A reconnaissance survey of farmers' awareness of hypomagnesaemic tetany in UK cattle and sheep farms.

Hypomagnesaemic tetany (HypoMgT) in ruminants is a physiological disorder caused by inadequate intake or impaired absorption of magnesium (Mg) in the gut. If it is not detected and treated in time, HypoMgT can cause the death of the affected animal. A semi-structured questionnaire survey was conducted from July 2016-2017 to assess farmers' awareness of HypoMgT in cattle and sheep in the UK. The questionnaire was distributed to farmers at farm business events and agricultural shows, and through a collaborative group of independent veterinary practices to their clients. Farmers were asked about (i) the incidence of presumed HypoMgT (PHT); (ii) their strategies to treat or prevent HypoMgT; (iii) mineral tests on animals, forage and soil, and (iv) farm enterprise type. A total of 285 responses were received from 82 cattle, 157 mixed cattle and sheep, and 46 sheep farmers, of whom 39% reported HypoMgT in their livestock, affecting 1-30 animals. Treatment and/or prevention against HypoMgT was reported by 96% respondents with PHT and 79% of those without. Mineral tests on animal, forage, and soil was conducted by 24%, 53%, and 66% of the respondents, respectively, regardless of PHT. There was a highly significant association between the use of interventions to tackle HypoMgT and the incidence of PHT (p < 0.01). The top three treatment/prevention strategies used were reported as being free access supplementation (149), in feed supplementation (59) and direct to animal treatments (drenches, boluses and injections) (45) although these did vary by farm type. Although some (9) reported using Mg-lime, no other pasture management interventions were reported (e.g., Mg-fertilisation or sward composition). Generally, the results indicate that UK farmers are aware of the risks of HypoMgT. A more integrated soil-forage-animal assessment may improve the effectiveness of tackling HypoMgT and help highlight the root causes of the problem.

Temporal and Spatial Dynamics of Monkeypox in Democratic Republic of Congo, 2000-2015.

Monkeypox is a viral disease with a clinical presentation resembling that of smallpox. Although monkeypox is considered to be an important zoonotic viral disease, its epidemiology remains poorly understood, especially the spatial and temporal distribution of the disease. The present study examined weekly reports of monkeypox cases collected from 2000 to 2015 at the health zone scale in the Democratic Republic of Congo. SaTScan® was performed to identify spatial and temporal clusters of monkeypox cases. Significant primary spatial clusters were detected in the districts of Sankuru and Tshuapa. A centrifugal pattern was found, with significant primary spatial clusters extending over time from Sankuru and Tshuapa to several neighboring districts. Peaks of cases occurred from July to September for the 2000-2002 and 2003-2009 sub-periods and from January to March for the 2010-2015 sub-period. Despite the lack of additional data for confirmation, the increasing of monkeypox reported incidence was observed in the Democratic Republic of Congo during 2000-2015 period and this increase cannot be explain only by the improvements of surveillance systems. The detected spatial clusters were located in the dense rainforest of the Congo basin. The reasons for the excess incidence of monkeypox cases in the central region of the country are unknown, and the relative influence of ecological, environmental, and human factors on the mechanism of emergence of monkeypox has yet to be identified.

Population-Based Incidence of Potentially Life-Threatening Complications of Hypocalcemia and the Role of Vitamin D Deficiency.

OBJECTIVES: To determine the incidence of potentially life-threatening complications of hypocalcemia in infants and children in Olmsted County, Minnesota; and to determine if vitamin D deficiency contributed to these events and was, at the time of clinical presentation, considered as a possible cause. STUDY DESIGN: In this population-based descriptive study, data were abstracted from the Rochester Epidemiology Project, a medical record linkage system covering 95% of patients in Olmsted County, Minnesota. Participants were children aged 0-5 years who resided in Olmsted County between January 1, 1996 and June 30, 2017, and who received diagnoses of seizures, cardiomyopathy, cardiac arrest, respiratory arrest, laryngospasm, and/or tetany. The incidence of hypocalcemia plus a potentially life-threatening complication was calculated. RESULTS: Among 15 419 patients aged 0-5 years in Olmsted County during the study period, 1305 had eligible complications: 460 had serum calcium checked within 14 days of presentation and 85 had hypocalcemia. Patients were excluded when causes other than hypocalcemia likely triggered the complication, leaving 16 children whose complication was attributed to hypocalcemia. Three of these 16 patients had a serum 25-hydroxyvitamin D measurement and 2 were deficient (≤6 ng/mL [15 nmol/L]). Among children aged 0-5 years, the incidence of hypocalcemia plus a potentially life-threatening complication was 6.1 per 100 000 person-years (95% CI, 3.5-10.0). CONCLUSIONS: Vitamin D deficiency is an underinvestigated cause of complications of hypocalcemia in children. Serum calcium and 25-hydroxyvitamin D should be measured in children with these complications to identify possibly life-threatening vitamin D deficiency.

