Calcium Score Predicts Mortality After Revascularization in Critical Limb Ischemia

Purpose: The calcium score is a measure of vessel wall calcification and has clinical applications when studied in different vascular beds. The presence of vascular calcification in the arteries of the lower limbs is very common in patients with peripheral arterial disease; however, its relationship with the postoperative outcomes in patients undergoing lower limb revascularization is still poorly studied. The aim of this study is to evaluate association between the calcium score of lower limbs and the postoperative outcomes in patients with peripheral arterial disease undergoing revascularization procedures. Methodology: We retrospectively analyzed 88 lower limb revascularization procedures in 72 patients with critical limb ischemia who had enhanced computed tomography for preoperative evaluation. The calcium score was calculated, from the angiographic phase of preoperative computed tomography, in the segments of the aorta, iliac, femoropopliteal, and infrapopliteal. It was also calculated the calcium score of the operated limb, and the total calcium score using a standardized method. The outcomes evaluated were the occurrence of acute myocardial infarction, amputation, patency, technical success, and death from any cause. Patients were followed up through a 12 month period. Results: Among the 88 procedures performed, 31 (43.1%) lesions were classified as Trans-Atlantic Inter-Society Consensus Document II D. There were 66 (75%) endovascular procedures, 16 (18.2%) open surgery, and 6 (6.8%) hybrid interventions. No statistically significant relationship was found between the calcium score of the segments (aorta, iliac, femoropopliteal, infrapopliteal, the operated limb, and total calcium score) and the outcomes of acute myocardial infarction, amputation, patency, and technical success in any of the periods analyzed. The calcium score of the operated limb was higher in patients who died within 30 days and 6 months (6571 vs 2590.6; p=0.026) and (5227.8 vs 2335.3; p=0.036). Conclusion: A standardized calcium score calculation method with the angiographic phase of the computed tomography is feasible and reproducible. Higher values of the calcifications of the operated limb are related to a greater chance of death in the postoperative period. The calcium score of the operated limb can be considered as a marker of clinical severity and prognosis in this group of patients

The macro- and microelement provision of preschool children with psychomotor developmental disorders. Literature review and authors’ research

Background. An integral part of a child’s physical and mental development is a balanced diet. Insufficient or inadequate for a child developing organism’s needs nutrition in preschool age leads to a delay in physical, cognitive, and mental development. The study was aimed to assess the macro-and micronutrient provision status of preschool children with psychomotor developmental delay, identify the presence of macro- and micronutrient deficiencies, define the connection between macro- and micronutrient levels in patient’s serum and psychomotor developmental disorders. Materials and methods. The study analyzed the results of biochemical blood tests of blood serum samples for total calcium, magnesium, and iron level in 30 preschool children with psychomotor developmental disorders. Results. Mental retardation was observed in 53.33 % of examined children, autism spectrum disorders — in 20 % of exami­ned children; minimal brain dysfunction — in 13.33 %, attention deficit hyperactivity disorder (ADHD) — in 13.33 %. 93.33 % of exami­ned children had a deficiency of total calcium, magnesium — in 63.33 %, iron — in 20 %. Ten percent of patients had a deficiency of both total calcium, magnesium, and iron; one child (3.33 %) had no deficits. The most common deficiency in almost all subgroups of examined children was a combined deficiency of total calcium and magnesium. Only in the minimal brain dysfunction subgroup, in 50 % of cases, there was a combined deficiency of total calcium and magnesium, and in other 50 % of cases — an isolated deficiency of total calcium. This study identified a reliable inverse correlation of moderate strength between the level of total calcium and psychomotor development disorders and between the level of magnesium and the hyperexcitability syndrome. This study detected a weak unreliable correlation between the levels of magnesium and neurological disorders; an inverse unreliable weak correlation was found between iron and psychomotor developmental disorders. Conclusions. The most common deficiency in almost all subgroups of examined children was a combined deficiency of total calcium and magnesium. This study identified a reliable inverse correlation of moderate strength between the level of total calcium and psychomotor developmental disorders and between the level of magnesium and the hyperexcitability syndrome. There is also a weak direct unreliable correlation between magnesium level and psychomotor disorders. An inverse unreliable weak correlation was detected between the concentration of iron and psychomotor disorders.

