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2.
Medicine (Baltimore) ; 100(25): e26443, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160437

RESUMO

RATIONALE: Autosomal dominant hypocalcaemia type 1 (ADH1) is a genetic disease characterized by benign hypocalcemia, inappropriately low parathyroid hormone levels and mostly hypercalciuria. It is caused by the activating mutations of the calcium-sensing receptor gene (CASR), which produces a left-shift in the set point for extracellular calcium. PATIENT CONCERNS: A 50-year-old man presenting with muscle spasms was admitted into the hospital. He has a positive familial history for hypocalcemia. Auxiliary examinations demonstrated hypocalcemia, hyperphosphatemia, normal parathyroid hormone level and nephrolithiasis. A missense heterozygous variant in CASR, c 613C > T (p. Arg205Cys) which has been reported in a familial hypocalciuric hypercalcemia type 1 patient was found in the patient's genotype. It is the first time that this variant is found associating with ADH1. The variant is predicted vicious by softwares and cosegregates with ADH1 in this pedigree. CASR Arg205Cys was deduced to be the genetic cause of ADH1 in the family. DIAGNOSIS: The patient was diagnosed with ADH1 clinically and genetically. INTERVENTIONS: Oral calcitriol, calcium and hydrochlorothiazide were prescribed to the patient. OUTCOMES: After the treatments for 1 week, the patient's symptom was improved and the re-examination revealed serum calcium in the normal range. A 3-month follow-up showed his symptom was mostly relieved. LESSONS: The variant of CASR Arg205Cys, responsible for ADH1 in this family, broadened the genetic spectrum of ADH1. Further and more studies are required to evaluate the correlation between genotype and phenotype in ADH1 patients.


Assuntos
Cálcio/administração & dosagem , Hipercalciúria/diagnóstico , Hipocalcemia/diagnóstico , Hipoparatireoidismo/congênito , Receptores de Detecção de Cálcio/genética , Calcitriol/administração & dosagem , Cálcio/sangue , Análise Mutacional de DNA , Quimioterapia Combinada/métodos , Feminino , Testes Genéticos , Heterozigoto , Humanos , Hidroclorotiazida/administração & dosagem , Hipercalciúria/sangue , Hipercalciúria/genética , Hipocalcemia/sangue , Hipocalcemia/genética , Hipoparatireoidismo/sangue , Hipoparatireoidismo/diagnóstico , Hipoparatireoidismo/genética , Masculino , Anamnese , Pessoa de Meia-Idade , Mutação de Sentido Incorreto , Linhagem , Resultado do Tratamento
3.
Eur Rev Med Pharmacol Sci ; 25(10): 3772-3790, 2021 05.
Artigo em Inglês | MEDLINE | ID: covidwho-1264762

RESUMO

Multiple epidemiological studies have suggested that industrialization and progressive urbanization should be considered one of the main factors responsible for the rising of atherosclerosis in the developing world. In this scenario, the role of trace metals in the insurgence and progression of atherosclerosis has not been clarified yet. In this paper, the specific role of selected trace elements (magnesium, zinc, selenium, iron, copper, phosphorus, and calcium) is described by focusing on the atherosclerotic prevention and pathogenesis plaque. For each element, the following data are reported: daily intake, serum levels, intra/extracellular distribution, major roles in physiology, main effects of high and low levels, specific roles in atherosclerosis, possible interactions with other trace elements, and possible influences on plaque development. For each trace element, the correlations between its levels and clinical severity and outcome of COVID-19 are discussed. Moreover, the role of matrix metalloproteinases, a family of zinc-dependent endopeptidases, as a new medical therapeutical approach to atherosclerosis is discussed. Data suggest that trace element status may influence both atherosclerosis insurgence and plaque evolution toward a stable or an unstable status. However, significant variability in the action of these traces is evident: some - including magnesium, zinc, and selenium - may have a protective role, whereas others, including iron and copper, probably have a multi-faceted and more complex role in the pathogenesis of the atherosclerotic plaque. Finally, calcium and phosphorus are implicated in the calcification of atherosclerotic plaques and in the progression of the plaque toward rupture and severe clinical complications. In particular, the role of calcium is debated. Focusing on the COVID-19 pandemia, optimized magnesium and zinc levels are indicated as important protective tools against a severe clinical course of the disease, often related to the ability of SARS-CoV-2 to cause a systemic inflammatory response, able to transform a stable plaque into an unstable one, with severe clinical complications.


