“COMPARATIVE STUDY OF CALCIUM LEVEL IN PREECLEMPTIC AND NORMAL PREGNANT TRIBAL & NON-TRIBAL WOMEN IN JHARKHAND”

Introduction- Pregnancy is a physiological stress in which many biochemical changes changes occur in the body. Preeclampsia, the complication of pregnancy, refers to a syndrome of new onset of hypertension proteinurea after 20 weeks of gestation in previously normotensive women, is due to rise in blood pressure,which is related with calcium change in blood. Recent study, implicated alterations in calcium metabolism in the pathogenesis of hypertension in pregnancy. Serum calcium level of 75 Material & Methodnd rd normal pregnant and 75 preeclemptic Tribal & non-tribal women at 2 & 3 trimesters were estimated by using Arsenazo 3 method, one of the most standard method used for estimation of serum calcium based on colorimetric principle and compared.Observation & Result- The Mean serum calcium level in cases of normal pregnant women in Jharkhand 9.65±0.58mg/dl while mean total serum calcium level of pre-eclamptic was 6.97mg/dl is lesser in comparison to normal pregnancy. There is signicant Conclusion- decrease in total serum calcium level in preeclemptic as compare to normal pregnant women in Jharkhand.

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.

Serum calcium levels in newly detected essential hypertensive patients

Background: Systemic hypertension is global disease responsible for significant mortality and morbidity. Essential or primary hypertension accounts for the majority of people with hypertension. Although our understanding of the pathophysiology of essential hypertension has grown a lot, its aetiology still remains hypothetical. Few studies in literature have found some correlation with serum calcium levels and blood pressure of the individuals.Methods: A total 200 patients, 100 newly diagnosed essential hypertensive and 100 normotensive patients were included in the study. A detailed history and clinical profile was taken. Blood sample was collected and serum calcium, serum albumin were determined and corrected calcium was calculated and the results were tabulated and appropriate statistical analysis was done.Results: The mean total serum calcium and corrected calcium levels were significantly lowered in essential hypertensive compared to the normotensive individuals. There was no correlation between total serum and corrected calcium levels against systolic and diastolic blood pressure. There was also no difference in serum total and corrected calcium levels among different subsets in essential hypertensive group.Conclusion: Essential hypertension still remains the most common form of hypertension present worldwide causing significant mortality and morbidity. Despite increased advances in medicine and large number of studies done in context with the cause of essential hypertension, its aetiology still remains hypothetical. Even though studies have shown some correlation of calcium fractions with hypertension, the aetiology is still unclear.

Occurrence of Hypocalcaemia in Admitted Neonates in NICU

Introduction: Hypocalcaemia is common metabolic manifestation in neonates and associated with both maternal and foetal conditions. Hypocalcaemia is labeled if term neonate’s total serum calcium is < 8 mg/dl and preterm has < 7 mg/dl. Association of neonatal and maternal hypovitaminosis D is very common. . Methods: One year retrospective study was conducted in a tertiary level private children hospital of Kathmandu, Nepal from 2018 June to 2019 July. Total 299 cases were selected and serum calcium were sent and analysed for its association with illness, associated maternal hypovitaminosis D and other relevant maternal tests. Result: Among 686 NICU cases, calcium level was sent for 299 cases. Among these, 254 were term and 45 were preterm babies and male to female ratio was 4:1. Mean calcium in term babies were 8.6 mg/dl and in preterm it was 8.1 mg/dl. Hypocalcaemia was found in 19% of cases with mean calcium level was 7.1 ± 0.84 mg/dl and severe hypocalcaemia accounted for 12%. There was no significant presence of hypocalcaemia in relation to gestation of newborn (p value 0.798). We found higher incidence of late onset hypocalcemia than early onset hypocalcemia but was not of statistical significance (p value 0.771). Associated disease were perinatal asphyxia, congenital heart diseases and prematurity. Among 27 late onset hypocalcaemia, 22% had hypovitaminosis D both in neonates and mother. Conclusions: Neonatal hypocalcaemia is a common condition associated with sick newborns. In late hypocalcaemia both newborn and mother should be screened for associated lab tests like vitamin D, magnesium, PTH as there may be association between the two.

Progression of PTH-resistance in autosomal dominant pseudohypoparathyroidism type Ib due to maternal STX16 deletions

Context Maternally inherited STX16 deletions that cause loss-of-methylation at GNAS exon A/B and thereby reduce Gsα expression are the most frequent cause of autosomal dominant pseudohypoparathyroidism type 1B (AD-PHP1B). Early identification of these disease-causing variants in the children of affected and unaffected female carriers would prompt treatment with calcium and calcitriol, once PTH levels increase, thereby preventing hypocalcemia and associated complications. Objectives Determine when PTH and calcium abnormalities develop after birth if a STX16 deletion is inherited maternally. Patients and Methods Forty-four children of affected (n=7) or unaffected (n=7) females with a STX16 deletion were investigated for the presence of these variants. If a deletion was identified, measurement of PTH, calcium, phosphate, and TSH was advised. Results The STX16 deletion that causes AD-PHP1B was identified in 25 children. Pre-treatment laboratory results were available for 19 of those cases. Elevated PTH levels were detected by 2 years of age and these were progressively higher if laboratory testing was first performed after establishing the genetic defect later in life. Total serum calcium levels remained within normal limits until about five years of age. TSH levels showed no consistent rise over time. Conclusion Establishing whether a STX16 deletion is inherited from a female carrier of a disease-causing variant rapidly establishes the diagnosis of AD-PHP1B. Several years before overt hypocalcemia developed, PTH levels increased thereby establishing the onset of PTH-resistance. Our findings provide diagnostic guidance and when treatment with calcium and calcitriol should be considered, in order to prevent hypocalcemia and associated sequelae.