Association of Vitamin D and Calcium Levels in E-waste Workers and Environmentally Exposed Participants in Southwestern Nigeria

Exposure to e-waste either by occupation or through the environment have been implicated in cancer development. The growing influx of e-waste to Nigeria and inadequate recycling, part salvaging, distribution and disposal of discarded or obsolete electronic devices is creating new sets of environmental and public health challenges. This study investigated the effect of exposure on vitamin D (25(OH) Vit D), total and ionized calcium levels in workers and individuals environmentally exposed to e-waste in Lagos, Benin and Ibadan cities in Southwestern Nigeria. Six hundred and thirty-two participants from three major cities in Nigeria were recruited for this study. They included e-waste workers, environmental e-waste exposed individuals and age matched unexposed individuals. 25(OH) Vit D was determined using ELISA, while total and ionized calcium by colorimetric method. Total calcium (tCa) in e-waste workers was significantly different from environmental exposed groups (p=0.000) while ionized calcium (iCa) was significantly increased for both e-waste exposed groups when compared with the unexposed group. 25(OH)Vit D level was significantly increased in e-waste workers compared with environmental and unexposed populations (p<0.001). Optimal levels of tCa, iCa and vitamin D in the e-waste exposed population may offer some forms of defense against the severity of existing and undiagnosed cancers or reduce the risk of cancer development in the e-waste exposed participants. However, e-waste may unfavourably modulate these expected beneficial roles in the e-waste exposed populations with continued exposure.

Intermittent Bi-Daily Sub-cutaneous Teriparatide Administration in Children With Hypoparathyroidism: A Single-Center Experience

Introduction: The use of teriparatide has been reported in children with hypoparathyroidism as an investigational physiologic replacement therapy.Methods: We aimed to retrospectively report our pediatric experience of bi-daily sub-cutaneous teriparatide. Results are presented as median (25th−75th quartile). As part of the routine follow-up of these patients with hypoparathyroidism, total calcium at H0 (i.e., just before injection) and H4 (i.e., 4 h after teriparatide injection) and other biomarker parameters were regularly assessed.Results: At a median age of 10.7 (8.1–12.6) years, an estimated glomerular filtration rate (eGFR) of 110 (95–118) mL/min/1.73 m2, calcium levels of 1.87 (1.81–1.96) mmol/L and an age-standardized phosphate of 3.8 (2.5–4.9) SDS, teriparatide therapy was introduced in 10 patients at the dose of 1.1 (0.7–1.5) μg/kg/day (20 μg twice daily), with further adjustment depending on calcium levels. Six patients already displayed nephrocalcinosis. Severe side effects were reported in one child: two episodes of symptomatic hypocalcemia and one of iatrogenic hypercalcemia; one teenager displayed dysgueusia. Calcium levels at H0 did not significantly increase whilst calcium at H4 and phosphate levels significantly increased and decreased, respectively. After 12 months, eGFR, calcium and age-standardized phosphate levels were 108 (90–122) mL/min/1.73 m2, 2.36 (2.23–2.48) mmol/L, 0.5 (−0.1 to 1.5), and 68 (63–74) nmol/L, respectively, with a significant decrease in phosphate levels (p = 0.01). Urinary calcium and calcium/creatinine ratio remained stable; no nephrolithiasis was observed but two moderate nephrocalcinosis appeared.Conclusion: Intermittent teriparatide therapy significantly improves calcium and phosphate control, without increasing calciuria. It appears to be safe and well-tolerated in children.

