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1.
J Laryngol Otol ; 134(6): 541-552, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32519635

RESUMO

OBJECTIVE: Hypocalcaemia is the most common complication after total or completion thyroidectomy. This study assesses recent evidence on predictive factors for post-thyroidectomy hypocalcaemia in order to identify the patients affected and aid prevention. METHOD: Two authors independently assessed articles and extracted data to provide a narrative synthesis. This study was an updated systematic search and narrative review regarding predictors of post-thyroidectomy hypocalcaemia using the Ovid Medline, Embase, Cochrane and Cinahl databases. Results were limited to papers published from January 2012 to August 2019. RESULTS: Sixty-three observational studies with a total of 210 401 patients met the inclusion criteria. The median incidence was 27.5 per cent for transient biochemical hypocalcaemia, 12.5 per cent for symptomatic hypocalcaemia and 2.2 per cent for permanent hypocalcaemia. The most frequent statistically significant predictor of hypocalcaemia was peri-operative parathyroid hormone level. Symptomatic hypocalcaemia and permanent hypocalcaemia were seen more frequently in patients undergoing concomitant neck dissection. CONCLUSION: Many factors have been studied for their link to post-thyroidectomy hypocalcaemia, and this study assesses the recent evidence presented in each case.


Assuntos
Hipocalcemia/etiologia , Hipocalcemia/prevenção & controle , Neoplasias/cirurgia , Tireoidectomia/efeitos adversos , Estudos de Casos e Controles , Regras de Decisão Clínica , Feminino , Humanos , Hipocalcemia/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Narração , Esvaziamento Cervical/efeitos adversos , Estudos Observacionais como Assunto , Hormônio Paratireóideo/sangue , Período Perioperatório/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Doenças da Glândula Tireoide/epidemiologia , Doenças da Glândula Tireoide/patologia
6.
Endocrine ; 68(2): 253-254, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32346814
7.
Artigo em Chinês | MEDLINE | ID: mdl-32268694

RESUMO

Objective: To evaluate the effect of glucocorticoid used in perioperative period of total thyroidectomy (TT) plus central compartment lymph node dissection (CCLND) or combining with lateral neck dissection on postoperative hypoparathyroidism (HPT) and hypocalcemia (HPC). Methods: The data of 117 patients with papillary thyroid carcinoma (PTC) undergone the surgeries in Tongren Hospital between Nov 2015 and Mar 2017 were retrospectively analyzed. There were 36 males and 81 females, and their ages ranged from 21 to 74 years old, average age of 47.8±12.5. TT and CCLND were performed in 81 (69.2%) patients, and TT, CCLND and unilateral or bilateral lateral neck dissection were performed in 36 (30.8%) patients. The patients were divided into 4 groups: Group A (40 patients), no glucocorticoid was applied; Group B (36 patients), 5 mg dexmethasone sodium phosphate was sprayed on the surface of wound on both sides of trachea during operation; Group C (21 patients), 40 mg methylprednisolone was applied by intravenous injection after operation, one time per day for 3 days; Group D (20 patients), 5 mg dexmethasone sodium phosphate was sprayed on the surface of wound on both sides of trachea during operation and 40 mg methylprednisolone were applied by intravenous injection after operation, one time per day for 3 days. Serum parathyroid hormone and calcium were tested before operation and at the 1(st), 2(nd) and 3(rd) day after operation. Spss19.0 was used to analyze the data. Results: There were statistically significant differences in the incidences of both no HPT and no HPC and the incidence of HPT alone between Group A and B (35.0% vs 61.1%, 15.0% vs 2.8%, χ(2) were 5.182 and 3.885, respectively, P<0.05), but not in the incidence of HPC alone between the two groups. There were statistically significant difference in the incidences of both no HPT and no HPC between Group A and D (35% vs 70.0%, χ(2)=6.530, P<0.05), but not in the incidences of HPT or HPC between the two groups. There were not statistically significant differences in the individual incidences between Groups A and C (P>0.05). There were statistically significant differences in the incidence of both no HPT and no HPC and the incidence of HPT alone between Groups B and C (61.1% vs 23.8%, 2.8% vs 23.8%, χ(2) were 7.402 and 6.229, respectively, P<0.05), but not in the incidence of HPC between the two groups (P>0.05). HPT and HPC often occurred on the 1(st) or 2(nd) day after operation. Permanent hypocalcemia did not occur in all cases. Conclusions: Intraoperative especially plus post-operative application of glucocorticoid can decrease the incidence of HPT after operation.


