hyperplasia is a safe and effective method for treating secondary hyperparathyroidism. Single-session RFA was more cost-effective and resulted in a shorter hospital stay compared to two sessions. However, patients with two-session RFA had less hypocalcemia, especially those with high ALP.

SAT-110 PREVALENCE, PATTERN AND CHARACTERISTICS OF CKD-MBD IN RIVERS STATE NIGERIA

Mineral bone disease (MBD) is a common complication in patients with chronic kidney disease (CKD). Various studies reported a global prevalence between 33% and 67%. However, there is paucity of study of CKD-MBD in Africa and in particular Nigeria. Paucity of information on the prevalence, pattern and characteristics of CKD-MBD in our environment may be contributing to the diagnostic difficulties and suboptimal management of this condition. This study, therefore set out to determine the prevalence, pattern and characteristics of CKD-MBD among adult patients with CKD, ultimately to contribute to improved quality of life and general outcome of these patients. This was a cross-sectional study of one hundred and fifty consecutive consenting CKD patients who fulfilled the inclusion criteria for this study. Detail clinical assessment, biochemical and radiological evaluations for CKD-MBD were conducted. 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 reference values of PTH in CKD stage 3-5 was 16.5-72.7pg/ml and 145-654pg/ml for CKD stage 5D (2-9 times the upper limit of normal for assay). In this study therefore, CKD-MBD was defined as follows:Tabled 1Stages of CKDLow turnover bone diseaseHigh turnover bone diseaseStage 3-5PTH < 16.5pg/mlPTH >72.7pg/mlStage 5DPTH < 145pg/mlPTH >654pg/ml Open table in a new tab The mean age of the patients was 45.1(±11.9) years (range of 22-80 years). There were 90 males and 60 females with male to female ratio of 1.5 : 1. The prevalence of CKD-MBD in the study population was 55.3%. Of this, 61 (73.5%) patients had low turnover bone disease while 22 (26.5%) patients had high turnover bone disease. Symptoms suggestive of CKD-MBD in the study population were bone pain and pruritus occuring in 36.7% and 13.3% of the study population, respectively but present in 34.9% and 12.0% of the CKD-MBD patients respectively. Other symptoms present in the study population 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%). The mean values for serum PTH, serum calcium, serum phosphate, alkaline phosphatase and Ca x P 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 but the values among non CKD-MBD patients were 123.08±120.99pg/ml, 2.32±0.46mmol/l, 1.54±0.57mmol/l, 108.13±51.84I U/L and 3.52±1.32mmol2/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. Hypercalcaemia was the most common biochemical abnormality in this study occuring in 44.6% of the patients while only 6% of those with CKD-MBD had radiological features of CKD-MBD. The prevalence of CKD-MBD in our environment is high and low turnover bone disease is the commonest type.

Association between Serum Calcium and Risk of Cardiometabolic Disease among Community-dwelling Adults in Taiwan

Serum calcium, although only comprising 1% of total body calcium, is involved in intracellular signal pathways, vascular dilatation/constriction, and muscle contraction, which are crucial for insulin secretion, cholesterol catabolism, and blood pressure regulation. As far as we know, research on the relationship between serum calcium level and metabolic syndrome (MetS), diabetes, and hypertension in one longitudinal study is rare. Owing to the crucial role of serum calcium in human cardiometabolic physiology and lack of related study so far, this study aims to describe the relationship between serum calcium level and the incidence of MetS, diabetes, and hypertension. During the period 2010–2016, there are two parts to our study: cross-sectional analysis and longitudinal analysis. Logistic regression was applied for cross-sectional analysis of the association between serum calcium level or albumin-corrected calcium (ACCA) and the prevalence of MetS, diabetes, or hypertension. Receiver operating characteristic (ROC) curve analysis was used for calculating of optimal cut-off value of serum calcium and ACCA. Cox proportional regression for development of MetS, diabetes, and hypertension according to different cut-off values of serum calcium level and ACCA were conducted. At baseline, there were 27,364 participants in our study. Serum calcium level had positive association with diabetes in the total population, male, and female. ACCA level had positive association with diabetes in the total population, male, and female. In unadjusted and multivariate Cox proportional hazard models, serum calcium level was associated with increased risk of incident MetS in the total population and male. ACCA was associated with increased risk of incident MetS in the total population and male. ACCA was associated with increased risk of incident diabetes in the total population and male participants. This study describes the relationship between serum calcium level and the incidence of MetS, diabetes, and hypertension. Higher serum calcium level is associated with increased risk of MetS, diabetes, and hypertension.