To Study the Association of Total Serum Calcium Level in Assessing the Severity of Pancreatitis

Background: Pancreatitis is an inflammatory condition that affects the pancreas and may also affect other tissues or distant organ. In this study our aim is to see if blood calcium level can be used as a prognostic marker in determining the severity of acute pancreatitis because hypocalcaemia is linked to higher mortality and hospitalization. Method: A retrospective study was conducted in the medical records department of a tertiary care health facility. A total of 75 participants were included in the research. .demographic details of all patients were collected .Patients above 18 years who presented with of epigastric pain, pre-Diagnosed gallstones, alcoholism were included int this study. The lowest total calcium levels were collected in order to examine total calcium as a predictive factor for severity. All of these information were collected and analyzed to get the appropriate findings. Results: A total of 75 patients were included in the research. The age of patients in each severity grade did not differ significantly (p value>0.05). The gender distribution of the two groups did not differ. (P >0.05). For mild and severe acute pancreatitis, mean total calcium levels were 7.98 and 6.67, respectively, which was statistically significant (p< 0.05). Conclusion: The total serum calcium level is a useful indicator for assessing pancreatitis.

Dose-dependent effect of chronic exposure to lead acetate on the dynamics of the content of delta-aminolevulinic acid and essential trace elements in the serum of laying hens

One of the most global and dangerous pollutants is considered to be lead, due to its ability to accumulate in living organisms, to be included in the metabolic cycle, to form highly toxic organometallic compounds, not being biodegradable. To study the chronic effects of lead acetate, an experiment was performed on laying hens of Lohmann Brown cross. For research, one control and three experimental groups were formed, 20 chickens in each. Birds of the experimental groups were administered lead acetate daily with compound feed in doses (in terms of metal): Group I – 50 mg/kg of feed, II – 75 mg/kg of feed, III – 150 mg/kg of feed. Access to water was not restricted. The birds of the control group received a complete diet without lead acetate. On the 30th, 90th, 120th days of the experiment and the 20th day after withdrawal of the toxicant (the 140th day of the experiment), we took blood samples from birds for biochemical and toxicological studies. The concentration of delta-aminolevulinic acid (δ-ALA) in the serum of laying hens was determined by reversed-phase high-performance liquid chromatography. Determination of the content of lead in the serum of laying hens was performed by X-ray fluorescence analysis. The concentration of total calcium, inorganic phosphorus, and magnesium in the serum of the laying hens was determined using production kits. We detected the dose-dependent chronic effect of lead acetate on the dynamics of the content of delta-aminolevulinic acid and essential trace elements in the serum of laying hens. The administration of lead acetate into the body of productive poultry for 120 days in doses of 50, 75, and 150 mg/kg with feed did not cause visible clinical signs of poisoning, but caused a violation of porphyrin metabolism, manifested in a reliable increase in the concentration of delta-aminolevulinic acid in serum on the 30th, 90th and 120th days of the experiment. It has been experimentally proven that the administration into the body of laying hens of lead acetate in doses of 50, 75 and 150 mg/kg of feed for 120 days leads to the maximum accumulation of lead in the serum on the 30th, 90th, and 120th days of the experiment. Prolonged administration of lead acetate to laying hens at high concentrations is characterized by a reliable decrease in the content of total calcium, inorganic phosphorus and magnesium in the serum of laying hens and a reliable increase in the content of ferrum. In the future it is necessary to study the intensity of lipid peroxidation processes in laying hens under chronic exposure to lead acetate.

Hypoparathyroidism and pseudohypoparathyroidism in pregnancy: an Italian retrospective observational study

