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.

Radiofrequency Ablation of Parathyroid Glands to Treat a Patient With Hypercalcemia Caused by a Novel Inactivating Mutation in CaSR

ObjectiveWe identified a novel inactivating mutation in the calcium-sensing receptor (CaSR) gene in a patient with refractory hypocalciuric hypercalcemia and analyzed its function. The effectiveness of radiofrequency ablation of the parathyroid glands to treat hypercalcemia caused by this mutation was explored.MethodsClinical data of patients before and after radiofrequency ablation were retrospectively analyzed. The CaSR mutation (D99N) found in the patient was studied in cell lines. HEK-293 cells were transfected with plasmids containing wild-type (WT) or mutant CaSR genes (D99N and W718X). Expression levels of the respective CaSR proteins were measured, and their functions were assessed by examining the effect of NPS R-568 (a CaSR agonist) on intracellular Ca2+ oscillations and that of exogenous parathyroid hormone (PTH) on intracellular cyclic adenosine monophosphate (cAMP) levels.ResultsThe effectiveness of pharmacological treatment was poor, whereas radiofrequency ablation of the parathyroid glands resulted in controlled blood calcium and PTH levels in the patient. In cell lines, upon NPS R-568 administration, the amplitude of intracellular Ca2+ oscillations in the D99N group was lower than that in the WT group and higher than that in the W718X group. Upon administration of PTH, intracellular cAMP levels in the D99N group were higher than those in the WT group and lower than those in the W718X group.ConclusionThe homozygous mutation D99N reduced CaSR activity and caused more severe hypocalciuric hypercalcemia. For patients with this type of hypercalcemia and poor response to pharmacological treatments, radiofrequency ablation of the parathyroid glands may be a suitable treatment option.

Calcium imbalance in comorbid gastroduodenal ulcers

Purpose of the study. To study the level of blood calcium, reflecting the functional state of the calcium-regulating system (CRS), in the comorbid course of gastroduodenal ulcers (GDU) with chronic erosive gastritis / chronic erosive duodenitis (CEG/CED), arterial hypertension (AH), their symptomatic nature when taking non-steroidal drugs (NSAIDs) and find out its effect on the activity of the ulcerous process, the state of regional microcirculation and the secretory function of the stomach.Materials and methods. 132 patients with GDU were examined. All patients were divided into groups: the first (39 people) – patients with recurrent peptic ulcer (PU) and CEG/CED, the second – 23 people with recurrent peptic ulcer and hypertension, the third – 20 patients with symptomatic gastroduodenal ulcers (SGDU) when taking NSAIDs. The fourth (control) group included 56 patients with PU without associated pathology.Results and discussion. Recurrence of PUr, comorbid to its course with CEG/CED, AH, SGDU, when taking NSAIDs, occurs with an increase in the level of calcium in the blood, which contributes to the activation of the acid-peptic factor, impaired microcirculation and repair processes in the mucous of the gastroduodenal zone, the development and maintaining the ulcerous process.Conclusion. Gastroduodenal ulcers are accompanied by dysfunction of the calcium regulatory system, which is characterized by an increase in blood calcium, which supports the formation of the main ulcerous mechanisms. In the treatment of comorbid and symptomatic gastroduodenal ulcers, it is necessary to include drugs for correcting the calcium-regulating system, which will increase the activity of sanogenic mechanisms.

Concentration of essential chemical elements in whole blood and in paranasal sinuses mucosa is related to chronic rhinosinusitis severity in children