[The process of eliminating neonatal Tetanus in Colombia, 1989-2005]. / Proceso de eliminación del Tétanos neonatal en Colombia 1989-2005.

OBJECTIVE: To describe the country's progress in eliminating neonatal tetanus based on the information obtained from epidemiologic surveillance. MATERIAL AND METHODS: A retrospective descriptive study of the epidemiological surveillance of neonatal tetanus in Colombia in the period ranging from 1989 to 2005. Available information was consulted regarding confirmations of this event of interest for Public Health. RESULTS: During the study period, a total of 830 cases of neonatal tetanus were reported. In 1989, the rate of neonatal tetanus in Colombia was 0.22 per 1000 live births. In 2005, this value was reduced to 0.01 cases per 1000 live births; a reduction of nearly 94 %. CONCLUSIONS: Given the information provided by epidemiological surveillance, Colombia has achieved the goal of maintaining a rate<1 case per 1000 live births. Nevertheless, even one case anywhere in the country should be considered a failure of the healthcare system.

One-day thyroid surgery - is it safe?

THE AIM OF THE STUDY: was to evaluate the safety of one-day thyroid surgery based on the assessment of the incidence of early postoperative complications. MATERIAL AND METHODS: The study comprised 726 patients who underwent total thyroidectomy during the period between January, 2012 and February, 2013. The study considered the three most common thyroidectomy complications. RESULTS: In the group of 726 patients, recurrent laryngeal nerve paralysis was observed in 22 cases, accounting for 3.07% of all patients. Postoperative bleeding was observed in 12 cases (1.65%). In 8 cases, bleeding occurred during the first 8 hours after surgery, while in the remaining four cases- 9, 12, 18, and 26 hours after surgery. The study group was divided into three subgroups, in which the concentrations of calcium and parathyroid hormone, 6 hours and 20 hours after surgery, were determined. In the first group (223 patients), only the parathyroid hormone level was determined. The decreased PTH level was associated with the appearance of tetany symptoms in 15% of cases. Amongst patients in whom the parathyroid hormone level was normal, tetany symptoms were observed in 0.5% of cases. In the second group (256 patients), only the serum calcium level was determined. Amongst patients with normal serum calcium levels, 1% of cases presented with tetany symptoms. In patients where the serum calcium level was reduced, tetany symptoms appeared in 35% of cases. In the third group (247 patients), both serum calcium and parathyroid hormone levels were determined. In the group of patients with normal, both serum calcium and parathyroid hormone levels, tetany symptoms were not observed. Amongst patients with normal serum calcium levels and decreased PTH levels on the day of surgery, tetany symptoms were observed in 25% of cases, while during the first postoperative day-37% of cases. CONCLUSION: One-day thyroid surgery, due to the appearance of complications cannot be regarded as a completely safe procedure.

Cost-effectiveness analysis regarding postoperative administration of vitamin-D and calcium after thyroidectomy to prevent hypocalcaemia / Análisis de costo-efectividad de la administración postoperatoria de Vitamina D y calcio después de tiroidectomía para la prevención de la hipo calcemia

Objective Hypocalcaemia is a frequently arising complication following total thyroidectomy. Routine postoperative prophylactic administration of vitamin D or metabolites and calcium reduce the incidence of symptomatic hypocalcaemia; this article reports evaluating its cost-effectiveness in Colombia. Methods Meta-analysis was used for comparing the administration of vitamin D or metabolites to oral calcium or no treatment at all in patients following total thyroidectomy and a cost-effectiveness analysis was designed based on a decision-tree model with local costs. Results The OR value for the comparison between calcitriol and calcium compared to no treatment and to exclusive calcium treatment groups was 0.32 (0.13-0.79 95 %CI) and 0.31 (0.14-0.70 95 %CI), respectively. The most cost-effective strategy was vitamin D or metabolites and calcium administration, having a US $0.05 incremental cost-effectiveness ratio. Conclusion Prophylactic treatment of hypocalcaemia with vitamin D or metabolites + calcium or calcium alone is a cost-effective strategy.