COMPARISON OF SERUM CALCIUM LEVELS AMONG EXTREMELY PRETERM AND SEVERLY PRETERM NEONATES AT A PERIPHERAL MILITARY HOSPITAL

Objective: To determine the frequency and compare serum calcium levels amongst extremely preterm and very preterm neonates. Study Design: Comparative cross sectional study. Place and Duration of Study: Combined Military Hospital, Multan Pakistan, from May to Oct 2018. Methodology: A total of 217 preterm neonates, born at Combined Military Hospital Multan up to the gestational age of 32 weeks completed from last menstrual period, were included in the study. They were divided in to two group’s i.e. very preterm and extremely preterm neonates. Those born between 28-32 weeks completed of gestation were categorized as severely preterm. Extremely preterm were those born between 24-28 weeks completed of gestation. Venous blood samples were acquired at approximately 36 hours after birth and total serum calcium levels were analyzed. Neonates having total serum calcium levels <7 mg/dL were declared as suffering from hypocalcaemia. Results: Out of 217 neonates, 117 (53.9%) were male while 100 (46.1%) were female. Mean gestational age was 30.98 ± 2.12 weeks while mean parity of the mothers was 2.82 ± 1.08 children. Mean birth weight was 1510.26 ± 142.38 grams. One hundred and seventeen (53.9%) of the preterm neonates suffered from hypocalcaemia with the mean total serum calcium level being 6.58 ± 0.86 mg/dL. Hypocalcaemia was more common in extremely preterm neonates compared to very preterm neonates (p<0.05). Conclusion: Hypocalcaemia is a frequent complication encountered in preterm neonates born between 24-32 weeks gestation. Within these neonates, the frequency of hypocalcaemia is higher in extremely preterm compared to severely preterm babies.

The Role of Serum Calcium Levels in Pediatric Dyslipidemia: Are There Any?

Background: No previous study explored the association between serum calcium levels and dyslipidemia in children. This study aimed to explore this relationship in children, based on a multicenter cross-sectional study population in China.Methods: Cross-sectional data was derived from the Pediatric Reference Intervals in China (PRINCE) study conducted between 2017 and 2018 involving 5,252 males and 5,427 females with a mean age of 10.0 ± 4.6 years. Multivariable logistic regression models were applied to calculate odds ratios (ORs), with 95% confidence intervals (CIs), for dyslipidemia of each serum calcium level and albumin-corrected calcium levels, which were sorted into quartiles. The restricted cubic spline model was fitted for the dose-response analysis. An L-shaped dose-response relation between calcium levels and the probability of dyslipidemia was found after the adjustment for multiple potential confounding factors, p for non-linear &lt; 0.001.Results: Using the middle category of calcium level as the reference, multivariable-adjusted ORs and 95% CIs of the lowest and the highest quartile categories were 0.96 (0.82–1.12) and 1.29 (1.12–1.48), respectively, for total serum calcium levels and 1.06 (0.91–1.23) and 1.39 (1.21–1.60) for albumin-corrected calcium levels.Conclusions: Individuals with higher levels of serum calcium were associated with increased risk of dyslipidemia in a sample of a healthy Chinese pediatric population. The association between serum calcium levels and dyslipidemia needs to be examined prospectively in future studies.

Association of dietary calcium intake, total and ionized serum calcium levels with preeclampsia in Ethiopia