Assuntos
Aterosclerose/patologia , Oligoelementos/metabolismo , Aterosclerose/metabolismo , COVID-19/patologia , COVID-19/virologia , Cálcio/sangue , Cálcio/metabolismo , Cobre/sangue , Cobre/metabolismo , Humanos , Ferro/sangue , Ferro/metabolismo , Magnésio/sangue , Magnésio/metabolismo , Metaloproteinases da Matriz/metabolismo , Fósforo/sangue , Fósforo/metabolismo , Risco , SARS-CoV-2/isolamento & purificação , Selênio/sangue , Selênio/metabolismo , Índice de Gravidade de Doença , Oligoelementos/sangue , Zinco/sangue , Zinco/metabolismo
4.
Eur Rev Med Pharmacol Sci ; 25(10): 3772-3790, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34109586

RESUMO

Multiple epidemiological studies have suggested that industrialization and progressive urbanization should be considered one of the main factors responsible for the rising of atherosclerosis in the developing world. In this scenario, the role of trace metals in the insurgence and progression of atherosclerosis has not been clarified yet. In this paper, the specific role of selected trace elements (magnesium, zinc, selenium, iron, copper, phosphorus, and calcium) is described by focusing on the atherosclerotic prevention and pathogenesis plaque. For each element, the following data are reported: daily intake, serum levels, intra/extracellular distribution, major roles in physiology, main effects of high and low levels, specific roles in atherosclerosis, possible interactions with other trace elements, and possible influences on plaque development. For each trace element, the correlations between its levels and clinical severity and outcome of COVID-19 are discussed. Moreover, the role of matrix metalloproteinases, a family of zinc-dependent endopeptidases, as a new medical therapeutical approach to atherosclerosis is discussed. Data suggest that trace element status may influence both atherosclerosis insurgence and plaque evolution toward a stable or an unstable status. However, significant variability in the action of these traces is evident: some - including magnesium, zinc, and selenium - may have a protective role, whereas others, including iron and copper, probably have a multi-faceted and more complex role in the pathogenesis of the atherosclerotic plaque. Finally, calcium and phosphorus are implicated in the calcification of atherosclerotic plaques and in the progression of the plaque toward rupture and severe clinical complications. In particular, the role of calcium is debated. Focusing on the COVID-19 pandemia, optimized magnesium and zinc levels are indicated as important protective tools against a severe clinical course of the disease, often related to the ability of SARS-CoV-2 to cause a systemic inflammatory response, able to transform a stable plaque into an unstable one, with severe clinical complications.


Assuntos
Aterosclerose/patologia , Oligoelementos/metabolismo , Aterosclerose/metabolismo , COVID-19/patologia , COVID-19/virologia , Cálcio/sangue , Cálcio/metabolismo , Cobre/sangue , Cobre/metabolismo , Humanos , Ferro/sangue , Ferro/metabolismo , Magnésio/sangue , Magnésio/metabolismo , Metaloproteinases da Matriz/metabolismo , Fósforo/sangue , Fósforo/metabolismo , Risco , SARS-CoV-2/isolamento & purificação , Selênio/sangue , Selênio/metabolismo , Índice de Gravidade de Doença , Oligoelementos/sangue , Zinco/sangue , Zinco/metabolismo
5.
Clin Nutr ESPEN ; 43: 276-282, 2021 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1188426

RESUMO

BACKGROUND AND AIM: COVID-19 is a global public health concern. As no standard treatment has been found for it yet, several minerals and vitamins with antioxidants, immunomodulators, and antimicrobials roles can be sufficient for the immune response against the disease. The present study evaluates the serum vitamin D, calcium, and Zinc levels in patients with COVID-19. MATERIALS & METHODS: This research is a case-control study performed in May 2020 on 93 patients with COVID-19 hospitalized in a Shoushtar city hospital and on 186 healthy subjects with no symptoms of COVID-19. The serum vitamin D, calcium, and zinc levels were collected and analyzed using correlation coefficient and independent t-test via SPSS 18. RESULTS: Vitamin D levels had a significant difference between the case and control groups (p = 0.008). Serum calcium and serum zinc levels also had statistically significant differences between the two groups (p < 0.001). CONCLUSION: The research results showed that serum zinc, calcium, and vitamin D levels in COVID-19 patients are lower than in the control group. The supplementation with such nutrients is a safe and low-cost measure that can help cope with the increased demand for these nutrients in risk of acquiring the COVID-19 virus.


Assuntos
COVID-19/sangue , Cálcio/sangue , Deficiências Nutricionais/sangue , Estado Nutricional , Vitamina D/sangue , Zinco/sangue , Adulto , Anti-Infecciosos/sangue , Antioxidantes/metabolismo , COVID-19/complicações , COVID-19/prevenção & controle , Cálcio/deficiência , Estudos de Casos e Controles , Cidades , Deficiências Nutricionais/complicações , Deficiências Nutricionais/prevenção & controle , Suplementos Nutricionais , Feminino , Hospitalização , Hospitais , Humanos , Fatores Imunológicos/sangue , Irã (Geográfico) , Masculino , Micronutrientes/sangue , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , População Urbana
6.
Clin Nutr ESPEN ; 43: 276-282, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34024527