Assuntos
Glucocorticoides/administração & dosagem , Hipocalcemia/prevenção & controle , Hipoparatireoidismo/prevenção & controle , Tireoidectomia/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Hipocalcemia/etiologia , Hipoparatireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Assistência Perioperatória , Complicações Pós-Operatórias , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/cirurgia , Adulto Jovem
8.
Am Surg ; 86(2): 121-126, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167046

RESUMO

We performed a retrospective study of our large patient cohort aiming to examine the ability to predict postthyroidectomy hypocalcemia. A retrospective review of patients who underwent total or near-total thyroidectomy at our institution between 2008 and 2018 was performed. Postoperative hypocalcemia was defined as Ca level <8.0 mg/dL (reference range: 8.9-10.1 mg/dL) within 30 days of operation. Logistic regression was used to develop models for prediction of the occurrence of postoperative hypocalcemia. Inclusion criteria were met by 1463 patients. Hypocalcemia was documented in 223 patients (15%). Models based on parathyroid hormone (PTH) levels alone had an associated receiver operator characteristic with an areas under the curve (AUC) of 0.79. There was an inverse relationship between time of measurement and PTH levels within the first two hours after thyroidectomy (P < 0.01). When measured two to six hours after closure, the predictive ability of PTH compared favorably (AUC = 0.82) with either earlier (within the first two hours after closure, AUC = 0.79) or later measurement (6-24 hours after closure, AUC = 0.77). When measured between two and six hours postoperatively, PTH < 19 pg/mL had a sensitivity of 90 per cent and negative predictive value of 96 per cent for postoperative hypocalcemia. The model that included the PTH level, concurrently measured total blood calcium level, and time of measurement had an improved predictive ability with an AUC of 0.87. PTH level of 19 pg/mL measured two to six hours after thyroidectomy had a sensitivity of 90 per cent and a negative predictive value of 96 per cent in our cohort. The model including postoperative PTH level, calcium level, and time of measurement may further improve the ability to predict postthyroidectomy hypocalcemia.


Assuntos
Hipocalcemia/etiologia , Hormônio Paratireóideo/sangue , Complicações Pós-Operatórias , Tireoidectomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores/sangue , Cálcio/sangue , Feminino , Humanos , Hipocalcemia/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de Tempo , Adulto Jovem
10.
Animal ; 14(S1): s44-s54, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32024567

RESUMO

Aspects of neutrophil function are diminished or dysregulated in dairy cows in the weeks just before and after calving, which appears to be an important contributor to the occurrence of retained placenta, mastitis, metritis and endometritis. The timing and mechanisms by which specific elements of neutrophil function are impaired are only partially understood. Oxidative burst capacity is the element of neutrophil function most consistently shown to be impaired in the week after calving, but that observation may partially be biased because oxidative burst has been studied more than other functions. There is sufficient evidence to conclude that the availability of calcium and glucose, and exposure to elevated concentrations of non-esterified fatty acids or ß-hydroxybutyrate affect some aspects of neutrophil function. However, these factors have mostly been studied in isolation and their effects are not consistent. Social stressors such as a competitive environment for feeding or lying space should plausibly impair innate immune function, but when studied under controlled conditions such effects have generally not been produced. Similarly, treatment with recombinant bovine granulocyte colony-stimulating factor consistently produces large increases in circulating neutrophil count with modest improvements in function, but this does not consistently reduce the incidence of clinical diseases thought to be importantly attributable to impaired innate immunity. Research is now needed that considers the interactions among known and putative risk factors for impaired neutrophil function in dairy cows in the transition period.


