Contributing Factors for Calcium Changes During Hospitalization in COVID-19: A Longitudinal Study.

Background: Hypocalcemia is highly prevalent in Coronavirus disease 2019 (COVID-19). There is limited evidence about the course and roles of different parameters in the occurrence of new or worsening hypocalcemia. Objectives: This prospective longitudinal study was conducted on hospitalized COVID-19 patients in Qazvin, Iran, in 2021. Methods: Serum levels of calcium, albumin, parathormone (PTH), 25(OH)D (vitamin D), magnesium, and phosphate were assessed on the first day (time one), as well as fourth to sixth days (time two) of hospitalization. Paired t-test, McNemar's test, and multivariate logistic regression test were used to compare data at two times and evaluating the independent roles of different variables in the occurrence or worsening of hypocalcemia. Results: Out of a total of 123 participants, 102 patients completed the study. The mean serum calcium level significantly decreased from 8.32 ± 0.52 mg/dL to 8.02 ± 0.55 mg/dL at time two compared to time one (P < 0.001). Also, we witnessed new or worsening hypocalcemia at time two in 44 (55%) patients with normal serum calcium or mild hypocalcemia at time one (P < 0.001). The PTH level decreased from 42.17 ± 27.20 pg/mL to 31.28 ± 23.42 pg/mL (P < 0.001). The decrease in albumin and PTH levels was an independent significant factor in the occurrence or worsening of hypocalcemia at time two (OR = 1.27; 95% CI: 1.10 - 1.46; P = 0.001 for each 1 g/L decrement in albumin and OR = 1.29; 95% CI: 1.03 - 1.62; P = 0.026 for each 10 pg/mL decrement in PTH). Vitamin D deficiency or changes during hospitalization did not have a significant role in new or worsening hypocalcemia. Conclusions: Decreased PTH secretion and hypoalbuminemia have significant roles in the occurrence of new or worsening hypocalcemia during hospitalization due to COVID-19.

Association of weekly or biweekly use of 50 000 IU vitamin D3 with hypervitaminosis D.

Since the beginning of the COVID-19 pandemic, many Iranian people have been taking 50 000 IU of vitamin D3 on weekly or biweekly bases in order to enhance their immune system function. This cross-sectional study was conducted on the patients of endocrinology clinic to compare 25(OH)D levels of weekly or biweekly consumption with the monthly users of vitamin D3 50 000 IU. The level >100 ng/mL of 25(OH)D was defined as hypervitaminosis D. In total, 211 patients (108 and 103 patients in monthly and weekly/biweekly groups, respectively) were studied. In the subgroups of weekly and biweekly users, the rates of hypervitaminosis were 18.9% and 4.5%, respectively. In contrast, only 0.9% of monthly users had hypervitaminosis D. The highest vitamin D value of 185 ng/mL was detected in a patient who had consumed 50 000 IU vitamin D3 weekly for 6 years. No hypercalcaemia was detected in patients with hypervitaminosis D.

Comparing the effects of upper limb and breathing exercises on six-minute walking distance among patients with chronic obstructive pulmonary disease: a three-group randomized controlled clinical trial.

INTRODUCTION: Physical exercise can improve patient outcomes and reduce hospitalization and mortality rates among subjects with chronic obstructive pulmonary disease. This study aimed to compare the effects of upper limb and breathing exercises on six-minute walking distance among these patients. MATERIAL AND METHODS: This three-group randomized controlled clinical trial was conducted in 2017-2018 in Velayat hospital, Qazvin, Iran. Seventy-five patients were purposively selected from the outpatient lung clinic of the hospital and randomly allocated to either the 25-patient groups of upper limb exercise, breathing exercise, or control. The patients in the first group were performing upper limb exercises thrice weekly for one month in the study setting. Their counterparts in the second group were doing pursed-lip and diaphragmatic breathing exercises four times daily for one month at their homes. However, the patients in the control group received no exercise intervention. Six-minute walk test was performed by each participant both before and after the study intervention. The SPSS for Windows program (v. 23.0) was used to analyze the data via the Chi-square test, the paired-sample t test, and the one-way analysis of variance. RESULTS: Before the intervention, the groups did not significantly differ from each other respecting six-minute walking distance. During the study, walking distance in the control group did not change significantly, while it remarkably increased in both the upper limb exercise and the breathing exercise groups (p < 0.05). After the intervention, walking distance in the upper limb exercise group was significantly greater than the breathing exercise group (p < 0.05) and the control group (p < 0.05); however, the difference between the breathing exercise and the control groups was not statistically significant (p > 0.05). CONCLUSION: Upper limb exercise is more effective than breathing exercise in increasing walking distance among patients with chronic obstructive pulmonary disease. Therefore, upper limb exercise can be used as a safe, simple, and inexpensive rehabilitation technique for these patients.