RESUMO

BACKGROUND AND AIM: COVID-19 is a global public health concern. As no standard treatment has been found for it yet, several minerals and vitamins with antioxidants, immunomodulators, and antimicrobials roles can be sufficient for the immune response against the disease. The present study evaluates the serum vitamin D, calcium, and Zinc levels in patients with COVID-19. MATERIALS & METHODS: This research is a case-control study performed in May 2020 on 93 patients with COVID-19 hospitalized in a Shoushtar city hospital and on 186 healthy subjects with no symptoms of COVID-19. The serum vitamin D, calcium, and zinc levels were collected and analyzed using correlation coefficient and independent t-test via SPSS 18. RESULTS: Vitamin D levels had a significant difference between the case and control groups (p = 0.008). Serum calcium and serum zinc levels also had statistically significant differences between the two groups (p < 0.001). CONCLUSION: The research results showed that serum zinc, calcium, and vitamin D levels in COVID-19 patients are lower than in the control group. The supplementation with such nutrients is a safe and low-cost measure that can help cope with the increased demand for these nutrients in risk of acquiring the COVID-19 virus.


Assuntos
COVID-19/sangue , Cálcio/sangue , Deficiências Nutricionais/sangue , Estado Nutricional , Vitamina D/sangue , Zinco/sangue , Adulto , Anti-Infecciosos/sangue , Antioxidantes/metabolismo , COVID-19/complicações , COVID-19/prevenção & controle , Cálcio/deficiência , Estudos de Casos e Controles , Cidades , Deficiências Nutricionais/complicações , Deficiências Nutricionais/prevenção & controle , Suplementos Nutricionais , Feminino , Hospitalização , Hospitais , Humanos , Fatores Imunológicos/sangue , Irã (Geográfico) , Masculino , Micronutrientes/sangue , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , População Urbana
7.
Diabetes Res Clin Pract ; 176: 108867, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34023340

RESUMO

AIMS: Maturity-Onset Diabetes of the Young (MODY) caused by glucokinase (GCK) mutations is characterized by lifelong mild non-progressive hyperglycemia, with low frequency of coronary artery disease (CAD) compared to other types of diabetes. The aim of this study is to estimate cardiovascular risk by coronary artery calcification (CAC) score in this group. MATERIALS AND METHODS: Twenty-nine GCK-MODY cases, 26 normoglycemic controls (recruited among non-affected relatives/spouses of GCK mutation carriers), and 24 unrelated individuals with type 2 diabetes were studied. Patients underwent CAC score evaluation by computed tomography and were classified by Agatston score ≥ or < 10. Framingham Risk scores of CAD in 10 years were calculated. RESULTS: Median [interquartile range] CAC score in GCK-MODY was 0 [0,0], similar to controls (0 [0,0], P = 0.49), but lower than type 2 diabetes (39 [0, 126], P = 2.6 × 10-5). A CAC score ≥ 10 was seen in 6.9% of the GCK group, 7.7% of Controls (P = 1.0), and 54.2% of individuals with type 2 diabetes (P = 0.0006). Median Framingham risk score was lower in GCK than type 2 diabetes (3% vs. 13%, P = 4 × 10-6), but similar to controls (3% vs. 4%, P = 0.66). CONCLUSIONS: CAC score in GCK-MODY is similar to control individuals from the same family and/or household and is significantly lower than type 2 diabetes. Besides demonstrating low risk of CAD in GCK-MODY, these findings may contribute to understanding the specific effect of hyperglycemia in CAD.


Assuntos
Cálcio/sangue , Vasos Coronários/metabolismo , Diabetes Mellitus Tipo 2/diagnóstico , Fatores de Risco de Doenças Cardíacas , Adulto , Idoso , Cálcio/análise , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Vasos Coronários/química , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/genética , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/diagnóstico , Feminino , Glucoquinase/genética , Humanos , Hiperglicemia/genética , Masculino , Pessoa de Meia-Idade , Mutação , Prognóstico , Medição de Risco , Fatores de Risco
8.
Biochem Med (Zagreb) ; 31(2): 020704, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-33927554

RESUMO

Introduction: A specific sequence is recommended for filling blood tubes during blood collection to prevent erroneous test results due to carryover of additives. However, requirement of this procedure is still debatable. This study was aimed to investigate the potassium ethylenediaminetetraacetic acid (K-EDTA) contamination in blood samples taken after a tube containing the additive during routine workflow. The study was also carried out to examine the effect of order of draw on potassium results, regardless of K-EDTA contamination. Materials and methods: In 388 outpatients, to determine the probability of K-EDTA cross-contamination, blood was drawn sequentially into a serum tube, followed by a tube containing K-EDTA, and by another serum tube. In another 405 outpatients, to evaluate the effect of order of draw blood unrelated to K-EDTA contamination, two serum tube were successively collected. Potassium was measured on Cobas 6000 c501 analyser (Roche Diagnostic GmbH, Mannheim, Germany) by indirect ion selective electrode method. Results: Of paired samples collected before and after a K-EDTA tube, 24% had a potassium difference of above 0.3 mmol/L. However, no EDTA contamination was detected in these samples as well as 95% confidence intervals (CI) of limits of agreement for calcium were within the allowable error limits based on reference change values. Interestingly, of blood samples drawn successively, 24% had also a difference greater than 0.3 mmol/L for potassium. Conclusion: Incorrect order of draw using closed blood collection system does not cause K-EDTA contamination, even in routine workflow. However, regardless of K-EDTA contamination, order of draw has significant influence on the potassium results.


