Explore the vast range of titles available.

Background:Past sun exposure and vitamin D3 supplementation have been associated with a reduced risk of multiple sclerosis (MS). There are no previous longitudinal studies of vitamin D in MS.Objectives:To compare regulation of vitamin D and calcium homeostasis between patients with MS and healthy controls. To study the correlation of parameters of vitamin D metabolism with MS activity.Methods:We measured 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), calcium, phosphate, magnesium, chloride, alkaline phosphatase, albumin and thyroid stimulating hormone in serum every 3 months and at the time of relapse over 1 year in 23 patients with MS and in 23 healthy controls. MRI burden of disease and T2 activity were assessed every 6 months.Results:Vitamin D deficiency (S-25(OH)D ⩽37 nmol/l) was common, affecting half of the patients and controls at some time in the year. Seasonal variation of 25(OH)D was similar in patients and controls, but 25(OH)D serum levels were lower and intact PTH (iPTH) serum levels were higher during MS relapses than in remission. All 21 relapses during the study occurred at serum iPTH levels >20 ng/l (2.2 pmol/l), whereas 38% of patients in remission had iPTH levels ⩽20 ng/l. Patients with MS had a relative hypocalcaemia and a blunted PTH response in the winter. There was no correlation between serum 25(OH)D and MRI parameters.Conclusions:The endocrine circuitry regulating serum calcium may be altered in MS. There is an inverse relationship between serum vitamin D level and MS clinical activity. The role of vitamin D in MS must be explored further.

Background Total thyroidectomy is increasingly used as a surgical approach for many thyroid conditions. Subsequently, postoperative hypocalcaemia is observed with increasing frequency, often resulting in prolonged hospital stay, increased use of resources, reduced quality of life and delayed return to work. The administration of vitamin D is essential in the therapy of postoperative hypocalcaemia; calcitriol is most commonly used. What has not been examined so far is whether and how routine preoperative vitamin D prophylaxis using calcitriol can help to prevent postoperative hypocalcaemia. This study evaluates routine preoperative calcitriol prophylaxis for all patients who are to undergo a total thyroidectomy, compared with the current standard of post-treatment, i.e., selective vitamin D treatment for patients with postoperative hypocalcaemia. Methods/design This clinical observational (minimal interventional clinical trial) trial is a multicentre, prospective, randomized superiority trial with an adaptive design. Datasets will be pseudonymized for analysis. Patients will be randomly allocated (1:1) to the intervention and the control groups. The only intervention is 0.5 μg calcitriol orally twice a day for 3 days prior to surgery. For the primary endpoint measure (number of patients with hypocalcaemia), hypocalcaemia is defined as serum calcium of less than 2.1 mmol/l on any day during the postoperative course; this measure will be analyzed using a Chi-square test comparing the two groups. Secondary endpoint measures, such as number of days to discharge, quality of life, and economic parameters will also be analyzed. Discussion By virtue of the direct comparison of clinically and economically relevant endpoints, the efficacy as well as efficiency of preoperative calcitriol prophylaxis of hypocalcaemia will be clarified. These results should be available 24 months after the first patient has been enrolled. The results will be used to inform a revised practice parameter guideline of whether or not to recommend preoperative calcitriol for all patients in whom total thyroidectomy is planned. Trial registration Deutsches Register Klinischer Studien, DRKS00005615 (Feb.12.2016).

The diagnosis of milk fever or hypocalcemia in lactating cows has a significant economic impact on the dairy industry. It is challenging to identify asymptomatic subclinical hypocalcemia (SCH) in transition dairy cows. Monitoring subclinical hypocalcemia in milk samples can expedite treatment and improve the health, productivity, and welfare of dairy cows. In this study, an attomolar-sensitive sensor is developed using extrusion-based 3D-printed sensing structures to detect the ratio of ionized calcium to phosphate levels in milk samples. The unique geometries of the lateral structure of 3D-printed sensors, along with the wrinkled surfaces, provide a limit of detection down to the attomole (138 a m ) concentration of the target analyte. The calcium-to-phosphate ratio in milk samples not only provides early disease indications but also enables on-site testing. This highly selective test is validated using real milk and blood samples, and the results are compared with those of commercial meters. This fast response (~10 s) low-cost sensor opens a promising tool for the farm-side diagnostic of dairy cows that can promote best practice management of dairy cows. A 3D-printed sensor with surface-wrinkled structures detects subclinical hypocalcemia in dairy cows by measuring the calcium-to-phosphate ratio in milk. With attomolar sensitivity and rapid results, it enables early treatment, improving cow health and productivity.

