Serum Level of Parathyroid Hormone, Alkaline Phosphatase, Calcium and Ionized Calcium After Forearm Fractures

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Mohamed Morsi ◽  
Tameem Mohamed Shafik ◽  
Ahmed Kamal Mohamed Hassan
Keyword(s):  
Alkaline Phosphatase ◽  
Parathyroid Hormone ◽  
Fracture Healing ◽  
Normal Level ◽  
High Energy ◽  
Low Energy ◽  
Ionized Calcium ◽  
Forearm Fractures ◽  
Energy Group ◽  
Pth Level

Abstract Background During the last two decades, our understanding of fracture healing has evolved rapidly. Bone is one of the few body tissues that can heal without forming a fibrous scar and, as such, the process of fracture healing recapitulates bone development and may be considered a form of tissue regeneration. The complex cell and tissue proliferation and differentiation processes involved in fracture healing are regulated by growth factors, inflammatory cytokines, antioxidants, hormones, amino acids, and other nutrients. Objective: To identify changes in serum level of calcium, ionized calcium, alkaline phosphatase and parathyroid hormone according to mode of trauma (low and high energy) in forearm fractures and their role in fracture healing. Patients and Methods 50 Patients with forearm fracture were prospectively recruited from the Accident and Emergency Department of Trauma Surgery, El Zaitoun specialized hospital within 48 hours of sustaining the fracture. Patients included in the study were asked to avoid calcium supplementation during fracture healing. Results Mean PTH was elevated in both groups at Day 1 with low energy group was insignificantly higher than high energy group, whereas after 8 weeks mean PTH level decreased in both groups but in low energy group mean PTH level was significantly higher than high energy group. Mean ALP level increased in both groups at Day 1 whereas in low energy group it was insignificantly higher than that of high energy group, After 8 weeks mean ALP level insignificantly decreased to normal level in both groups. Mean serum calcium level was below normal level in both groups where it was insignificantly higher in high energy group than that of low energy group which increased after 8 weeks in both groups but remained elevated in high energy than low energy group. Mean serum ionized calcium level was below normal level at Day 1 in both groups whereas it was insignificantly higher in high energy group than low energy group which after 8 weeks increased in both groups but remained elevated in high energy group than low energy group. Conclusion Serial monitoring of these physiological markers reflect the actual status of bone resorption, and bone formation respectively over a short period. Thus, they can be used as an adjunct to clinical and radiological evidence of fracture healing.

scholarly journals Ruminal Microbiota and Fermentation in Response to Dietary Protein and Energy Levels in Weaned Lambs

Animals ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 109 ◽  
Author(s):  
Xiaokang Lv ◽  
Kai Cui ◽  
Minli Qi ◽  
Shiqin Wang ◽  
Qiyu Diao ◽  
...  
Keyword(s):  
Growth Performance ◽  
Energy Levels ◽  
High Energy ◽  
Metabolizable Energy ◽  
Low Energy ◽  
Dietary Energy ◽  
Ruminal Fermentation ◽  
Protein Levels ◽  
Energy Group ◽  
Low Energy Diet

Supplying sufficient nutrients, such as dietary energy and protein, has a great effect on the growth and rumen development of ruminants. This study was conducted to evaluate the effects of dietary energy and protein levels on growth performance, microbial diversity, and structural and physiological properties of the rumen in weaned lambs. A total of 64 two-month-old Hu lambs were randomly allotted to 2 × 2 factorial arrangements with four replicates and with four lambs (half male and half female) in each replicate. The first factor was two levels of dietary metabolizable energy (ME) density (ME = 10.9 MJ/Kg or 8.6 MJ/Kg), and the second factor was two levels of dietary crude protein (CP) content (CP = 15.7% or 11.8%). The trial lasted for 60 days. A low dietary energy level restrained the growth performance of lambs (p < 0.05). The ruminal concentration of acetate and the ratio of acetate to propionate increased but the propionate concentration decreased significantly with the low energy diet. However, the rumen morphology was not affected by the diet energy and protein levels. Moreover, a low energy diet increased ruminal bacterial diversity but reduced the abundance of the phylum Proteobacteria (p < 0.05) and genus Succinivibrionaceae_uncultured (p < 0.05), which was associated with the change in ruminal fermentation phenotypes. By indicator species analysis, we found three indicator OTUs in the high energy group (Succinivibrionaceae_uncultured, Veillonellaceae_unclassified and Veillonellaceae_uncultured (p < 0.01)) and two indicator OTUs in the low energy group (Bacteroidales_norank and Lachnospiraceae_uncultured (p < 0.01)). In conclusion, these findings added new dimensions to our understanding of the diet effect on rumen microbial community and fermentation response, and are of great significance for establishing the optimal nutrient supply strategy for lambs.