Assuntos
Coleta de Amostras Sanguíneas , Ácido Edético/farmacologia , Potássio/sangue , Fluxo de Trabalho , Adolescente , Adulto , Idoso , Cálcio/sangue , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Int J Infect Dis ; 107: 153-163, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-1300797

RESUMO

INTRODUCTION: Studies have revealed hypocalcemia and low vitamin D levels in severe covid-19 that warrant further research. OBJECTIVE: Our study investigates the correlation between calcium levels at presentation as a primary endpoint and pre-existing calcium levels as a secondary endpoint to the severity of disease presentation and progression. METHOD: Observational cohort study in adults admitted with COVID-19 from March utill September 2020. Multiple clinical scales and laboratory parameters were used to correlate corrected calcium and vitamin D associations with risk factors and outcomes. RESULTS: Four hundred and forty five patients were included in the study. Hypocalcemic patients had more abnormal laboratory parameters and longer hospitalization duration. Hypocalcemia was in 60-75% of all age groups (p-value 0.053), for which 77.97% were ICU admissions (p-value 0.001) and 67.02% were diabetic (p-value 0.347). There were non-significant correlations between Vitamin D and almost all the parameters except for chronic respiratory diseases, which had a P-value of 0.024. CONCLUSION: It can be concluded that hypocalcemia is a significant and reliable marker of disease severity and progression regardless of underlying comorbidities. Vitamin D levels fail to reflect correlation with severity of COVID-19 infections.


Assuntos
COVID-19/sangue , Cálcio/sangue , SARS-CoV-2 , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/complicações , Estudos de Coortes , Feminino , Hospitalização , Humanos , Hipocalcemia/sangue , Masculino , Pessoa de Meia-Idade , Vitamina D/sangue , Adulto Jovem
10.
Int J Infect Dis ; 107: 153-163, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33892191

RESUMO

INTRODUCTION: Studies have revealed hypocalcemia and low vitamin D levels in severe covid-19 that warrant further research. OBJECTIVE: Our study investigates the correlation between calcium levels at presentation as a primary endpoint and pre-existing calcium levels as a secondary endpoint to the severity of disease presentation and progression. METHOD: Observational cohort study in adults admitted with COVID-19 from March utill September 2020. Multiple clinical scales and laboratory parameters were used to correlate corrected calcium and vitamin D associations with risk factors and outcomes. RESULTS: Four hundred and forty five patients were included in the study. Hypocalcemic patients had more abnormal laboratory parameters and longer hospitalization duration. Hypocalcemia was in 60-75% of all age groups (p-value 0.053), for which 77.97% were ICU admissions (p-value 0.001) and 67.02% were diabetic (p-value 0.347). There were non-significant correlations between Vitamin D and almost all the parameters except for chronic respiratory diseases, which had a P-value of 0.024. CONCLUSION: It can be concluded that hypocalcemia is a significant and reliable marker of disease severity and progression regardless of underlying comorbidities. Vitamin D levels fail to reflect correlation with severity of COVID-19 infections.


Assuntos
COVID-19/sangue , Cálcio/sangue , SARS-CoV-2 , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/complicações , Estudos de Coortes , Feminino , Hospitalização , Humanos , Hipocalcemia/sangue , Masculino , Pessoa de Meia-Idade , Vitamina D/sangue , Adulto Jovem
11.
Medicine (Baltimore) ; 100(17): e25602, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907111