Background Hypoparathyroidism (HypoPT) or pseudo-hypoparathyroidism (pseudo-HypoPT) during pregnancy may cause maternal and fetal/neonatal complications. In this regard, only a few case reports or case series of pregnant or lactating women have been published. The purpose of this study was to describe clinical and biochemical course, pharmacological management, and potential adverse events during pregnancy and post-partum in pregnant women with HypoPT or pseudo-HypoPT. This was a retrospective, observational, multicenter, study involving nine Italian referral centers for endocrine diseases affiliated with the Italian Society of Endocrinology and involved in “Hypoparathyroidism Working Group”. Results This study identified a cohort of 28 women (followed between 2005 and 2018) with HypoPT (n = 25, 84% postsurgical, 16% idiopathic/autoimmune) and pseudo-HypoPT (n = 3). In HypoPT women, the mean calcium carbonate dose tended to increase gradually from the first to third trimester (+ 12.6%) in pregnancy. This average increase in the third trimester was significantly greater compared to the pre-pregnancy period (p value = 0.03). However, analyzing the individual cases, in 44% the mean calcium dosage remained unchanged throughout gestation. Mean calcitriol doses tended to increase during pregnancy, with a statistically significant increase between the third trimester and the pre-pregnancy period (p value = 0.02). Nevertheless, analyzing the individual cases, in the third trimester most women with HypoPT (64%) maintained the same dosage of calcitriol compared to the first trimester. Both mean calcium carbonate and calcitriol doses tended to decrease from the third trimester to the post-partum six months. Most identified women (~ 70%) did not display maternal complications and (~ 90%) maintained mean serum albumin-corrected total calcium levels within the low-to-mid normal reference range (8.5 ± 0.8 mg/dl) during pregnancy. The main complications related to pregnancy period included: preterm birth (n = 3 HypoPT women), and history of miscarriages (n = 6 HypoPT women and n = 2 pseudo-HypoPT women). Conclusion This study shows that mean serum albumin-corrected total calcium levels were carefully monitored during pregnancy and post-pregnancy, with limited evaluation of other biochemical parameters, such as serum phosphate, 24 h urinary calcium, 25-OH vitamin D, and creatinine clearance. To avoid complications in mothers affected by (HypoPT) or (pseudo-HypoPT) and offspring, intense biochemical, clinical and pharmacological monitoring during pregnancy and breastfeeding is highly recommended.

Physical development and individual metabolic parameters in various forms of congenital epidermolysis bullosa depending on supplementation treatment

Congenital epidermolysis bullosa (CEB) is a group of rare genetic diseases of varying severity, which are characterized with the formation of blisters on the skin and/or mucous membranes with minor trauma. In this case, the clinical course of the disease in some cases is aggravated by the development of malnutrition, which further worsens the quality of life of patients.Aim of the study. To assess the physical development and laboratory findings of nutritional status in children with simple (SCEB) and dystrophic forms of CEB (DCEB).Methods and materials. The study included children with SCEB and DCEB at the age of 8 months to 18 years old, treated at the National Medical Research Centre of Children's Health (Moscow, Russia) from January 2018 to January 2019. Anthropometric parameters were assessed in all patients, and a biochemical blood test was performed for total calcium, phosphorus, albumin, and magnesium. Data are presented using the median (Me) and quartiles of 25 % and 75 % [Q25; Q75], as well as the mean (M) and 95 % confidence interval (95 % CI) for variables with a normal distribution.Results. A total of 87 children were included in the study, 70 with DCEB and 17 with SCEB. There were no differences in sex and age between the groups. According to the results of the study, all anthropometric parameters (WAZ, HAZ and BAZ) in children with DCEB were statistically significantly lower (p < 0.001) than in children with SCEB. Although in both forms of CEB the averaged values of WAZ, HAZ and BAZ turned out to be within the normal range, in children with DCEB, a decrease in HAZ less than -2 was noted in 22 children (31%). Moderate protein-energy malnutrition (-3 < BAZ < -2) was detected in 29 patients (41 %), while 20 of them (29%) were diagnosed with severe protein-energy malnutrition (BAZ < -3). Biochemical parameters were within the reference values, however, the levels of albumin and total calcium were statistically significantly reduced in children with DCEB compared with SCEB children (p < 0.001 and p = 0.005, respectively). Hypoalbuminemia was observed in 64 %, and hypocalcemia in 9 % of DCEB children.Conclusion. All anthropometric values in children with DCEB were lower than in children with SCEB. The study of albumin and total calcium level in the blood of children with DCEB can reveal preclinical forms of malnutrition.