Objectives to evaluate the association between essential chemical element levels in whole blood and in pathologic mucosa and chronic rhinosinusitis severity in children. Material and methods. A total of 154 children aged from 6 to 17 years were examined. Among them, 88 children had chronic rhinosinusitis (CRS) and underwent functional endoscopic sinus surgery (FESS). The 66 healthy children were included in the control group. Life quality was assessed using SNOT-20 (Sino-Nasal Outcome Test-20). Endoscopic and computer tomography findings were evaluated using Lund Kennedy and Lund Mackay scales, respectively. The assessment of essential element levels in whole blood samples was performed using inductively-coupled plasma mass-spectrometry. Results. The obtained data demonstrate that total SNOT-20 scores in CRS patients were 68% higher than in controls. At the same time, whole blood calcium, selenium, zinc, and magnesium levels were 6%, 28%, 20%, and 3% lower than the respective control values. The analysis of pathologic mucosa demonstrated that the chemical element contents were reducing in the following order: Ca Mg = Fe Zn Cu Mn Se. However, only whole blood selenium level correlated significantly with its tissue level. In multiple regression models, the whole blood Se level was inversely associated with SNOT-20 and Lund Mackay total scores. Conclusion. Therefore, the obtained data allow to propose the potential role of altered calcium, magnesium, zinc and selenium metabolism in CRS progression.

Changes in Acute-Phase Proteins in Plasma during the Periparturient Period of Dairy Goats

The present study was conducted regarding four acute-phase proteins (APPs) including C-reactive protein (CRP), ceruloplasmin (CP), serum amyloid A (SAA), and haptoglobin (HP) in dairy goats during the periparturient period. The aim of this study was to detect the changes in APPs in plasma during the periparturient period of healthy dairy goats. Guanzhong dairy goats with no other symptoms (n = 15) were selected on the basis of their blood calcium (Ca) and β-hydroxybutyrate (BHBA) concentration. The plasma was collected once a week for ±3 weeks delivery. The concentrations of the four APPs mentioned above were determined using goat-specific ELISA kits. The results showed the CRP level in plasma decreased from 3 weeks to 1 week antepartum and increased later until 1 week postpartum and then decreased to a similar level with antepartum between 1 and 3 weeks postpartum. The content of CP showed a decline in 3 weeks before parturition and an upward trend between 1 week antepartum and 3 weeks postpartum. The SAA concentration decreased from 3 weeks antepartum to 2 weeks postpartum and rebounded later. The level of HP decreased during 3 weeks before parturition and increased until 1 week postpartum, then reached a stable value. Clear variation range and rules of APPs contribute to perinatal health monitoring of dairy goats.

A meta-analysis of the therapeutic effect of intranasal salmon calcitonin on osteoporosis

Objective To evaluate the efficacy and safety of intranasal salmon calcitonin in the treatment of osteoporosis. Methods Eight Chinese and English databases were searched by electronic search (from the establishment of the database to October 2019). The literature was screened according to the inclusion criteria and exclusion criteria, the quality was evaluated according to Cochrane software, and the Review Manager 5.2 software was used for statistical analysis. Results A total of 374 documents were retrieved and 12 (12 original studies) were included after the screening, with a total sample capacity of 1068 cases. Meta-analysis showed that the intranasal salmon calcitonin had obvious advantages in reducing blood calcium, improving the ratio of serum creatinine and alkaline phosphatase. In addition, the intranasal salmon calcitonin had no obvious advantages in other indicators. It cannot be illustrated that the combination of intranasal salmon calcitonin and other conventional drugs is more effective than the simple use of conventional drugs. Conclusion The intranasal salmon calcitonin is superior to conventional drugs in reducing blood calcium, increasing creatinine ratio, and alkaline phosphatase, but its advantages in other indicators such as improving the bone mineral density (BMD) of lumbar vertebrae and hip have not been confirmed, and it is not clear that the combination of intranasal salmon calcitonin and other conventional drugs is better than the simple conventional drugs.

The effect of imatinib and nilotinib on blood calcium and blood potassium levels in chronic myeloid leukemia patient: a literature review

Imatinib and nilotinib are first-line treatments for chronic myeloid leukemia (CML) patients, which act specifically against target cells. However, these drugs may cause side effects, such as electrolyte disturbances. This literature review aimed to provide a comparison of the effects of imatinib and nilotinib on blood potassium and calcium levels. It also summarized their hypothetical mechanism. A comprehensive electronic search of the different databases was conducted using "chronic myeloid leukemia”, “tyrosine kinase inhibitors”, “imatinib”, “nilotinib”, “potassium”, “calcium”, “electrolytes” as keywords. This review used Pubmed-MEDLINE, Cochrane Library, and Google Scholar as electronic databases. Related 16 articles published from 2006 to 2020 were reviewed. Changes in blood potassium levels range from increased to decreased levels, while changes in blood calcium levels tend to below the normal value. Tyrosine Kinase Inhibitors (TKIs), including imatinib and nilotinib, have a non-specific target, namely platelet-derived growth factor receptor (PDGFR), which indirectly affects blood potassium and calcium levels in CML patients. The clinical manifestations of these changes vary from being visible only in laboratory tests to displaying a variety of signs and symptoms.