RESUMO

ABSTRACT: To explore the influencing factors of prostate cancer occurrence, set up risk prediction model, require reference for the preliminary diagnosis of clinical doctors, this model searched database through the data of prostate cancer patients and prostate hyperplasia patients National Clinical Medical Science Data Center.With the help of Stata SE 12.0 and SPSS 25.0 software, the biases between groups were balanced by propensity score matching. Based on the matched data, the relevant factors were further screened by stepwise logistic regression analysis, the key variable and artificial neural network model are established. The prediction accuracy of the model is evaluated by combining the probability of test set with the area under receiver operating characteristic curve (ROC).After 1:2 PSM, 339 pairs were matched successfully. There are 159 cases in testing groups and 407 cases in training groups. And the regression model was P = 1 / (1 + e (0.122 ∗ age + 0.083 ∗ Apo lipoprotein C3 + 0.371 ∗ total prostate specific antigen (tPSA) -0.227 ∗ Apo lipoprotein C2-6.093 ∗ free calcium (iCa) + 0.428 ∗ Apo lipoprotein E-1.246 ∗ triglyceride-1.919 ∗ HDL cholesterol + 0.083 ∗ creatine kinase isoenzyme [CKMB])). The logistic regression model performed very well (ROC, 0.963; 95% confidence interval, 0.951 to 0.978) and artificial neural network model (ROC, 0.983; 95% confidence interval, 0.964 to 0.997). High degree of Apo lipoprotein E (Apo E) (Odds Ratio, [OR], 1.535) in blood test is a risk factor and high triglyceride (TG) (OR, 0.288) is a protective factor.It takes the biochemical examination of the case as variables to establish a risk prediction model, which can initially reflect the risk of prostate cancer and bring some references for diagnosis and treatment.


Assuntos
Modelos Biológicos , Neoplasias da Próstata/etiologia , Medição de Risco/métodos , Adulto , Idoso , Apolipoproteínas/sangue , Biomarcadores/sangue , Cálcio/sangue , HDL-Colesterol/sangue , Creatina Quinase/sangue , Humanos , Calicreínas/sangue , Masculino , Pessoa de Meia-Idade , Redes Neurais de Computação , Valor Preditivo dos Testes , Pontuação de Propensão , Antígeno Prostático Específico/sangue , Curva ROC , Análise de Regressão , Triglicerídeos/sangue
12.
Med Sci Monit ; 27: e930513, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33859156

RESUMO

BACKGROUND Regional citrate anticoagulation (RCA) is a recommended anticoagulation alternative for patients at high risk of bleeding while undergoing intermittent hemodialysis. Previous reports implied the risk of citrate application on bone metabolism. It is unclear whether long-term use of RCA is safe for maintenance hemodialysis patients in terms of bone metabolism. MATERIAL AND METHODS Seven patients with cerebral hemorrhage were included in the study. Blood samples were collected at baseline and 4 and 8 weeks after treatment. Spent dialysate samples were collected during each mid-week dialysis session, using the partial dialysate collection method. All patients were treated with RCA for 4 to 8 weeks, according to their clinical condition. We assessed bone metabolism-associated parameters, bone turnover markers, and magnesium loss at each dialysis session. RESULTS Serum magnesium levels were 1.24±0.13 mmol/L at baseline and significantly decreased to 1.16±0.14 mmol/L after 4 weeks of RCA treatment (P=0.025). Most patients had negative magnesium balance during citrate hemodialysis. Serum total calcium levels did not change significantly after treatment. One bone marker, N-terminal propeptide of type I procollagen (PINP), significantly decreased from 146.07±130.12 mmol/L to 92.42±79.01 mmol/L after citrate treatment (P=0.018). No significant changes were detected in other bone turnover markers. CONCLUSIONS Relatively long-term RCA treatment may decrease serum magnesium levels due to negative magnesium balance. Bone formation marker PINP seemed to decrease after treatment, while other bone turnover markers did not change significantly. Further investigation is needed to verify the effect of RCA on bone remodeling.


Assuntos
Anticoagulantes/uso terapêutico , Hemorragia Cerebral/terapia , Ácido Cítrico/uso terapêutico , Diálise Renal/métodos , Idoso , Idoso de 80 Anos ou mais , Remodelação Óssea , Cálcio/sangue , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteogênese , Fragmentos de Peptídeos/sangue , Pró-Colágeno/sangue
13.
J Cardiothorac Surg ; 16(1): 86, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33858470

RESUMO

BACKGROUND: A rare cause of primary hyperparathyroidism (PHPT) is a parathyroid carcinoma. Hypercalcemia with an elevated parathyroid hormone (PTH) level seen in recurrent and metastasis disease cases is often refractory to medical therapy, thus surgical resection is recommended when possible. We performed debulking surgery for pleural dissemination of parathyroid cancer for improvement of symptoms in a patient with hypercalcemia. CASE PRESENTATION: A 30-year-old male with hypercalcemia was diagnosed with parathyroid cancer. Following surgery, intact PTH level elevation and hypercalcemia progression due to recurrent disease were noted. An active status of functional left pleural dissemination was revealed in 99mTc-methoxyisobutylisonitrile and somatostatin receptor scintigraphy results, but not in the area of pulmonary metastasis, and debulking surgery was performed. Thereafter, the PTH level was decreased temporarily and activities of daily living improved. CONCLUSION: Aggressive resection of metastatic disease in patients with a parathyroid carcinoma is taken into consideration to control hypercalcemia.