This article provides a comprehensive overview of electrolyte and water homeostasis in pediatric patients, focusing on some of the common serum electrolyte abnormalities encountered in clinical practice. Understanding pathophysiology, taking a detailed history, performing comprehensive physical examinations, and ordering basic laboratory investigations are essential for the timely proper management of these conditions. We will discuss the pathophysiology, clinical manifestations, diagnostic approaches, and treatment strategies for each electrolyte disorder. This article aims to enhance the clinical approach to pediatric patients with electrolyte imbalance-related emergencies, ultimately improving patient outcomes. Trial registration This manuscript does not include a clinical trial; instead, it provides an updated review of literature.

Objective To analyze the risk factors associated with the development of severe hypocalcemia (SH) in patients who have undergone parathyroidectomy (PTX). Methods This research involved patients with chronic kidney disease–secondary hyperparathyroidism who underwent PTX between June 1, 2021, and May 31, 2023. SH was characterized by a serum total calcium (tCa) level below 1.8 mmol/L. This study aimed to analyze differences in preoperative laboratory findings and clinical manifestations between patients with and without SH. Logistic regression analysis was used to identify potential risk factors associated with the development of SH. Results The incidence of SH was 23% ( n  = 176). Significant differences were observed in free thyroxine (FT4), free triiodothyronine, alanine aminotransferase, osteocalcin, tCa, alkaline phosphatase (ALP), C-terminal cross-linked telopeptide of type I collagen, and parathyroid hormone between the SH and non-SH groups. The three independent risk factors for SH were tCa [odds ratio ( OR ) 0.063, 95% confidence interval ( 95% CI ) 0.006–0.663], ALP ( OR 1.003, 95% CI 1.001–1.005), and FT4 ( OR 0.439, 95%CI 0.310–0.621). The area under the curve, sensitivity, specificity, and overall accuracy of this model were 0.904 ( 95% CI 0.856–0.952), 46.3%( 95% CI 32.0%-61.3%), 94.8% ( 95% CI 89.7%-97.5%), and 83.5% ( 95% CI 77.3%-88.3%), respectively. Conclusion The preoperative level of FT4 plays a crucial role in predicting the risk of SH after PTX. The combined FT4–ALP–tCa model demonstrates the ability to predict SH risk, providing valuable insights for customizing calcium supplementation strategies and improving clinical decision-making.

Background Hypocalcemia is a frequent complication in patients undergoing maintenance hemodialysis and is closely linked to disturbances in mineral metabolism, increased cardiovascular risk, and bone disorders. Early identification of high-risk individuals is essential for effective prevention and management. This study aimed to evaluate risk factors associated with hypocalcemia and to develop a nomogram prediction model for individualized risk assessment. Methods This retrospective study included 386 adult patients receiving maintenance hemodialysis between January 2020 and December 2024. Hypocalcemia was defined as total serum calcium < 2.1 mmol/L. Patients were categorized into a hypocalcemia group ( n  = 135) and a normocalcemia group ( n  = 251). Demographic, dialysis-related, biochemical, and clinical variables were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. A nomogram prediction model was constructed and its discrimination, calibration, and clinical utility were assessed using the receiver operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA). Internal validation was performed using bootstrap resampling with 1000 iterations to assess model stability. Results Multivariate logistic regression revealed that thyroid disease, elevated serum creatinine, and hyperphosphatemia were independent risk factors for hypocalcemia, while higher parathyroid hormone (PTH) levels and compound α-ketoacid use were protective factors. The nomogram incorporating these variables demonstrated good discrimination (AUC = 0.846, 95% CI 0.802–0.891), with a sensitivity of 81.5% and specificity of 77.3%. The calibration curve showed strong agreement between predicted and observed outcomes, and DCA indicated favorable net clinical benefit. Internal validation showed robust performance with a bootstrap-corrected area under the ROC curve (AUC) of 0.832. Conclusions The developed nomogram provides a reliable and clinically applicable tool for individualized prediction of hypocalcemia in hemodialysis patients, facilitating improved risk stratification and management.