Assuntos
Doenças dos Bovinos/imunologia , Endometrite/veterinária , Imunidade Inata , Mastite Bovina/imunologia , Placenta Retida/veterinária , Ácido 3-Hidroxibutírico/metabolismo , Adaptação Fisiológica , Animais , Bovinos , Endometrite/imunologia , Metabolismo Energético , Ácidos Graxos não Esterificados/metabolismo , Feminino , Fator Estimulador de Colônias de Granulócitos , Hipocalcemia , Lactação , Contagem de Leucócitos , Neutrófilos/metabolismo , Período Periparto , Placenta Retida/imunologia , Gravidez , Proteínas Recombinantes
11.
Postgrad Med ; 132(4): 385-390, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32066311

RESUMO

BACKGROUND: We conducted a single-center historical cohort study to evaluate the association between admission serum ionized calcium and mortality in hospitalized patients. METHODS: We included hospitalized patients from January 2009 to December 2013 who had available serum ionized calcium at the time of admission. We assessed the in-hospital and 1-year mortality risk based on admission serum ionized calcium using multivariate logistic and Cox proportional hazard analysis, respectively. To test non-linear association, we categorized serum ionized calcium into six groups; ≤4.39, 4.40-4.59, 4.60-4.79, 4.80-4.99, 5.00-5.19, ≥5.20 mg/dL and selected serum ionized calcium of 4.80-4.99 mg/dL as a reference group. RESULTS: We studied a total of 33,255 hospitalized patients. The mean admission serum ionized calcium at 4.8 ± 0.4 mg/dL. Hospital and 1-year mortality observed in 1,099 (3%) and 5,239 (15.8%), respectively. We observed a U-shaped association between admission serum ionized calcium and in-hospital and 1-year mortality. Ionized calcium lower threshold for increased in-hospital and 1-year mortality rates was ≤4.59 and ≤4.39 mg/dL, respectively. Ionized calcium upper threshold for increased in-hospital and 1-year mortality rates was ≥5.20 mg/dL. CONCLUSION: Both hypocalcemia and hypercalcemia were associated with increased short- and long-term mortality with a U-shape relationship.


Assuntos
Cálcio/sangue , Mortalidade Hospitalar/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Feminino , Humanos , Hipercalcemia/mortalidade , Hipocalcemia/mortalidade , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco
12.
Medicine (Baltimore) ; 99(3): e18844, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011500

RESUMO

BACKGROUND: To investigate the relationship between intracerebral hemorrhage hematoma expansion with low serum calcium level. METHODS: We will search the following electronic bibliographic databases: MEDLINE, Embase, PubMed, The Cochrane Library, and Web of Science. All sources have to be searched from the earliest date until May 1, 2019. The quality of the included studies will assess by 2 evaluation members according to the Cochrane Collaboration network standard or the Newcastle-Ottawa Scale. The included studies will analysis by using RevMan 5.3 software. RESULTS AND CONCLUSION: This will be the first systematic review and meta-analysis to evaluate the association of hematoma following intracerebral hemorrhage with hypocalcemia. The study will provide more reliable, evidence-based data for clinical decision making. PROSPERO REGISTRATION NUMBER: CRD42019135956.


Assuntos
Hemorragia Cerebral/sangue , Hematoma/sangue , Hipocalcemia/sangue , Biomarcadores/sangue , Humanos , Metanálise como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
14.
J Dairy Sci ; 103(3): 2591-2601, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31980230

RESUMO

Rumination involves a complex series of muscle contractions that bring a bolus of ingesta to the mouth for further mastication before it is swallowed again. Healthy cows ruminate 8 to 9 h/d. Hypocalcemia is known to disrupt nerve and muscle function. Our hypothesis was that hypocalcemia in periparturient cows would reduce rumination activity. Twenty-six Holstein cows entering their third lactation or greater were fed a control diet [dietary cation-anion difference (DCAD) = +196 mEq/kg of dry matter (DM)] or a low DCAD diet supplemented with anions (DCAD = -9 mEq/kg of DM) prepartum. Periparturient plasma Ca concentration and rumination rate were determined. Four of 12 control cows developed clinical milk fever, necessitating intravenous Ca therapy. Rumination rate decreased in all cows around the time of calving. Rumination rate on the first and second day of lactation was highly correlated with the cow's plasma Ca concentration on the first day of lactation. In one of our statistical models, a normocalcemic cow was defined as a cow whose plasma Ca concentration remained above 2.00 mM. Cows were retrospectively classified as normocalcemic, subclinically hypocalcemic, or clinically hypocalcemic (milk fever). Only 4 cows were considered normocalcemic, and all had been fed the low DCAD diet. Normocalcemic cows spent more time ruminating on the first day after calving than subclinically hypocalcemic cows or cows with milk fever. Cows with milk fever had a lower rumination rate than normocalcemic cows through d 3 of lactation. Rumination activity in cows with milk fever was almost nondetectable in the hours before and after intravenous Ca treatment for an extended period, despite the return of muscle function that allowed the cows to stand and eructate following treatment. Other statistical models using different definitions of normocalcemia gave qualitatively similar results. Diet had a great effect on plasma Ca concentration and rumination rate. Even when cows with clinical milk fever were removed from the control cow data set, cows on the low DCAD diet had significantly greater plasma Ca concentrations in the first 36 h after calving and a higher rumination rate on d 1 of lactation (248 ± 26 min) than control cows (158 ± 32 min).