Objetivos La hipo calcemia es la complicación más frecuente después de tiroidectomía. La administración profiláctica de vitamina D o metabolitos y calcio reduce la incidencia de hipocalcémia sintomática. Se evalúa su costo-efectividad en Colombia. Materiales y métodos Utilizamos la información de un meta-análisis que comparó la administración de vitamina D o metabolitos contra calcio no tratamiento en pacientes llevados a tiroidectomía total y diseñamos un análisis de costo-efectividad basados en un modelos de decisiones con costos locales. Resultados El valor del OR para la comparación entre calcitriol y calcio comparado con no tratamiento o calcio exclusivo fue de 0.32 (95 % IC, 0.13- 0.79) y 0.31 (95 % IC, 0.14-0.70), respectivamente. La estrategia más costo-efectiva fue la administración de vitamina D o metabolitos y calcio, con una relación de costo-efectividad incremental de US $0.05. Conclusiones El tratamiento profiláctico de la hipo calcemia con vitamina D o metabolitos y calcio o calcio exclusivo después de tiroidectomía total es una estrategia costo-efectiva.

Cost-effectiveness analysis regarding postoperative administration of vitamin-D and calcium after thyroidectomy to prevent hypocalcaemia.

OBJECTIVE: Hypocalcaemia is a frequently arising complication following total thyroidectomy. Routine postoperative prophylactic administration of vitamin D or metabolites and calcium reduce the incidence of symptomatic hypocalcaemia; this article reports evaluating its cost-effectiveness in Colombia. METHODS: Meta-analysis was used for comparing the administration of vitamin D or metabolites to oral calcium or no treatment at all in patients following total thyroidectomy and a cost-effectiveness analysis was designed based on a decision-tree model with local costs. RESULTS: The OR value for the comparison between calcitriol and calcium compared to no treatment and to exclusive calcium treatment groups was 0.32 (0.13-0.79 95 %CI) and 0.31 (0.14-0.70 95 %CI), respectively. The most cost-effective strategy was vitamin D or metabolites and calcium administration, having a US $0.05 incremental cost-effectiveness ratio. CONCLUSION: Prophylactic treatment of hypocalcaemia with vitamin D or metabolites + calcium or calcium alone is a cost-effective strategy.

Spasmophilia comorbidity in fibromyalgia syndrome.

OBJECTIVES: To evaluate the role of spasmophilia (SP) in fibromyalgia syndrome (FM). METHODS: Three hundred and fourteen patients (280 F, 34 M) with a diagnosis of FM or FM and spasmophilia (FM+SP) were recruited. Clinical assessment of patients and controls included the Questionnaires FIQ, HAQ and the tender point (TP) count. Life-time or ongoing psychiatric aspects were evaluated by trained psychiatrists by means of the classic scales: Structured Clinical Interview (SCID) for DSM-IV. The following analysis were evaluated: cytokine (IL1, IL2, IL6, IL8, IL10), TNF-α, cortisol, GH, ACTH, IGF1, 5HT, intracellular Mg, plasma calcium p(Ca), PTH, (25(OH)D) and thyroid functionality. Some typical symptoms were investigated. RESULTS: Eighty-one patients resulted positive for spamophilia (FM+SP), while 233 resulted negative for spasmophilia (FM). The mean TP number resulted higher in the FM group (15.33±3.88) with respect to FM+SP (12.88±6.17, p=0.016), while FIQ and HAQ did not differ between the two studied groups. FM patients exhibited a higher frequency of psychiatric disorders with respect to FM+SP patients (72% FM vs. 49% FM+SP, p<0.01). In particular the frequency of depression was 65.5% FM vs. 35% FM+SP (p<0.01). CONCLUSIONS: The presence of spasmophilia seems to influence psychiatric comorbidity which was less prevalent in FM+SP patients. FM is indeed characterised by an abnormal sensory processing of pain that seems to result from a combination of interactions between neurotransmitters, stress, hormones and the nervous system; spasmophilia would seem to be more linked to a dysfunction at the neuromuscular level.

[Complications of blood donation in Morocco (during and immediately after the donation)]. / Les complications du don du sang au Maroc (pendant et immédiatement après le don).

