Calcemia, Vitamin D and seasonal influences in preeclampsia in Goma

Background: The etiology of preeclampsia remains less well known. It is noted that low vitamin D levels are associated with a high risk of preeclampsia (PE). Calcium (Ca2+) levels during pregnancy appear to be involved in pregnancy-induced hypertension. Recent studies indicate that serum calcium levels may have a role in preeclampsia. Vitamin D promotes absorption of proper concentration of calcium in the blood which helps to lower blood pressure. The complications associated with calcium deficiency during a normal pregnancy are numerous and have not been extensively studied in Goma. Objective: To assess blood calcium levels (ionic and total) in preeclamptic women and to analyse the seasonal influence on preeclampsia in Goma. Method: A prospective case-control study (without matching) of 190 pregnant women without cardiovascular or endocrine diseases for a case-control ratio of 1∶1 was conducted in six hospitals in Goma. Blood ionogram was performed by an automated system directly after blood sampling and vitamin D was measured using enzyme-linked immunosorbent method. Results: The mean ionised calcium level in preeclamptic woman was 1.24±0.16 mmol/L (0.48-1.59) compared to 1.27±0.17 mmol/L (0.88-2.30) in normal pregnant woman (p=0.214). A slight negative correlation between blood calcium and blood pressure was observed in pregnant women. Low vitamin D levels were associated with preeclampsia. Hypovitaminosis D in the preeclamptic group was more observed during the rainy season than during the dry season. Pregnancies complicated by PE were from fertilisations occurring during the rainy season while the dry season was characterised by a high admission of preeclamptics. Conclusion: The study found that preeclamptic women in Goma had hypocalcemia. There was also a weak negative correlation between blood pressure and serum calcium levels. The majority of preeclamptics were diagnosed during the dry season, while conception with a PE complication occurred during the rainy season. As this is a first study in this area for the Great Lakes region of Africa, a more in-depth study with a larger sample size is desired.

Longitudinal Effects of Serum Calcium and Phosphate Levels and Their Ratio on Incident Ischemic Heart Disease among Korean Adults

Serum calcium and phosphate levels are controlled by a regulatory system, but their individual concentration tendencies and interactions may affect long-term vascular health. This study aimed to assess the effects of serum calcium and phosphate levels on incident ischemic heart disease (IHD) in a large-scale community-dwelling Korean cohort. We evaluated 15,259 non-diabetic individuals (median age, 45 years; range, 30–85) without previous IHD or ischemic stroke using the Korean National Health Insurance data. The study population was classified based on the calcium, phosphate, and calcium/phosphate ratios. Using Cox proportional hazards regression models, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for IHD over 50 months after baseline enrolment. The age- and sex-adjusted incidence of IHD gradually increased with serum calcium and phosphate quartiles and decreased with calcium/phosphate ratio quartiles, with an overall crude rate of 2.1% (315/15,259). After setting the lowest calcium, phosphate, and calcium/phosphate ratio quartiles as a reference group, the HRs (95% CIs) of the highest calcium, phosphate, and calcium/phosphate ratio quartiles for IHD were 1.77 (1.15–2.72), 1.73 (1.18–2.55), and 0.58 (0.39–0.87), respectively, after adjusting for potential confounding variables. Serum calcium and phosphate levels were positively associated with IHD incidence, while the serum calcium/phosphate ratio exhibited an inverse relationship. Serum calcium and phosphate homeostasis may merit serious consideration to understand the pathogenesis of coronary atherosclerosis as a risk modifier for IHD.

Recurrent Bilateral Lower Motor Neuron Type of Facial Palsy with Hearing Impairment: Hyperphosphatemic Familial Tumoral Calcinosis

Hyperphosphatemic familial tumoral calcinosis (HFTC) presents with varied neurological manifestations that have been reported in the literature like facial palsy, vision and hearing impairment, stroke, and headache. In this article, we reported a 12-year-old girl child patient with recurrent facial weakness with bilateral hearing impairment and multiple ulcerative lesions on lower limbs and elbows. On examination, she had lower motor neuron (LMN) facial palsy with conductive hearing loss. The investigations showed hyperphosphatemia (9.3 mg/dL) with normal serum calcium (10.4 mg/dL), alkaline phosphatase (147.9 U/L), parathyroid hormone (23.12 pg/mL), and renal function tests. Elevated serum calcium and phosphorus product (96.72 mg2/mL2) and elevated renal tubular reabsorption of phosphate (TMPxGFR) value (9.16) were noted. Skeletal survey showed hyperostosis in the long bone diaphysis, vertebrae, ribs, pelvic bone, skull, and facial bones with narrowing of cranial ostium, characteristically without any peri-articular soft tissue calcifications. An angiogram showed multiple intravascular calcifications. She was managed with a low-phosphate diet, sevelamer, niacinamide, acetazolamide, sucroferric oxyhydroxide to lower serum phosphate level, and topical sodium thiosulfate ectopic cutaneous calcification. Exome sequencing showed novel homozygous inframe deletion of ACG in FGF23 gene exon 3 at c.374_376 delins position (p. Asp125del) in the proband and a mutation in the heterozygous state in the mother and elder sibling, thus confirming a molecular diagnosis of HFTC. Our case had a unique neurological presentation of recurrent bilateral lower motor nerve facial palsy, hearing loss, multiple ectopic cutaneous calcifications without peri-articular deposits, multiple intravascular, intracranial, and vertebral endplate calcification, which has not been reported earlier. The proband showed a novel pathogenic variant suggesting an expanding phenotype of HFTC.