Assuntos
Ânions/administração & dosagem , Cálcio/sangue , Cátions/administração & dosagem , Doenças dos Bovinos/fisiopatologia , Hipocalcemia/veterinária , Paresia Puerperal/fisiopatologia , Ração Animal/análise , Animais , Bovinos , Dieta/veterinária , Feminino , Hipocalcemia/fisiopatologia , Lactação , Gravidez , Estudos Retrospectivos , Ruminação Digestiva/efeitos dos fármacos
15.
Einstein (Sao Paulo) ; 18: eRC4819, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31994611

RESUMO

We describe a patient with tertiary hyperparathyroidism with history of three episodes of deep vein thrombosis and on rivaroxaban. The patient underwent a subtotal parathyroidectomy, developing cervical hematoma with airway compression. Therefore, emergency surgical decompression was necessary. Later, on the ninth postoperative day, the serum ionized calcium levels were low. Medical team knowledge about preexisting diseases and their implication in the coagulation state are essential conditions to reduce morbidity and mortality of surgeries. However, no reports were found in literature about the association of hypocalcemia with the use of the new class of anticoagulants, which act as factor X inhibitors (Stuart-Prower factor), predisposing to increased bleeding in the immediate postoperative period.


Assuntos
Transtornos da Coagulação Sanguínea/tratamento farmacológico , Inibidores do Fator Xa/efeitos adversos , Hipocalcemia/induzido quimicamente , Rivaroxabana/efeitos adversos , Cálcio/sangue , Humanos , Hiperparatireoidismo/etiologia , Hiperparatireoidismo/cirurgia , Hipocalcemia/cirurgia , Masculino , Pessoa de Meia-Idade , Paratireoidectomia/efeitos adversos , Paratireoidectomia/métodos , Insuficiência Renal Crônica/complicações , Fatores de Risco
16.
J Dairy Sci ; 103(3): 2909-2927, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31954573

RESUMO

The effects of subclinical hypocalcemia have been explored in numerous observational and mechanistic studies in recent years. Besides obvious, well-known effects on muscle contractility, the role of Ca with respect to immune function and intermediary metabolism explains the contribution of subclinical hypocalcemia to the development of several diseases observed in early lactation and underlines its importance in high-performing dairy cows. The present review aims at integrating recent scientific progress, such as discoveries about the role of the mammary gland in regulating bone mobilization, into generally accepted aspects of the endocrine control of Ca homeostasis. We will discuss Ca transport mechanisms through absorption, resorption, secretion, and mobilization, as well as the physiological regulation of Ca through parathyroid hormone, 1,25-dihydroxyvitamin D, fibroblast growth factor 23, and serotonin, in addition to dietary mineral requirements. To improve hypocalcemia prevention strategies, our knowledge of the physiological mechanisms necessary to maintain normocalcemia and their endogenous regulation should be combined with data derived from herd-level studies. Using such studies, we will discuss prepartum nutritional strategies aimed at reducing the incidence of subclinical hypocalcemia, as well as options for postpartum Ca supplementation and their effects on early-lactation health and production. Especially in respect to approaches that might interfere with endogenous adaptation processes, such as supplementation with vitamin D metabolites or large doses of Ca, a thorough understanding of the underlying mechanisms that might induce unwanted hypocalcemia rebound effects will be crucial to ameliorate our future management of transition cows. Continued efforts by researchers to understand the interaction of Ca homeostasis with prevention strategies is necessary to optimize cow health and support copious milk production.