Low-Phosphate Meals Accompanied by a Minimum Dose of CaCO3 Downregulates Pro-inflammation by Reducing CKD-MBD Indicators and Triggers by Decreasing Dietary Phosphate Intake

High dietary phosphate intake and poor adherence to phosphate-binding-therapy elevate the risk of hyperphosphatemia in maintenance hemodialysis (HD; MHD) patients. Therefore, chronic kidney disease-related mineral and bone disorder (CKD-MBD) indicators increase; consequently, risks of CKD-MBDs and inflammation are elevated. This double-blind, randomized control trial intervention study was designed to investigate the possibility of reducing blood CKD-MBD indicators and modulating inflammatory indicators by consuming low-phosphate (LP) meals accompanied by a minimum dose of a calcium-based phosphate binder (CaCO3). MHD patients were recruited and randomly assigned to an LP meal group (LP group) or a control group. After initial data collection, blood collection, and dietary counseling, subjects were asked to consume a washout diet for 1 week. During the washout diet period, subjects consumed their usual diet but took 1 tablet of calcium carbonate (1CaCO3) as a phosphate binder with each meal. After the washout diet period, subjects in the LP group and control group respectively consumed LP meals and regular meals twice a day for 1 week. Meat in the LP meals was boiled before the regular cooking process, but meat in control meals was not. All meals were supplied by a central kitchen so that the contents of phosphate and other nutrients could be identified. In total, 40 MHD patients completed the study program. After 1 week of the dietary intervention, the blood Ca x P product and dietary phosphate had significantly decreased in the LP group compared to the control group (p<0.05). The LP group had significantly lower variations in dietary phosphate intake, blood calcium, Ca x P product, and tumor necrosis factor (TNF)-α than the control group by comparing differences between after the dietary intervention and the baseline (△after intervention - baseline, p<0.05). The increase in dietary phosphate intake (△3rd - 2nd dietary phosphate intake) augmented the increase in the TNF-α level by 6.24-fold (odds ratio [95% confidence interval]: 6.24 [1.12~34.92], p<0.05). These results highlighted the conclusion that LP meals accompanied by a minimum dose of CaCO3 downregulated pro-inflammation by reducing CKD-MBD indicators which was triggered by decreasing dietary phosphate intake.

Rối loạn canxi, phospho ở bệnh nhân bệnh thận mạn giai đoạn cuối điều trị bảo tồn