Assuntos
Carcinoma/cirurgia , Procedimentos Cirúrgicos de Citorredução , Neoplasias das Paratireoides/patologia , Neoplasias Pleurais/cirurgia , Adulto , Cálcio/sangue , Carcinoma/sangue , Carcinoma/diagnóstico por imagem , Carcinoma/secundário , Procedimentos Cirúrgicos de Citorredução/métodos , Evolução Fatal , Humanos , Hipercalcemia/sangue , Hipercalcemia/etiologia , Hipercalcemia/terapia , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/etiologia , Hiperparatireoidismo Primário/terapia , Masculino , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/terapia , Neoplasias Pleurais/sangue , Neoplasias Pleurais/diagnóstico por imagem , Neoplasias Pleurais/secundário , Reoperação
14.
Biomed Res Int ; 2021: 6612276, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33928149

RESUMO

Background: Although serum calcium has been proven to be a predictor of mortality in a wide range of diseases, its prognostic value in critically ill patients with cardiogenic shock (CS) remains unknown. This retrospective observational study is aimed at investigating the association of admission calcium with mortality among CS patients. Methods: Critically ill patients diagnosed with CS in the Medical Information Mart for Intensive Care-III (MIMIC-III) database were included in our study. The study endpoints included 30-day, 90-day, and 365-day all-cause mortalities. First, admission serum ionized calcium (iCa) and total calcium (tCa) levels were analyzed as continuous variables using restricted cubic spline Cox regression models to evaluate the possible nonlinear relationship between serum calcium and mortality. Second, patients with CS were assigned to four groups according to the quartiles (Q1-Q4) of serum iCa and tCa levels, respectively. In addition, multivariable Cox regression analyses were used to assess the independent association of the quartiles of iCa and tCa with clinical outcomes. Results: A total of 921 patients hospitalized with CS were enrolled in this study. A nonlinear relationship between serum calcium levels and 30-day mortality was observed (all P values for nonlinear trend < 0.001). Furthermore, multivariable Cox analysis showed that compared with the reference quartile (Q3: 1.11 ≤ iCa < 1.17 mmol/L), the lowest serum iCa level quartile (Q1: iCa < 1.04 mmol/L) was independently associated with an increased risk of 30-day mortality (Q1 vs. Q3: HR 1.35, 95% CI 1.00-1.83, P = 0.049), 90-day mortality (Q1 vs. Q3: HR 1.36, 95% CI 1.03-1.80, P = 0.030), and 365-day mortality (Q1 vs. Q3: HR 1.28, 95% CI 1.01-1.67, P = 0.046) in patients with CS. Conclusions: Lower serum iCa levels on admission were potential predictors of an increased risk of mortality in critically ill patients with CS.


Assuntos
Cálcio/sangue , Hospitalização , Choque Cardiogênico/sangue , Choque Cardiogênico/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Íons , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida
15.
Isr Med Assoc J ; 23(4): 245-250, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33899358

RESUMO

BACKGROUND: Hypomagnesemia (serum magnesium level < 1.7 mg/dl) occurs more frequently in patients with type 2 diabetes mellitus (T2DM).Serum magnesium levels are not routinely tested in hospitalized patients, including in hospitalized patients with T2DM. OBJECTIVES: To evaluate the prevalence of hypomagnesemia among hospitalized T2DM patients treated with proton pump inhibitors (PPIs) and/or diuretics. METHODS: A total of 263 T2DM patients hospitalized in general departments were included in the study and were further divided into four groups: group 1 (patients not treated with PPIs or diuretics), group 2 (patients treated with PPIs), group 3 (patients treated with diuretics), and group 4 (patients treated with both PPIs and diuretics).  Blood and urine samples were taken during the first 24 hours of admission. Electrocardiogram was performed on admission. RESULTS: Of the 263 T2DM patients, 58 (22.1%) had hypomagnesemia (serum magnesium level < 1.7 mg/dl). Patients in group 2 had the lowest mean serum magnesium level (1.79 mg/dl ± 0.27). Relatively more patients with hypomagnesemia were found in group 2 compared to the other groups, although a statistically significant difference was not observed. Significantly more patients in group 3 and 4 had chronic renal failure. Patients with hypomagnesemia had significantly lower serum calcium levels. CONCLUSIONS: Hospitalized T2DM patients under PPI therapy are at risk for hypomagnesemia and hypocalcemia.