Background Preeclampsia is a well-known cause of maternal mortality and morbidity in Ethiopia. The exact pathophysiology has not been fully understood. Calcium and magnesium deficiencies have been given emphasis to play roles in the pathophysiology. Although evidence is abundant, they are equivocal. The study aimed to see the association of dietary calcium intake, serum total calcium level and ionized calcium level with preeclampsia. It also evaluated the association between dietary calcium intake and serum calcium levels. Materials and methods An unmatched case–control study was conducted in Gandhi Memorial, Tikur Anbessa, and Zewditu Memorial Hospitals, all in Addis Ababa, between October to December, 2019. Cases were 42 women with preeclampsia and controls were 42 normotensive women. The medical and obstetric history was gathered using a structured questionnaire and the dietary calcium intake information using a 24-h dietary recall. The serum levels of total serum calcium and ionized (free) calcium were measured using an inductively coupled mass spectrophotometer. Bivariate and multivariate logistic regression and Pearson correlation test were utilized during data analysis. Results In comparison with controls, women with preeclampsia had lower mean (± 1SD) levels of ionized calcium level (1.1 mmol/l ± 0.11), total serum calcium level (1.99 mmol/l ± 0.35) and lower median (IQR) dietary calcium intake (704 mg/24 h,458–1183). The odds of having preeclampsia was almost eight times greater in those participants with low serum ionized calcium level (OR 7.5, 95% CI 2.388–23.608) and three times higher in those with low total serum calcium level (OR 3.0, 95% CI 1.024–9.370). Low dietary calcium intake also showed statistically significant association with preeclampsia (OR 3.4, 95% CI 1.092 -10.723). Serum ionized calcium level and total serum calcium level showed positive correlation of moderate strength (p = 0.004, r = 0.307), but no correlation was found between dietary calcium intake with both forms of serum calcium levels. Conclusion This study showed significant association between low dietary calcium intake and low serum calcium levels with preeclampsia, hence this can be used as a supportive local evidence for the current context-specific recommendation of calcium supplementation in societies with low-dietary calcium consumption in an attempt to prevent preeclampsia, therefore implementation study should be considered in Ethiopia to look for the feasibility of routine supplementation.

Evaluation of the Prognostic Value of Red Cell Distribution Width to Total Serum Calcium Ratio in Patients with Acute Pancreatitis

Introduction. Acute pancreatitis (AP) is a sudden inflammatory process in the pancreas with variable involvement of nearby organs or other organ systems, and it is a common cause for hospitalization of gastrointestinal origin. Early prediction of the prognosis of patients with AP is important to help physicians triage the patients and decrease mortality. Red cell distribution width (RDW) and total serum calcium (TSC) have been reported to be useful predictors of the severity of AP, but if these parameters are associated with the prognosis of AP is unknown. The objective of the study was to evaluate whether RDW/TSC can be used to predict the prognosis of patients with AP at an early stage. Methods. We retrospectively enrolled AP patients admitted to the emergency department of West China Hospital of Sichuan University from January 1, 2016, to June 30, 2016. According to the prognosis, AP patients were divided into ICU group and non-ICU group, surgery group and nonsurgery group, and hospital survival group and hospital death group. Demographic information and clinical and laboratory parameters of all enrolled patients after being admitted to ED were compared between the groups. The receiver operator characteristic (ROC) curves were used to evaluate the prognostic values of RDW, TSC, and RDW/TSC in patients with AP. Results. A total of 666 AP patients were enrolled in this study, with an average age of 47.99 ± 14.11 years, including 633 patients who survived to discharge and 33 patients who died during hospitalization. The areas under the curve (AUC) of RDW and RDW/TSC predict that patients need to be admitted to ICU (0.773 vs. 0.824 vs. 0.723), patients need surgery treatment (0.744 vs. 0.768 vs. 0.690), and patients survived to hospital discharge (0.809 vs. 0.855 vs. 0.780) were greater than that of TSC, with RDW/TSC being the greatest. Conclusions. RDW/TSC may be a new method to identify the AP patients who need to be transferred to the ICU, accompanying complications which need surgery treatment, or may be died in hospital at an early stage, and we should pay more attention to RDW/TSC in patients with AP, for they may have a worse prognosis.

A Study of Serum Calcium and Magnesium Levels in Idiopathic Epilepsy Patients of Hubli, Karnataka, India

BACKGROUND Magnesium is a potential modulator of seizure activity because of its ability to antagonize the excitatory calcium influx through N-methyl-D-aspartate (NMDA) receptor which is thought to play a role in many human forms of epilepsy. When the extracellular concentration of calcium ion falls below normal, the nervous system becomes more excitable, allowing easy initiation of action potentials. Consequently, hypocalcaemia causes seizures because of its action of increasing excitability in the brain. We wanted to estimate the serum concentration of calcium and magnesium in idiopathic epilepsy patients and its co-relation. METHODS 94 cases of idiopathic epilepsy with breakthrough seizures admitted to KIMS Hospital, Hubli, meeting the inclusion criteria were considered for the study which was for 2-years’ time period. It’s a single centred, time bound and cross sectional study. RESULTS Mean serum calcium was low 8.36 ± 0.45 mg / dL and mean serum magnesium was 1.79 ± 0.28 mg / dL. 64.9 % had total serum calcium less than 8.5 mg / dL and 44.7 % had serum magnesium of < 1.8 mg / dL. 35.1 % had both low calcium and magnesium. There was significant difference in mean serum calcium with respect to number of episodes. There was no significant difference in mean serum magnesium with respect to number of episodes. CONCLUSIONS Serum calcium and magnesium levels which play a role in seizure initiation should be measured in all idiopathic epilepsy patients with breakthrough seizures as a seizure trigger. Considering the role of calcium and magnesium in the pathophysiology of seizures and by evaluating the results from the present study, breakthrough seizure could be provoked by hypocalcaemia and hypomagnesemia. Hence they may be used for the treatment of intractable seizures. KEYWORDS Calcium, Magnesium, Idiopathic Epilepsy