TÓM TẮT Mục tiêu: Khảo sát nồng độ canxi, phospho và hocmon tuyến cận giáp ở bệnh nhân bệnh thận mạn giai đoạn cuối điều trị bảo tồn. Phương pháp: Nghiên cứu mô tả cắt ngang được thực hiện trên 50 bệnh nhân bệnh thận mạn giai đoạn cuối điều trị bảo tồn tại Bệnh viện hữu nghị đa khoa Nghệ An. Nồng độ canxi, phospho và PTH máu được xét nghiệm định lượng và so sánh với khoảng giới hạn bình thường của mỗi loại xét nghiệm. Kết quả: Nồng độ canxi máu trung bình là 1,94 ± 0,05 mmol/l, trong đó có 78,00% số bệnh nhân có tình trạng giảm canxi máu. Nồng độ phospho máu trung bình là 1,84 ± 0,58 mmol/l, trong đó 52,00% số bệnh nhân có tăng phospho máu. Chỉ số Ca x P máu trung bình là 3,52 ± 1,13 mmol2/l2, trong đó có 22,00% có tăng chỉ số Ca x P máu. Nồng độ PTH máu trung bình là 280,87 ± 222,35 pg/ml, trong đó tỷ lệ bệnh nhân có tăng nồng độ PTH máu là 36,00%. Nhận thấy nồng độphospho, chỉ số Ca x P và nồng độ PTH máu tương quan nghịch với tuổi và mức lọc cầu thận. Kết luận: Nghiên cứu cho thấy ở bệnh nhân bệnh thận mạn giai đoạn cuối điều trị bảo tồn có một tỷ lệ cao bệnh nhân có giảm nồng độ canxi máu, tăng nồng độ phospho máu và PTH máu. ABSTRACT DISORDERS OF BLOOD CALCIUM, PHOSPHO IN PATIENTS WITH END - STAGE RENAL DISEASE RECEIVING CONSERVATIVE THERAPY Objective: To investigate the concentration of blood calcium, phosphorus and parathyroid hormone in patients with ESRD who were treated by conservative therapy. Methods: A cross - sectional descriptive study was performed on 50 patients with ESRD who were treated by conservative therapy at Nghe An Friendship General Hospital. Blood calcium, phosphorus and parathyroid hormone levels were calculated and compared with the normal ranges, respectively. Results: The average blood calcium concentration was 1.94 ± 0.05 mmol/l, of which 78.00% of the patients had hypocalcemia. The average blood phosphorus concentration was 1.84 ± 0.58 mmol/l, of which 52.00% of the patients had hyperphosphatemia. The average blood Ca x P index was 3.52 ± 1.13 mmol2/l2, of which 22.00% had high blood Ca x P index. The average blood PTH concentration was 280.87 ± 222.35 pg/ml, in which the proportion of patients with increased blood PTH concentration was 36.00%. It was found that blood phosphorus concentration, Ca x P index and blood PTH concentration were inversely correlated with age and glomerular filtration rate. Conclusion: The study shows that in patients with ESRD who were treated by conservative therapy has a high percentage of patients with low concentration of blood calcium, high concentration ofblood phosphorus and high concentration of blood PTH.

Childhood Hypercalciuric Hypercalcemia With Elevated Vitamin D and Suppressed Parathyroid Hormone: Long-Term Follow Up

Purpose: Hypercalcemia with low parathyroid hormone (PTH) level, hypercalciuria, nephrocalcinosis, or nephrolithiasis, was recently reported as caused by mutations in CYP24A1 and SLC34A genes. These encode for vitamin D-24A-hydroxylase and for the renal phosphate transporters NaPiIIa and NaPiIIc, respectively. We aimed to describe the clinical course of these monogenic disorders in patients with and without found mutations during long-term follow-up.Methods: Ten patients with hypercalcemia, hypercalciuria, elevated 1,25-(OH)2D levels and suppressed PTH were followed in our center during 1998–2019. Relevant laboratory and imaging data and results of genetic evaluation were retrieved from medical files.Results: The median age at presentation was 9.5 months (range 1 month−11 years), six were males, and the median follow-up time was 3.8 (1.1–14) years. Mutations in CYP24A1 and SLC34A3 were identified in three and one patients, respectively. Five patients presented with nephrocalcinosis, three with nephrolithiasis, and two had normal renal ultrasound. High blood calcium and 1,25-(OH)2D levels at presentation decreased during follow-up [11.1 ± 1 vs. 9.9 ± 0.5 mg/dl (p = 0.012), and 307 ± 130 vs. 209 ± 65 pmol/l (p = 0.03), respectively]; this paralleled an increase in suppressed PTH levels (5.8 ± 0.9 vs. 11.8 ± 7.3 pg/ml, p = 0.2). Substantial improvements in hypercalciuria and renal sonography findings were not observed. Two patients had impaired renal function (eGFR 84–88 ml/min/1/73 m2) at the last follow up. Interventions included appropriate diet, citrate supplementation, and thiazides.Conclusion: Despite improvement in hypercalcemia and 1,25-(OH)2D levels, not all the patients showed improvements in hypercalciuria and nephrocalcinosis. Deterioration of renal function was also observed. Long-term follow up and intervention to prevent nephrocalcinosis and nephrolithiasis are recommended in these children.