scholarly journals High-Energy Diet at Antepartum Decreases Insulin Receptor Gene Expression in Adipose Tissue of Postpartum Dairy Cows

2013 ◽  
Vol 57 (2) ◽  
pp. 203-207 ◽  
Author(s):  
Zhigang Zhang ◽  
Jianguo Wang ◽  
Ruifeng Gao ◽  
Weiqian Zhang ◽  
Xinwei Li ◽  
...  
Keyword(s):  
Gene Expression ◽  
Adipose Tissue ◽  
Insulin Receptor ◽  
Dairy Cows ◽  
High Energy ◽  
Low Energy ◽  
Control Group ◽  
Insulin Receptor Gene ◽  
Energy Group ◽  
Low Energy Diet

Abstract The objective of the study was to determine expression of gene of insulin receptor (INSR) in adipose tissue of postpartum dairy cows fed diets containing different amounts of energy at the antepartum period. Healthy pregnant dairy cows (n=45) on 21st d of the antepartum were divided into three groups differing in diet composition, namely: control group fed a normal diet, high energy group fed a high energy diet, and low energy group fed a low energy diet. Twenty-one days after parturition, INSR gene expression in adipose tissue was determined by internally controlled reverse transcriptase PCR. The level of INSR mRNA in adipose tissues of cows fed the high energy diet was substantially lower than that in cows fed normal or low energy diets. A relatively higher level of INSR mRNA in the adipose tissue of cows fed low energy diet may be beneficial for gluconeogenesis and lipogenesis, which can relieve an energy negative balance. Reduced level of INSR mRNA in adipose tissue of cows fed high energy diet indicates that the response to insulin has significantly decreased.

scholarly journals Frequency of Raised Intraocular Pressure and its Correlations to the energy used following Neodymium YAG Laser Posterior Capsulotomy in Pseudophakes

2020 ◽  
Vol 24 (2) ◽  
pp. 144-148 ◽  
Author(s):  
Maria Zubair ◽  
Uzma Ali Kant ◽  
Muhammad Rizwan Baloch ◽  
Misbah Munchi ◽  
Bilal Humayun Mirza ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Case Series ◽  
High Energy ◽  
Low Energy ◽  
Yag Laser ◽  
Posterior Capsulotomy ◽  
Energy Group ◽  
Posterior Capsular Opacity ◽  
The Mean ◽  
Neodymium Yag Laser

Objective: To determine the frequency of raised intraocular pressure in pseudophakic undergoing Nd YAG laser posterior capsulotomy. To compare the frequency of raised intraocular pressure in pseudophakic undergoing high and low energy Nd YAG laser posterior capsulotomy Methods: This Descriptive case series included 140 patients with pseudophakic posterior capsular opacity. After dilating the pupils with tropicamide Nd YAG laser posterior capsulotomy was performed and the total amount of energy used was noted. The frequency of raised IOP in post-laser patients and comparison of frequencies of raised IOP undergoing high and low energy Nd YAG laser posterior capsulotomies (≤ 50 MJ labeled as low energy and > 50 MJ labeled as high energy) were calculated Results: The mean age was 57.37 ±8.74. Mean pre laser IOP was 15.15 and post-laser IOP was 17.50. The rise in IOP was normal in 82.9% and raised in 17.1%. In lower energy group normal IOP was found in 35.7% and raised in 2.9%. In a higher energy group, normal IOP was found in 47.1%, and raised IOP was found to be 14.3%. Conclusion: Higher the energy used during the Nd YAG laser posterior capsulotomy procedure, more is the chance of a rise in post-laser intraocular pressure as compared to those in which lesser energy was being used.

scholarly journals Hysteresis of the parathyroid hormone response to hypocalcemia in hemodialysis patients with low turnover aluminum bone disease.