Assuntos
Cálcio/sangue , Diabetes Mellitus Tipo 2 , Falência Renal Crônica , Magnésio/sangue , Doenças Metabólicas , Idoso , Comorbidade , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Diuréticos/administração & dosagem , Diuréticos/efeitos adversos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Israel/epidemiologia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Masculino , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/epidemiologia , Doenças Metabólicas/etiologia , Doenças Metabólicas/metabolismo , Pessoa de Meia-Idade , Prevalência , Inibidores da Bomba de Prótons/administração & dosagem , Inibidores da Bomba de Prótons/efeitos adversos
16.
Pan Afr Med J ; 38: 66, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33889232

RESUMO

Introduction: tuberculosis (TB) remains a global health issue with high morbidity and mortality rates especially in the developing countries. It is a multi-organ disease and can influence biochemical changes. This study sought to determine the influence of tuberculosis and its drug treatment on serum biochemical parameters in patients in Nigeria. Methods: it was a descriptive observational cohort study on 150 subjects whose blood samples were analyzed for serum albumin, serum sodium, and serum potassium. The subjects were grouped into 3: TB group= 50 new TB subjects not on treatment, F group= 50 TB subjects on treatment for 2/12 or more and C group= 50 non-TB control subjects. These biochemical variables were compared between the 3 groups. Results: male/female ratio was 1: 1.5, mean age 37.1±0.92 years, and range 18-65 years. The differences in mean values of serum albumin, calcium and sodium between the three groups were significant (p<0.001), whereas that of serum potassium was not significant (p=0.056). Those patients with new case TB had a significantly lower serum sodium, serum albumin and serum calcium than the control group and those on treatment, p<0.001. There was significant positive correlation between serum albumin and serum calcium (r=0.0.420, p<0.001) as well as serum sodium (r=0.310, p<0.001) in the study population. Similarly, the correlation between serum calcium and serum sodium was positive and significant (r=0.200, p=0.014). In contrast, the correlation between serum potassium and serum albumin and that between serum potassium and serum calcium was not significant. Conclusion: tuberculosis with or without anti-tuberculous medications was associated with significant reduction in serum albumin, serum sodium and serum calcium in this study.


Assuntos
Cálcio/sangue , Albumina Sérica/análise , Sódio/sangue , Tuberculose/sangue , Adolescente , Adulto , Idoso , Antituberculosos/administração & dosagem , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Potássio/sangue , Tuberculose/tratamento farmacológico , Adulto Jovem
17.
Res Vet Sci ; 136: 239-246, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33706075

RESUMO

Several strategies are available to control periparturient hypocalcaemia in dairy cows. Three complementary strategies were applied in this study: feeding a low DCAD (acidogenic) ration during late gestation, oral vitamin D3 (cholecalciferol) administration in late gestation, and oral Ca administration immediately after parturition. Multiparous Holstein cows (n = 240) were fed an acidogenic ration in late gestation and randomly assigned to one of three treatment groups. Group A (n = 80) were fed the acidogenic diet without supplementary Ca or cholecalciferol. Group Ca + A (n = 80) received 50 g of Ca as an oral bolus at calving and 12 h later. Group D3 + Ca + A (n = 80) were administered 3 mg of cholecalciferol orally each day starting 3 to 5 days before the anticipated calving date and 50 g of Ca as an oral bolus at calving and 12 h later. Blood and urine samples were obtained periodically from a random subset of 20 cows in each group from day 5 antepartum to day 21 postpartum and selected analytes measured. Data was analyzed using mixed models analysis. Serum Ca concentrations in group D3 + Ca + A were higher 12 h before and at parturition, compared to the two other groups. Oral Ca administration transiently increased mean serum Ca concentrations at 6 h after treatment initiation in groups D3 + Ca + A and Ca + A. We conclude that daily oral administration of 3 mg of cholecalciferol for up to 5 days before calving, combined with feeding an acidogenic ration in late gestation and oral Ca immediately after parturition, provided the highest periparturient serum Ca concentrations.


Assuntos
Cálcio/administração & dosagem , Cálcio/sangue , Bovinos/sangue , Colecalciferol/administração & dosagem , Dieta/veterinária , Administração Oral , Ração Animal/análise , Animais , Feminino , Período Periparto , Período Pós-Parto
18.
Clin Ther ; 43(4): 711-719, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33752899

RESUMO

PURPOSE: In patients with primary hyperparathyroidism (PHPT) and severe hypercalcemia, parathyroidectomy remains the only curative therapy. During the coronavirus disease 2019 (COVID-19) pandemic, when many hospital visits are suspended and surgeries cannot be performed, the management of these patients represents a challenging clinical situation. This article presents a literature review and discussion of the pharmacologic management of PHPT and severe hypercalcemia, which can be used as a temporary measure during the COVID-19 pandemic until parathyroidectomy can be performed safely. METHODS: This narrative review was conducted by searching literature on the PubMed, Medline, and Google Scholar databases using the terms primary hyperparathyroidism, hypercalcemia, cinacalcet, bisphosphonates, denosumab, vitamin D, raloxifene, hormone replacement therapy, coronavirus, and COVID-19. FINDINGS: Appropriate monitoring and remote medical follow-up of these patients are essential until the resolution of the pandemic. Cinacalcet is the drug of choice for controlling hypercalcemia, whereas bisphosphonate or denosumab is the drug for improving bone mineral density. Combined therapy with cinacalcet and bisphosphonates or cinacalcet and denosumab should be considered when the effects on serum calcium and bone mineral density are simultaneously desired. IMPLICATIONS: Medical management of PHPT and severe hypercalcemia presents a reasonable alternative for parathyroid surgery during the COVID-19 outbreak and should be instituted until the pandemic ends and surgery can be performed safely.