UNLABELLED: The complications that may arise in connection with a blood donation are usually benign. These complications can lead to disaffection for the donation. The purpose of this study is to determine the incidence of complications occurring during or shortly after blood donation and to identify factors that contribute to its occurrence. MATERIALS AND METHODS: A prospective study of 10 December 2005 to 09 June 2006 is conducted at the Regional Center for Blood Transfusion in Casablanca (Morocco) on the complications seen in 23 745 donors. RESULTS: During the study period, 23 745 samples were made and 122 complications were collected (0.51%). One hundred and sixteen (95%) complications of a general: 81 vagal malaise, 20 syncopations, two syncopations convulsivantes and three tetany. Seventy-three (63%) donors presented hypotension. Complications are more common in men than in women: 71 versus 45 (p < 0.001); patients give for the first time than to Former donors: 82 versus 34 (p < 0.001); donors have age less or egal to 30 years compared with than with age over 30 years: 78 versus 38 (p < 0.001). Eighty-two complications (71%) were observed among donors with weight more than 70 kg. CONCLUSION: In this study, the incidence of the complications for blood donation remains lower. The best choice of the donors by the doctor, taking into consideration the factors involved in these complications, reduces this incidence.

Randomized study on oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy.

BACKGROUND: Symptomatic hypocalcemia remains the main postoperative complication after total thyroidectomy. The aim of the present study was to evaluate the role of oral supplementation of calcitriol and calcium salts in preventing severe postoperative hypocalcemia after total thyroidectomy. METHODS: A consecutive series of patients undergoing total thyroidectomy followed by administration of 500 mg of calcium salts 3 times per day were randomized to 3 different postoperative medical treatments: in group A, .5 microg of calcitriol twice per day was administered to 104 patients; in group B, 1 mmicrog of calcitriol twice per day was administered to 111 patients; and in group C, 202 patients did not receive calcitriol. RESULTS: The rate of postoperative tetany in group A was 2.9%, in group B was 0%, and in group C was 7.4% (P=.03) and the rate of paresthesias was 28.8%, 17.1%, and 22.3%, respectively (P=.19). At discontinuation of calcitriol/calcium salts treatment, intact parathyroid hormone levels did not significantly differ from the preoperative levels. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve for serum concentration of calcium in predicting postoperative tetany was .749, .858 and .862 on the first, second, and third postoperative day, respectively. The best cut-off value of calcemia for prediction tetany was 7.5 mg/dL, and the rate of severe hypocalcemia on the third postoperative day was 23.1% in group A, 9.9% in group B, and 27.2% in group C (P=.001). CONCLUSIONS: Oral administration of 1 microg of calcitriol twice per day and 500 mg of calcium salts 3 times per day after total thyroidectomy significantly decreases the risk of severe postoperative hypocalcemia.

Espasmofilia familiar: valoración de algunos aspectos psicológicos / Family spasmophilia: assessment of some psychologic aspects

Se presenta la valoración realizada en las pesquisas y estudios psicológicos en una familia afectada por esta enfermedad, perteneciente al área de Salud Previsora, en el período del 1o de enero de 1999 al 1o de enero del 2001, ambos inclusive. Se precisan los aspectos clínicos y los psicológicos relacionados con esta enfermedad, al mismo tiempo que señalamos las orientaciones realizadas para elevar la calidad de vida de esta familia que, al tener un componente hereditario importante, nos motivó a insistir en el control preconcepcional y manejo integral de los miembros de la familia(AU)

Neonatal Tetanus Programme.

It presents overview, mission, and functions of the Programme, related links, contacts, and epidemiological data.

Seasonal changes in calcium homeostasis affect the incidence of postoperative tetany in patients with Graves' disease.

BACKGROUND: We have found that postoperative tetany occurs in patients with Graves' disease who have secondary hyperparathyroidism caused by a deficiency in calcium and vitamin D concomitant with transient hypoparathyroidism after surgery. There are seasonal variations in serum 25-hydroxyvitamin D (25[OH]D) concentrations. The purpose of this study was to investigate the effects of seasonal changes in calcium homeostasis on the incidence of postoperative tetany in patients with Graves' disease who undergo subtotal thyroidectomy. PATIENTS AND METHODS: A prospective study was carried out to investigate sequential changes in serum levels of intact parathyroid hormone (iPTH), calcium and other electrolytes, 25(OH)D, and 1,25-dihydroxyvitamin D (1,25[OH]2D) in female patients with Graves' disease who underwent subtotal thyroidectomy during the summer (n = 89) and during the winter (n = 89). RESULTS: The serum levels of calcium, magnesium, and 25(OH)D were significantly higher, but iPTH levels and 1,25(OH)2D levels were lower in summer than in winter. The percentage of vitamin D deficiency (25(OH)D < 25 nmol/L) was 23% in summer and 62% in winter (P < .001). iPTH was below the detection limit on the first postoperative day in 15 patients (13.8%) in summer and in 13 patients (11.4%) in winter. In summery, tetany developed in only 4 of 15 patients and in one patient whose iPTH level was below normal (incidence of tetany, 5.6%). In winter, however, tetany developed in 6 of 13 patients and in 4 patients whose iPTH level was below normal (incidence of tetany, 11.2%). CONCLUSIONS: Patients with Graves' disease are more susceptible to calcium and vitamin D deficiency during the winter than during the summer, resulting in the tendency toward a higher incidence of postoperative tetany in winter.