1991 ◽  
Vol 2 (6) ◽  
pp. 1136-1143
Author(s):  
A J Felsenfeld ◽  
D Ross ◽  
M Rodriguez
Keyword(s):  
Parathyroid Hormone ◽  
Serum Calcium ◽  
Bone Disease ◽  
Calcium Concentration ◽  
Hemodialysis Patients ◽  
Ionized Calcium ◽  
Total Serum ◽  
High Calcium ◽  
The Mean ◽  
Pth Level

During the study of parathyroid function in 19 hemodialysis patients with low turnover aluminum bone disease, it was observed that serum parathyroid hormone (PTH) levels were higher during the induction of hypocalcemia than during the recovery from hypocalcemia. This type of PTH response has been termed hysteresis. Hypocalcemia was induced during hemodialysis with a calcium-free dialysate. When the total serum calcium level decreased to 7 mg/dL, the dialysate calcium concentration was changed to 3.5 mEq/L and the dialysis session was completed. One week later, hypercalcemia was induced during hemodialysis with a high-calcium dialysate. The mean basal PTH level was 132 +/- 37 pg/mL (normal, 10 to 65 pg/mL; immunoradiometric (IRMA), Nichols Institute, San Juan Capistrano, CA) and increased to a maximal PTH level of 387 +/- 91 pg/mL during hypocalcemia. For the same ionized calcium concentration, the PTH level was higher during the induction of hypocalcemia than during the recovery from hypocalcemia. Conversely, for the same ionized calcium concentration, the PTH level was greater when hypercalcemia was induced from the nadir of hypocalcemia than when hypercalcemia was induced from basal serum calcium. The set point of calcium (defined as the serum calcium concentration required to reduce maximal PTH by 50%) was greater during the induction of hypocalcemia than during the recovery from hypocalcemia (4.44 +/- 0.10 versus 4.25 +/- 0.09 mg/dL; P = 0.03). The mean basal ionized calcium concentration and the mean ionized calcium concentration at the intersection of the two PTH-calcium curves were the same (4.61 +/- 0.13 versus 4.61 +/- 0.12 mg/dL).(ABSTRACT TRUNCATED AT 250 WORDS)

The Use of an Intact Molecule Parathyroid Hormone Assay in Disorders of Calcium Metabolism

1988 ◽  
Vol 25 (4) ◽  
pp. 367-372 ◽  
Author(s):  
E J Bicknell ◽  
W Van't Hoff
Keyword(s):  
Renal Failure ◽  
Alkaline Phosphatase ◽  
Parathyroid Hormone ◽  
Calcium Metabolism ◽  
Human Parathyroid Hormone ◽  
Normal Range ◽  
Intact Molecule ◽  
Parathyroid Hormone Assay ◽  
Plasma Alkaline Phosphatase ◽  
Pth Level

We present the results obtained using a 1–84 human parathyroid hormone (PTH) assay in patients with abnormal calcium metabolism. A normal range was established in a series of healthy volunteers. Patients with surgically proven hyperparathyroidism (HPT) showed increased PTH levels which were separate from the normal range. Patients with probable hyperparathyroidism and milder hypercalcaemia showed a raised median PTH level but the range overlapped with normal. Patients with hypercalcaemia of malignancy showed reduced PTH levels and these patients were readily differentiated from those with probable and proven HPT by the use of the assay. In patients with chronic renal failure PTH values ranged from normal to high, the PTH concentration was found to be correlated with plasma alkaline phosphatase, but not with plasma creatinine.

scholarly journals Functional outcome of traumatic spinopelvic instabilities treated with lumbopelvic fixation

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Emre Yilmaz ◽  
Martin F. Hoffmann ◽  
Alexander von Glinski ◽  
Christiane Kruppa ◽  
Uwe Hamsen ◽  
...  
Keyword(s):  
Functional Outcome ◽  
High Energy ◽  
Low Energy ◽  
Trauma Patients ◽  
Concomitant Injuries ◽  
High Energy Trauma ◽  
Lumbopelvic Fixation ◽  
Energy Group ◽  
And Function