Serum interleukin-18 and extent of coronary artery disease in unstable angina.

BACKGROUND: Interleukin-18 (IL-18) is an inflammatory marker with challenging role in atherosclerosis. The present study was carried out aiming to evaluate the association between IL-18 serum level and extent and severity of atherosclerosis among young patients with unstable angina (UA) who underwent coronary angiography. METHODS: This cross sectional study was performed from July to October 2015 in Chamran heart center, Isfahan, Iran. 180 patients with UA in the age range of below 50 years entered the study. All demographic, past history, physical examination, electrocardiogram (EKG or ECG), and transthoracic echocardiogram (TTE) data were collected. Serum level of IL-18 was measured using enzyme-linked immunosorbent assay (ELISA) method. A coronary angiography was performed on all patients to evaluate the presence and the incidence rate of coronary artery disease (CAD). RESULTS: Mean age of the patients was 46.0 ± 4.6 years [47.4 ± 4.3 and 45.9 ± 4.9 among patients with CAD and normal coronary, respectively (P = 0.040)]. Rate of severe CAD was greater among men compared to women with values 67.8% and 51.8%, respectively (P = 0.032). The median [interquartile range (IQR)] value of serum IL-18 among patients with CAD [192.86 (128.03,325.75)] was higher than normal coronary subjects [172.81 (139.77,243.21)], however it was not significant (198.4 ± 93.5, P = 0.287). A significant difference between serum IL-18 level and number of stenosis vessels was detected only among women (P = 0.032). CONCLUSION: Serum IL-18 level can predict the number of coronary arteries with significant stenosis among women with unstable angina.

Prognostic value of the high-mobility group box-1 in young patients with chest pain.

BACKGROUND: Atherosclerosis is accepted as an inflammatory disease. Evidence suggests that inflammation evoked by injury plays a pathogenic role in all stages of atherosclerosis. This study aimed to investigate whether the high-mobility group box-1 (HMGB1) a proinflammatory cytokine/nuclear protein, which is derived from both injured endothelium and activated macrophages/monocytes, could contribute to the progression of atherosclerosis and other cardiovascular diseases. METHODS: This study was designed as case-control. A total of 135 patients who referred to the hospital due to angina pectoris had the diagnosis of unstable angina and were candidates of angiography were recruited in this study. Forty patients who had coronary artery disease confirmed by angiography were considered as case group and control group consists of 40 persons who had no plaque, and 55 persons were excluded according to the exclusion criteria. At first, a questionnaire was filled for each patient including demographic factors and their medical history. Then a blood sample was taken to assess the level of HMGB1. Data were analyzed using SPSS, Student's independent t-test, and chi-square tests. RESULTS: The mean plasma level of HMGB1 in the case group was 27.1 ± 2.9 ng/ml, while it was 19.6 ± 1.9 ng/ml in control groups (P = 0.03). The odds ratio for coronary artery plaque associated with high (> 15.03 ng/ml) levels of HMGB1 was 2.50 (95% confidence interval, 1.02-6.17, P = 0.03). CONCLUSION: Increased plasma HMGB1 concentration may be associated with an increased risk of coronary atherosclerosis.