[Overview of tetanic syndrome occurrence]. / Prehl'ad výskytu tetanického syndrómu.

The clinical material of the EMG laboratory was analyzed to establish the annual incidence rate (approx. 1 per 1000) of tetanic syndrome as well as the age and sex of the patients affected. In inpatients of the Hospital's Department of Neurology the occurrence rate of neurogenic tetanic syndrome over a period of 5 years was evaluated and compared with that of multiple sclerosis. The high and ubiquitous occurrence of the syndrome was confirmed. The paper addresses some terminological and pathogenetic questions and substantiates the requirement of giving complex attention to the problem. (Tab. 2, Ref. 9.)

Rates of diseases and their associated costs in two Colorado sheep feedlots (1985-1986).

Data related to rates of disease and their associated costs were collected for 12 months from 2 sheep feedlots in northern Colorado. There was an apparent seasonal occurrence of many of the diseases. Pneumonia, enterotoxemia, acidosis, and transport tetany accounted for most of the diseases seen in these feedlots and were responsible for most of the economic losses. There was a large difference in the incidence of diseases between the 2 feedlots and in the expenditures for disease prevention between the 2 feedlots.

Factors predisposing dairy and beef cows to grass tetany.

In a study of dairy and beef herds on 120 farms in south-western Victoria, losses attributed to grass tetany were shown to have been an important cause of economic loss during the cooler months of 1980. Thin dairy cows had a higher incidence of suspected grass tetany than dairy cows in moderate body condition, and both thin and fat beef cows had a higher incidence than beef cows in moderate body condition. A lower incidence was found among dairy cows when the available pasture or hay contained a high percentage of clover, when cows in moderate body condition had been grazed on pastures topdressed with low rates of potassium fertilisers, and when cows had been rotated onto fresh pasture at least daily rather than at 2 or 3 day intervals. The incidence among dairy cows was also associated with the length of available pasture, the correlation being positive for cows of moderate body condition, but negative for thin cows. Possible reasons for the associations are discussed. Only a small proportion of farmers adopted measures to prevent grass tetany, and those who did often applied them inefficiently. Practicable control measures are suggested on the basis of the survey results.

Incidence of some metabolic diseases in dairy cows.

The incidence of parturient paresis, nonparturient paresis, ketosis and tetany were examined from 283 herds (2,590 cows per year) over a period of eight years. These metabolic diseases made up 29.4% of the cases treated by veterinarians during the farm visits. Significant variation in annual incidences was found only in ketosis. The monthly variation in parturient paresis and ketosis differed highly significantly from the seasonal variation in calving. They were most frequent in March-April. Most of the tetany cases were diagnosed in May-June. The incidence of parturient paresis (0.095 cases per cow per year) and the incidence of ketosis (0.058) varied significantly between herds of different size. The incidence of nonparturient paresis (0.008) and tetany (0.002) did not vary significantly between herds of different size. The incidence of ketosis was significantly higher on farms with milk recording than on other farms. The type of cowshed did not affect the incidence of metabolic disease.

Management factors and grass tetany in dairy cattle.

The relationship between intensity of production and the occurrence of hypomagnesaemia and grass tetany in dairy cattle was investigated from 1966-1970 at the Ellinbank Dairy Research Station, Warragul, Victoria. Hypomagnesaemia and/or grass tetany occurred in cows grazing at both high (3.2 cows/hectare) and low (2.2 cows/hectare) stocking rates over the four-year period. Pasture Mg concentrations remained relatively high (0.2% dry matter) throughout this period, except in the low stocking rate pastures in one year, 1967. It is concluded that hypomagnesaemia and grass tetany was precipitated by a combination of low dry matter intake in winter and the effects of a gradual increase of K concentration in autumn and winter pastures, following the heavy application of K fertilizer. Under these conditions, MgO supplementation was inadequate to prevent grass tetany occurring in some animals.