Abstract The aim of this study was to assess the functional outcome after lumbopelvic fixation (LPF) using the SMFA (short musculoskeletal functional assessment) score and discuss the results in the context of the existing literature. The last consecutive 50 patients who underwent a LPF from January 1st 2011 to December 31st 2014 were identified and administered the SMFA-questionnaire. Inclusion criteria were: (1) patient underwent LPF at our institution, (2) complete medical records, (3) minimum follow-up of 12 months. Out of the 50 recipients, 22 questionnaires were returned. Five questionnaires were incomplete and therefore seventeen were included for analysis. The mean age was 60.3 years (32–86 years; 9m/8f) and the follow-up averaged 26.9 months (14–48 months). Six patients (35.3%) suffered from a low-energy trauma and 11 patients (64.7%) suffered a high-energy trauma. Patients in the low-energy group were significantly older compared to patients in the high-energy group (72.2 vs. 53.8 years; p = 0.030). Five patients (29.4%) suffered from multiple injuries. Compared to patients with low-energy trauma, patients suffering from high-energy trauma showed significantly lower scores in “daily activities” (89.6 vs. 57.1; p = 0.031), “mobility” (84.7 vs. 45.5; p = 0.015) and “function” (74.9 vs. 43.4; p = 0.020). Our results suggest that patients with older age and those with concomitant injuries show a greater impairment according to the SMFA score. Even though mostly favorable functional outcomes were reported throughout the literature, patients still show some level of impairment and do not reach normative data at final follow-up.

scholarly journals Relationship Between the Incidence of Deep Vein Thrombosis During Hospitalization and the Energy of Injury in Tibial Plateau Fractures

2020 ◽  
Vol 26 ◽  
pp. 107602962091394
Author(s):  
Li Jiahao ◽  
Zhang Kun ◽  
Zhang Binfei ◽  
Zhuang Yan ◽  
Xue Hanzhong ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Tibial Plateau ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Low Energy ◽  
Type I ◽  
Vein Thrombosis ◽  
Energy Group ◽  
Energy Type ◽  
Deep Vein

This study aimed to investigate the relationship between the incidence of deep vein thrombosis (DVT) during hospitalization and the energy of injury in tibial plateau fractures (TPFs). One hundred and forty patients were enrolled between September 1, 2014, and October 1, 2017. According to Schatzker’s classification, they were classified into the low-energy (type I-III) and high-energy (type IV-VI) groups. For DVT evaluation, duplex ultrasonography was performed in the lower extremities preoperatively and postoperatively. The location and changes of DVT were recorded. All patients underwent mechanical and chemical thromboprophylaxis. The incidence of DVT in TPFs was 36.43% and 46.43% preoperatively and postoperatively, respectively. The DVT incidence was 31.75% (20/63) in the low-energy group and 40.26% (31/77) in the high-energy group preoperatively, and 44.44% (28/63) in the low-energy group and 48.05% (37/77) in the high-energy group postoperatively. There was no significant difference between the 2 groups preoperatively ( P = .298) and postoperatively ( P = .785). The days between operation and discharge ( P = .016), blood loss during surgery ( P = .016), and preoperative d-dimer level ( P = .02) showed differences between the 2 groups. Additionally, 29 new thrombi (14 [48.28%] in the high-energy group and 15 [51.72%] in the low-energy group) appeared and 16 preoperative thrombi disappeared postoperatively. Despite mechanical and chemical thromboprophylaxis, the DVT risk in patients with TPFs remains high. Although the DVT incidence is not significantly different between high-energy and low-energy injuries, the occurrence of DVT should be carefully monitored.

scholarly journals Functional Results of Open Reduction and Internal Fixation with Primary Arthrodesis for Injuries to the Tarsometatarsal Joint Complex

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Sean Lannon ◽  
Michael Clare
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Functional Results ◽  
High Energy ◽  
Low Energy ◽  
Lisfranc Joint ◽  
Energy Group ◽  
Energy Mechanism ◽  
Viable Treatment