The Synergy Beteeen Diurnal Temperature Range and Calcium Concentration Help to Predict Hospital Mortality in Patients with Acute Myocardial Infarction

Epidemiological studies have suggested that cold is an important contributor to acute cardiovascular events and mortality. However, little is known about the Diurnal Temperature Range(DTR)impact on mortality of the patients with myocardial infarction.Calcium ions(Ca2+)play a vital role in the human body, such as cardiac electrophysiology and contraction.To investigate whether DTR on admission moderates the association between serum calcium and in-hospital mortality in patients with acute myocardial infarction(AMI). This retrospective study enrolled consecutive adult patients with AMI at a single center in China (2003–2012). Patients were divided into four groups (Ca-Q1–4) according to serum calcium concentration quartiles. Multivariate logistic regression modeling was used to assess whether DTR moderated the association between serum calcium and in-hospital mortality. The predictive value of serum calcium was evaluated by receiver operating characteristic (ROC) curve and net reclassification improvement (NRI) analyses.The study included 3780 patients.In-hospital mortality was 4.97%(188/3780).DTR moderated the association between serum calcium and in-hospital mortality(P-interaction=0.020).Patients with low serum calcium in the highest DTR quartile exhibited an increased risk of in-hospital mortality(odds ratio for Ca-Q4 vs.Ca-Q1, 0.03;95%confidence interval[95%CI], 0.01–0.20;P for trend<0.001).In the highest DTR quartile, adding serum calcium concentration to the risk factor model increased the area under the ROC curve(0.81 vs.0.76;P<0.001)and increased NRI by 20.2%(95%CI 7.5–32.9;P=0.001).Low serum calcium was an independent risk factor for in-hospital mortality in patients with AMI, and this association was moderated by DTR.Careful attention should be paid to patients with low serum calcium who experience a higher DTR on admission.

Unusual hypocalcaemia in breast cancer relapse with multiple bone metastasis

Severe hypocalcaemia in breast cancer with bone metastasis is a rare finding usually associated with an advanced stage of the disease. We report a case of a 45-year-old woman with a history of local ductal carcinoma in situ (DCIS) of the breast, who presented with muscle tremors and general weakness. Hypocalcaemia was evident, with a positive Chvostek sign and a serum calcium level of 5.9 mg/dL (1.47 mmol/L), phosphorus 5.9 mg/dL (normal range: 2.3–4.7 mg/dL) with normal levels of albumin, magnesium and parathyroid hormone. High oral doses of alpha calcitriol and calcium with i.v. infusion of high calcium doses were instituted, altogether sufficient to maintain only mild hypocalcaemia. A whole-body CT revealed bone lesions along the axial skeleton. A biopsy from a bone lesion revealed a metastasis of breast carcinoma. With this pathological finding, leuprolide (GNRH analogue) and chlorambucil (alkylating agent) were initiated, followed by prompt tapering of infused calcium down to full discontinuation. Serum calcium was kept stable close to the low normal range by high doses of oral alpha calcitriol and calcium. This course raises suspicion that breast metastases to the skeleton caused tumour-induced hypocalcaemia by a unique mechanism. We assume that hypocalcaemia in this case was promoted by a combination of hypoparathyroidism and bone metastasis. Learning points Severe hypocalcaemia can a presenting symptom for breast cancer relapse.

Hsa_circ_0005729 enhances the accuracy in diagnosing parathyroid carcinoma

Background: Parathyroid carcinoma (PC), often misdiagnosed as parathyroid adenoma (PA), is prone to local relapse due to the initial surgery being restricted to parathyroid lesions instead of en bloc resection of parathyroid lesions with negative incision margins. However, it is very challenging to distinguish PC from PA preoperatively; hence, this study investigated an effective biomarker for increasing accuracy in PC diagnosis. Method: First, differentially expressed the circular RNAs between three PC tissues and three PA tissues were screened by high-throughput circular RNA sequencing, and the expression of hsa_circ_0005729 was verified by qRT-PCR in 14 patients with PC and 40 patients with PA. Second, the receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to analyze the diagnostic efficiency of hsa_circ_0005729 in PC by combining with laboratory data. Third, RNF138 mRNA, the corresponding linear transcript of hsa_circ_0005729 was measured, and the relationship between hsa_circ_0005729 and RNF138 mRNA was analyzed in patients with PA and patients with PC. Results: Hsa_circ_0005729 expression was significantly higher in patients with PC than in patients with PA. Serum calcium (p = 0.045), alkaline phosphatase (ALP) (p = 0.048), and creatinine levels (p = 0.036) were significantly higher in patients with PC than in patients with PA. The AUC increased to 0.86 when hsa_circ_0005729 combined with serum calcium, creatinine, and ALP. In addition, hsa_circ_0005729 was positively correlated with RNF138 mRNA in patients with PA but not in patients with PC. Conclusion: The novel circular RNA hsa_circ_0005729 was found to have a higher expression in patients with PC, and indicating its usefulness for distinguishing PC from PA.

A study on effect of phototherapy in term new-born in a tertiary care centre in south Rajasthan

Background: Phototherapy is a safe and effective method for management of neonatal hyperbilirubinemia with no serious untoward side effects. Hypocalcemia is a common and lesser observed adverse effect of phototherapy.Methods: This study was a prospective observational study done in department of pediatrics, RNT Medical College, Udaipur (Rajasthan). Serum calcium level was observed in term neonates admitted for phototherapy.Results: Out of total 80 neonates included in study 40 received phototherapy and 40 were control. Neonates receiving phototherapy had significantly lower level of serum calcium. Other complication were rashes, loose stool, fever and dehydration.Conclusions: We can conclude from this study that hypocalcemia is a significant complication of phototherapy in newborn and probably monitoring of serum calcium level in babies under phototherapy is warranted.