Scrotal Calcinosis mimicking malignancy - A rare case presentation

Scrotal calcinosis is a rare benign disease, which presents as multiple, painless, hard nodular growth in the scrotum without any systemic metabolic disorder. Histologic features of the lesion are extensive dermal deposits of calcium, with associated lympho-histiocytic aggregates and focal foreign body giant cell reaction. The pathogenetic mechanisms could be either purely idiopathic or any form of dystrophic calcification of the lining epithelial cysts or any inflammatory process with subsequent rupture, calcification and obliteration of the cyst wall. We present a rare case report of a 23-year-old male, who presented to the general surgery clinic with complaints of multiple, firm to hard scrotal swellings for the last 6 months. Microscopic examination of the excised growth showed multiple cysts with foci of normal and inflamed lining, with luminal calcific material with foci of ‘naked’ calcium deposits in the dermis. Biochemical tests showed normal values of serum calcium and phosphorus levels in our patient.

Retraso diagnóstico y terapéutico en el hiperparatiroidismo primario. Un problema no resuelto

IntroductionPrimary hyperparathyroidism (PHPT) remains underdiagnosed among patients with hypercalcemia, potentially causing increased morbidity. ObjectiveTo identify in surgically operated patients the presence of overlooked hypercalcemia and patients with criteria for surgery (CFS) for PHPT at least one year prior to referral to Endocrinology, and to determine whether this diagnostic delay leads to increased morbidity. MethodsAn observational study was carried out in 116 consecutive patients. We evaluated electronic medical records registered at least 12 months prior to referral and divided them in four groups: hypercalcemia with CFS (group 1), hypercalcemia without CFS (group 2), normocalcemia (group 3), and cases without previous biochemical evaluation (group 4). ResultsA total of 84 patients (72.4%) had a previous measurement of serum calcium at a time interval of ≥ 12 months. Sixty-six (56.9%) had hypercalcemia and 43 of them (37%) had ≥ 1 CFS, with an average delay of 57 months in receiving proper evaluation. Almost half of the calcemia measurements in group 1 had been made in the emergency room. Patients from group 1 were younger, and had a greater frequency of nephrolithiasis and renal impairment than patients in group 4. The serum calcium values at referral were similar in both groups and higher than the values found in patients from the other two groups. DiscussionIn patients with PHPT and CFS, referral to an endocrinologist is made with an average delay of almost 5 years. The identified causes of this delay, which conditions more kidney disease, are unrecognized hypercalcemia and/or unawareness of the surgical criteria, while calcium elevations promote referral. Interventions are needed to avoid this delay in the diagnosis and resolution of PHPT.

Relación IMC calcio sanguíneo de niños y adolescentes en escuelas rurales del cantón Cañar, periodo enero- junio 2019

Introducción: El consumo de calcio en la dieta, en particular el proveniente de lácteos, se asocia con la reducción de peso corporal. Objetivo: Evaluar la ingesta de calcio y su relación con el sobrepeso y la obesidad en niños y adolescentes de 4 a 12 años escuelas rurales del cantón Cañar, periodo enero- junio 2019. Metodología: Estudio descriptivo, prospectivo transversal y cuasi experimental. Se evaluó el estado nutricional de 122 niños y adolescentes utilizando indicadores tales como el IMC, con resultados de sobre peso. Por otra parte, se obtuvieron muestras de sangre para obtener el calcio sérico de cada uno de los adolescentes y clasificarlos según los valores normales de este indicador. A lo largo de 6 meses se inició un plan de suplementos de calcio a base de leche semidescremada. Después de este tiempo a cada uno de los adolescentes se evaluó el IMC obteniendo resultados importantes. Resultados: Los intervalos de IMC 22 y 24, se encontraron en 42 adolescentes categorizados con sobrepeso y obesidad. En cuanto a los valores de calcio sérico de los adolescentes en estudio se encontró que en un porcentaje del 63,3% tenían valores normales, por otra parte, un 41,7 % obtuvo hipocalcemia. Por último, se obtuvo una asociación significativa entre los valores de calcio y el IMC tomados antes y después de la suplementación de calcio, a partir de la aplicación del coeficiente de Pearson. Conclusión: Existe relación entre la ingesta de calcio y el IMC en los adolescentes analizados.