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Controversy remains as to the optimal treatment of injuries to the tarsometatarsal (Lisfranc) joint complex. Recent studies have described open reduction internal fixation (ORIF) with primary arthrodesis as a viable treatment option but there is limited orthopaedic literature as to the functional results of primary arthrodesis for these injuries. The senior author began treating these injuries with primary arthrodesis in 2005. We present the functional results of a consecutive series of patients with injuries to the TMT joint complex treated by ORIF with primary arthrodesis. Methods: Sixty-eight consecutive patients underwent ORIF with primary arthrodesis from 2006 to 2015. Seventeen patients were unable to be evaluated or contacted and were therefore lost to follow up, leaving 51 patients available for follow-up evaluation. Clinical follow up and/or telephone interviews was conducted. AOFAS Midfoot scores and Foot and Ankle Ability Measure (FAAM) were collected as a measure of functional outcome at final follow up. Results: Sixty-seven of 68 patients (98.5%) went on to radiographic union following the index procedure. Among patients with a low energy mechanism (32 patients), AOFAS and FAAM were 88.7 and 94.0; among those with a high- energy mechanism (19 patients), AOFAS and FAAM were 86.9 and 89. Outcome scores were higher in the low energy group: AOFAS by 2.1(p=0.667); and FAAM by 5.0 (p=0.021). Injury to the lateral midfoot necessitating fixation was less likely in the low energy group compared to the high-energy group (7.5% versus 37.0%; p=0.0032). Eighteen of the 51 patients participated in professional, collegiate or recreational sports preoperatively. All 18 were able to return to their previous sport, with a mean FAAM sports sub scale score of 93. Conclusion: ORIF with primary arthrodesis remains a viable treatment for injuries to the tarsometatarsal (Lisfranc) joint complex, with functional results in the good to excellent range at midterm follow up. Patients with low energy mechanisms demonstrated higher functional scores compared to patients with high energy mechanisms, but outcomes remained good to excellent in both groups. Of those who participated in athletics prior to injury, all were able to return to their previous sport.

scholarly journals High- Versus Low-Energy Acetabular Fracture Outcomes in the Geriatric Population

2020 ◽  
Vol 11 ◽  
pp. 215145932093954 ◽  
Author(s):  
Alexa Cecil ◽  
Jonathan W. Yu ◽  
Viviana A. Rodriguez ◽  
Adam Sima ◽  
Jesse Torbert ◽  
...  
Keyword(s):  
Older Adults ◽  
Acetabular Fracture ◽  
Hip Dislocation ◽  
Posterior Wall ◽  
High Energy ◽  
Low Energy ◽  
Acetabular Fractures ◽  
Heterotopic Bone ◽  
Geriatric Population ◽  
Energy Group

Introduction: High-energy mechanisms of acetabular fracture in the geriatric population are becoming increasingly common as older adults remain active later in life. This study compared outcomes for high- versus low-energy acetabular fractures in older adults. Materials and Methods: We studied outcomes of 22 older adults with acetabular fracture who were treated at a level-I trauma center over a 4-year period. Fourteen patients were categorized as low-energy mechanism of injury, and 8 were identified as a high-energy mechanism. We analyzed patient demographics with univariate logistic regressions performed to assess differences in high- and low-energy group as well as patient characteristics compared with surgical outcomes. Results: Most high-energy mechanisms were caused by motor vehicle collision (n = 4, 50.0%), with most having posterior wall fractures (50.0%). Among patient characteristics, the mechanism of injury, hip dislocation, fracture types, and fracture gap had the largest differences between energy groups effect size (ES: 2.45, 1.43, 1.36, and 0.83, respectively). The high-energy group was more likely to require surgery (odds ratio [OR] = 2.80, 95% CI: 0.26-30.70), develop heterotopic bone (OR = 4.33, 95% CI: 0.33-57.65), develop arthritis (OR = 3.60, 95% CI: 0.45-28.56), and had longer time to surgery (mean = 4.8 days, standard deviation [SD] = 5.8 days) compared to low-energy group (mean = 2.5 days, SD = 2.3 days). Discussion: The results of this case series confirm previous findings that patients with high-energy acetabular fractures are predominantly male, younger, and have fewer comorbidities than those who sustained low-energy fractures. Our results demonstrate that the majority of the high-energy fracture patients also suffered a concurrent hip dislocation with posterior wall fracture and experienced a longer time to surgery than the low-energy group. Conclusion: Geriatric patients who sustained high-energy acetabular fractures tend to have higher overall rates of complications, including infection, traumatic arthritis, and heterotopic bone formation when compared with patients with a low-energy fracture mechanism.

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