Assuntos
COVID-19 , Hipercalcemia/tratamento farmacológico , Hiperparatireoidismo Primário/tratamento farmacológico , Densidade Óssea/efeitos dos fármacos , Cálcio/sangue , Cinacalcete/administração & dosagem , Difosfonatos/uso terapêutico , Humanos , Pessoa de Meia-Idade , Paratireoidectomia , Cloridrato de Raloxifeno/uso terapêutico , Vitamina D/farmacologia
19.
Clin Ther ; 43(4): 711-719, 2021 04.
Artigo em Inglês | MEDLINE | ID: covidwho-1141678

RESUMO

PURPOSE: In patients with primary hyperparathyroidism (PHPT) and severe hypercalcemia, parathyroidectomy remains the only curative therapy. During the coronavirus disease 2019 (COVID-19) pandemic, when many hospital visits are suspended and surgeries cannot be performed, the management of these patients represents a challenging clinical situation. This article presents a literature review and discussion of the pharmacologic management of PHPT and severe hypercalcemia, which can be used as a temporary measure during the COVID-19 pandemic until parathyroidectomy can be performed safely. METHODS: This narrative review was conducted by searching literature on the PubMed, Medline, and Google Scholar databases using the terms primary hyperparathyroidism, hypercalcemia, cinacalcet, bisphosphonates, denosumab, vitamin D, raloxifene, hormone replacement therapy, coronavirus, and COVID-19. FINDINGS: Appropriate monitoring and remote medical follow-up of these patients are essential until the resolution of the pandemic. Cinacalcet is the drug of choice for controlling hypercalcemia, whereas bisphosphonate or denosumab is the drug for improving bone mineral density. Combined therapy with cinacalcet and bisphosphonates or cinacalcet and denosumab should be considered when the effects on serum calcium and bone mineral density are simultaneously desired. IMPLICATIONS: Medical management of PHPT and severe hypercalcemia presents a reasonable alternative for parathyroid surgery during the COVID-19 outbreak and should be instituted until the pandemic ends and surgery can be performed safely.


Assuntos
COVID-19 , Hipercalcemia/tratamento farmacológico , Hiperparatireoidismo Primário/tratamento farmacológico , Densidade Óssea/efeitos dos fármacos , Cálcio/sangue , Cinacalcete/administração & dosagem , Difosfonatos/uso terapêutico , Humanos , Pessoa de Meia-Idade , Paratireoidectomia , Cloridrato de Raloxifeno/uso terapêutico , Vitamina D/farmacologia
20.
Adv Clin Chem ; 101: 41-93, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33706890

RESUMO

Parathyroid hormone is an essential regulator of extracellular calcium and phosphate. PTH enhances calcium reabsorption while inhibiting phosphate reabsorption in the kidneys, increases the synthesis of 1,25-dihydroxyvitamin D, which then increases gastrointestinal absorption of calcium, and increases bone resorption to increase calcium and phosphate. Parathyroid disease can be an isolated endocrine disorder or part of a complex syndrome. Genetic mutations can account for diseases of parathyroid gland formulation, dysregulation of parathyroid hormone synthesis or secretion, and destruction of the parathyroid glands. Over the years, a number of different options are available for the treatment of different types of parathyroid disease. Therapeutic options include surgical removal of hypersecreting parathyroid tissue, administration of parathyroid hormone, vitamin D, activated vitamin D, calcium, phosphate binders, calcium-sensing receptor, and vitamin D receptor activators to name a few. The accurate assessment of parathyroid hormone also provides essential biochemical information to properly diagnose parathyroid disease. Currently available immunoassays may overestimate or underestimate bioactive parathyroid hormone because of interferences from truncated parathyroid hormone fragments, phosphorylation of parathyroid hormone, and oxidation of amino acids of parathyroid hormone.


Assuntos
Cálcio/metabolismo , Hormônio Paratireóideo/metabolismo , Bicarbonatos/metabolismo , Desenvolvimento Ósseo , Osso e Ossos/metabolismo , Cálcio/sangue , Regulação da Expressão Gênica , Homeostase , Humanos , Hiperparatireoidismo/diagnóstico , Hiperparatireoidismo/metabolismo , Hiperparatireoidismo/patologia , Hipoparatireoidismo/diagnóstico , Hipoparatireoidismo/metabolismo , Hipoparatireoidismo/patologia , Hormônio Paratireóideo/genética , Fosfatos/metabolismo , Receptor Tipo 1 de Hormônio Paratireóideo/metabolismo
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