Risk factors for hypercalcemia in patients with tuberculosis.

Tuberculosis (TB) is prevalent worldwide and causes significant morbidity and mortality. TB is known to cause hypercalcemia. We aimed to assess the prevalence and risk factors for developing hypercalcemia among patients with TB. In this retrospective case-control study, patients with microbiological evidence of TB and an available serum calcium value were included between 2005 and 2016. The demographic, clinical, and laboratory details were recorded. Various risk factors were compared in TB patients with and without hypercalcemia. A total of 129 patients fulfilled the inclusion criteria. Twenty percent were found to have an elevated serum calcium level, 65% of them had clinical features of hypercalcemia. In comparison, the odds of developing hypercalcemia in the presence of disseminated TB, diabetes and renal failure was 1.83, 1.60, and 7.33, respectively. One-fifth of patients with TB have hypercalcemia. Risk factors of the same are renal failure, diabetes, and disseminated TB.

Early Discharge and Selective Calcium Supplementation after Thyroidectomy Based on Post-Operative Day 1 Parathormone and Calcium Level: A Prospective Study.

Aim:This study aimed to evaluate a protocol using post thyroidectomy parathyroid hormone (PTH) levels on the day after surgery to facilitate early discharge of patients.Methods:This prospective observational study was done in Christian Medical College, India over 1 year with 125 consecutive patients who had serum PTH and calcium values measured in the morning following thyroidectomy/first postoperative day (D1). Patients with no symptoms and signs of hypocalcemia and with serum calcium ≥8 mg/dL and PTH ≥6 pg/ml according to the protocol were discharged without supplements on D1. Patients were followed up and tested for a week after surgery in the outpatient clinic to assess hypocalcemia and readmission rates.Results:Seventy five patients (60%) could be discharged early on D1without calcium supplementation; only one patient had mild hypocalcemia symptoms managed with oral calcium supplements during outpatient follow-up within 1 week and none who followed the protocol required readmission. Temporary biochemical hypocalcemia was encountered in 36 patients (28.8%) including symptomatic hypocalcemia in 13 patients (10.4%). Among the 36 patients with hypocalcemia, 26 patients (72.2%) had a PTH level <6 pg/ml. Three patients required intravenous calcium infusion to correct hypocalcemia. Sensitivity, specificity and positive predictive value, and ROC of PTH 6 pg/ml in predicting hypocalcemia were 70.5%, 94.5% and 83.3%, 0.86, respectively. The low PTH could also guide early supplementation of calcium and all the severe hypocalcemia patients had PTH lower than the cut off of 6 pg/ml.Conclusion:A PTH and calcium-based protocol can be effectively used for early discharge of thyroidectomy patients the day after surgery without calcium supplementation. The compliance of the patient for early discharge was good.

Hypocalcemia after ultrasound-guided microwave ablation and total parathyroidectomy for secondary hyperparathyroidism: a retrospective study

Objective To compare the postoperative hypocalcemia between ultrasound-guided microwave ablation (MWA) and total parathyroidectomy (TPTX) for secondary hyperparathyroidism (SHPT). Methods The retrospective study reviewed 286 SHPT patients (171 received MWA and 115 underwent TPTX) between March 2018 and May 2019. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics. A total of 184 SHPT patients (92 in each group) were finally enrolled, the occurrence and prognosis of postoperative hypocalcemia were compared. And the risk factors associated with severe hypocalcemia (SH) in each group were analyzed. Results Hypocalcemia encountered in 95cases (49 in the MWA group and 46 in the TPTX group). SH occurred in 76 cases (40 in the MWA group and 36 in the TPTX group). There were no statistically significant differences in the detection time, incidence, minimum value of serum calcium and symptomatic hypocalcemia between MWA and TPTX group (all p values > 0.05). Of patients developing hypocalcemia, serum calcium did not recover to normal range in 5 cases (10.2%) in the MWA group, while 13 cases (28.3%) were still hypocalcemia at 6 months follow-up in TPTX group (p = 0.035). The time to recovery from hypocalcemia in the TPTX group (mean 30 days, range 3–180 days) was longer than the WA group (mean 14 days, range 3–126 days) (p = 0.000). High serum alkaline phosphatase (ALP) level and low serum calcium level were the main risk factors of postoperative SH. Conclusion There was no difference in hypocalcemia between MWA and TPTX group. Hypocalcemia in the TPTX group might need a longer time to recover.