Assuntos
Cálcio/metabolismo , Doenças dos Bovinos/prevenção & controle , Hipocalcemia/veterinária , Necessidades Nutricionais , Animais , Bovinos , Dieta/veterinária , Feminino , Homeostase , Humanos , Hipocalcemia/prevenção & controle , Lactação , Minerais/metabolismo , Período Pós-Parto
17.
Arch Dis Child ; 105(4): 399-405, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31900251

RESUMO

Hypocalcaemia is a common clinical scenario in children with a range of aetiological causes. It will often present with common symptoms but may occasionally be identified in an asymptomatic child. An understanding of the physiological regulation of plasma calcium is important in understanding the potential cause of hypocalcaemia and its appropriate management. The age of presentation will influence the likely differential diagnosis. We have presented a stepwise approach to the investigation of hypocalcaemia dependent on the circulating serum parathyroid hormone level at the time of presentation. The acute and long-term management of the underlying condition is also reviewed.


Assuntos
Hipocalcemia/sangue , Hormônio Paratireóideo/sangue , Complicações Pós-Operatórias/sangue , Doenças da Glândula Tireoide/terapia , Deficiência de Vitamina D/tratamento farmacológico , Cálcio/sangue , Cálcio/uso terapêutico , Criança , Humanos , Hipocalcemia/tratamento farmacológico , Hipocalcemia/terapia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Guias de Prática Clínica como Assunto , Doenças da Glândula Tireoide/sangue , Doenças da Glândula Tireoide/fisiopatologia , Tireoidectomia , Vitamina D/sangue , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicações
18.
Clin Biochem ; 75: 48-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31786206

RESUMO

INTRODUCTION: The significance of hypomagnesemia and the need for treatment are under-recognized in clinical practice. Our objective was to design, establish, and test two interventions to screen for patients with hypomagnesemia and increase the rate of treatment of hypomagnesemia in the Emergency Department (ED). MATERIAL AND METHODS: A prospective two-year study was conducted. The Laboratory Information System was set to automatically order plasma magnesium in ED patients with plasma calcium < 7.5 mg/dL (1.9 mmol/L) and/or plasma potassium < 2.5 mEq/L (2.5 mmol/L). We counted the number of identified cases of hypomagnesemia, and calculated the total economic cost per identified patient. The study had three periods "Central lab" "Stat lab" and "Stat lab with comment" according to the availability to measure plasma magnesium levels in the stat laboratory and the inclusion of an automatic comment in the laboratory report in cases of hypomagnesemia. We retrospectively reviewed the medical records of patients with magnesium < 1.5 mg/dL (0.6 mmol/L), to investigate whether they have been appropriately treated. RESULTS: A total of 410 plasma magnesium were measured due to our intervention; 179 due to hypokalemia and 231 due to hypocalcemia. Two hundred thirty (56.1%) of 410 showed hypomagnesemia. Each detected case resulted in reagent cost of 0.7$, when prompted by hypocalcemia, and 0.6$ when prompted by hypokalemia. The rate of patients with hypomagnesemia that were appropriately treated increased from 15% to 75% along the study period. CONCLUSIONS: Our strategies successfully identified patients with hypomagnesemia in the ED at a very affordable cost, and increased the percentage of patients with hypomagnesemia that received treatment.


Assuntos
Sistemas de Informação em Laboratório Clínico , Hipocalcemia/sangue , Hipopotassemia/sangue , Deficiência de Magnésio/diagnóstico , Deficiência de Magnésio/terapia , Magnésio/sangue , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Humanos , Deficiência de Magnésio/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
19.
Animal ; 14(2): 330-338, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31337460

RESUMO

Calcium homeostasis is crucial for the normal function of the organism. Parathyroid hormone, calcitriol and calcitonin play critical roles in the homeostatic regulation of calcium. Serotonin and prolactin have also been shown to be involved in the regulation of calcium homeostasis. In modern dairy cows, the endocrine pathways controlling calcium homeostasis during non-lactating and non-pregnant physiological states are unable to fully support the increased demand of calcium required for milk synthesis at the onset of lactation. This review describes different endocrine systems associated with the regulation of calcium homeostasis in mammalian species around parturition with special focus on dairy cows. Additionally, classic and novel strategies to reduce the incidence of hypocalcemia in parturient dairy cows are discussed.


Assuntos
Cálcio na Dieta/metabolismo , Doenças dos Bovinos/metabolismo , Sistema Endócrino/metabolismo , Hipocalcemia/veterinária , Leite/metabolismo , Animais , Bovinos , Feminino , Homeostase , Hipocalcemia/metabolismo , Lactação , Glândulas Mamárias Animais/metabolismo , Hormônio Paratireóideo/metabolismo , Parto , Gravidez , Prolactina/metabolismo , Serotonina/metabolismo
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