A Study of Vitamin D and Calcium Level in Beta Thalassemia Major in Duhok Province

β-thalassemia major is severe hemolytic anemia which requires repeated blood transfusion and for survival, which leading to iron overload. Serious complications due to iron over load are recognized in the thalassemia patients. objectives Vitamin D and calcium are important factors for homeostasis of calcium in this study. This study was conducted for a period of two year including from patients with β- thalassemia major from Duhok Thalassemia Centre between 2014 -2015. Thirty eighth β- thalassemia major patients and thirty eighth persons with age- matched as control group were enrolled in the study. Serum concentration of 25- hydroxy vitamin D and calcium were estimated by enzyme linked fluorescent assay and colorimetric method, respectively. In patients, the level of serum 25- hydroxy vitamin D was significantly lower 11.11±4.36 ng/mL compared with control group (14.03±5.96ng/mL). Vitamin D deficiency is observed about 94.73% in patients. The mean level of serum calcium in patients group is 7.9±0.47mg/dL and 8.98±0.77 mg/dL in control group. There was a statistically significant difference in serum calcium value between patients and control group. 44.73% of patients have hypocalcaemia. This study demonstrated a high prevalence of Vitamin D deficiency and low total serum calcium levels in thalassemia patients with a significantly lower than healthy group. Hypocalcemia and vitamin D deficiency may be results from the negative effect of the repeated blood transfusion and malnourishment.

Robotic-assisted parathyroidectomy through lateral cervical approach: first results in Belgium

Objective A parathyroidectomy has been the treatment of choice for primary hyperparathyroidism. Especially the improved imaging techniques have led to minimally invasive techniques. Aim of this study was to evaluate our experience with robot-assisted parathyroidectomy through lateral cervical approach. Study design Prospective clinical cohort. Methods All consecutive patients who underwent a robotic-assisted parathyroidectomy for primary hyperparathyroidism since 2011 were enrolled in this study. Demographic data, biometrics, imaging data and surgery data were collected. Main outcomes were postoperative hypocalcemia, recurrent laryngeal nerve paralysis and other postoperative complications. Results Twenty-two patients were enrolled. When patients with conversion were excluded (39%) mean operating time was 69 min. In all patients a normal value of serum PTH-levels was achieved 4 h postoperatively. Mean value of serum calcium was 2.92mmol/L preoperative and 2.33mmol/L postoperative. There was no persistent hypocalcemia in any of our patients. 87% was discharged on the first postoperative day. Esthetic results were excellent. Conclusions Robotic-assisted parathyroidectomy through lateral cervical approach is a safe and feasible procedure in patients with posteriorly localized parathyroid adenomas. Preoperative imaging techniques are crucial to detect the exact location.

Serum Magnesium, Calcium and Phosphorus status in Heart Failure patients attending tertiary care center of Nepal

Background: Lack of proper diet and use of different medications in heart failure contributes to electrolyte imbalance. Due to absence of routine measurement, their abnormalities are not recognized. This study is an attempt to portrait a picture of serum levels of electrolytes in heart failure patients&#x0D; Materials and Methods: 102 heart failure patients were enrolled in this study over 6 months period. Serum levels of magnesium, calcium, phosphorus, sodium and albumin were measured. SPSS ver. 20.0 was used to analyze the data. Analysis of Variance was used to find mean differences and Pearson’s correlation was used to establish the correlation.&#x0D; Results: Majority of patient fell under New York Heart Association (NYHA) class II and had isolated systolic heart failure. Mean serum values of sodium and magnesium were below the reference range. Mean values of serum sodium, magnesium and corrected calcium was less in patients receiving diuretics and digitalis. Likewise, serum phosphorus was more with diuretics and digitalis use. Also, serum sodium was less in Acetylcholine Eseterose (ACE) inhibitors use. Isolated diastolic heart failure patients had least serum calcium values. Although, serum sodium and magnesium value in heart failure patients was positively correlated, was not statistically significant.&#x0D; Conclusion: This study showed that low serum sodium and magnesium values are frequently associated in heart failure. Disturbances in other serum electrolytes could also be other cause of complications in heart failure which are not under routine investigation. Identification and correction of these disturbances could have significant impact. However, further studies are required to reinforce this idea.