BackgroundThe most frequent complication of total thyroidectomy remains hypocalcemia due to low postoperative levels of serum intact parathyroid hormone (iPTH). The purpose of this study was to investigate the role of decreased iPTH at the end of surgery in predicting hypocalcemia. In addition, we examined the percentage decrease of iPTH as potential indicator of hypocalcemia.MethodsWe retrospectively collected the data of patients who underwent total thyroidectomy for benign and malignant diseases at our institution between 2010 and 2022. The iPTH level was measured before and at the end of surgery, and serum calcium levels on the first postoperative day. Demographic, clinical, and biochemical characteristics of patients with low iPTH were compared with patients with normal iPTH levels using ANOVA for continuous variables and χ2-tests for categorical variables. Multivariable logistic regression analysis evaluated the association of iPTH at the end of surgery and the relative reduction of iPTH with postoperative hypocalcemia.ResultsThe mean age of the 607 patients in this study was 55.6 years, and the female-to-male ratio was 5:1. Goiter was the most common indication for surgery (N = 382, 62.9%), followed by Graves’ disease (N = 135, 22.2%). The mean preoperative iPTH was 49.0 pg/ml, while the mean postoperative iPTH was 29.3 pg/ml. A total of 197 patients (32.5%) had an iPTH level below normal, 77 patients (39%), had iPTH levels of 10–15.0 pg/ml and 120 patients (61%) of < 10.0 pg/ml at the end of surgery. Among all patients, 124 (20.4%) developed hypocalcemia on the first postoperative day. The mean percentage of decrease of iPTH was highest among patients with iPTH < 10 pg/ml (76.9%, p < 0.01); this group of patients had also the highest rate of postoperative hypocalcemia on day one (45.0% vs. 26.0% vs 12.2%, p < 0.01).ConclusionsMeasurement of iPTH at the end of total thyroidectomy predicts patients who are at risk for postoperative hypocalcemia. The combination of low serum iPTH with a decrease in iPTH level of ≥ 50% may improve prediction of hypocalcemia compared to iPTH levels alone allowing for early calcium substitution in these patients at high risk of developing postoperative hypocalcemia.

Hypocalcaemia in pregnancy remains a major health issue, particularly in the developing world where daily calcium intakes are suboptimal. This electrolyte imbalance can lead to severe maternofoetal and childhood consequences. Calcium supplementation, amongst others, contributes significantly to meeting calcium demands in pregnancy. With ionised calcaemia as the gold standard for diagnosis, total calcaemia and albumin-corrected calcaemia in other pathological states have been found to overestimate the burden of hypocalcaemia. The main objectives of this study are to describe the blood calcium level (total, albumin corrected, and ionised calcaemia) and associated maternofoetal outcomes while identifying determinants of calcium supplementation and ionised hypocalcaemia. This study will also evaluate the sensitivity and specificity of albumin corrected calcaemia as a diagnostic tool for hypocalcaemia (ionised calcaemia as the gold standard) among pregnant women in the Nkongsamba Regional Hospital, Cameroon. Our study will target a total of 1067 term pregnant women who shall be included consecutively into the study as they arrive the maternity of the Nkongsamba Regional Hospital for their last antenatal care visit. Data shall be collected using a semi-structured interview-administered questionnaire and blood samples collected for total plasma calcium, albumin and serum ionized calcium assays. Additional data will be collected at birth (maternal and foetal variables; foetal outcomes evaluated as secondary outcomes). Total calcaemia and albuminemia shall be measured by atomic absorption spectrophotometry, while ionised calcaemia will be measured by ion-selective electrode potentiometry(using MSLEA15-H electrolyte analyzer) per standard BIOLABO and MSLEA15 protocols, respectively. Data will be analysed using the statistical softwares epi-Info version 7.2.2.16 and STATA version 16. This study will present a more precise estimate of the burden of hypocalcaemia in late pregnancy as well as identify and analyse the different factors associated with calcium supplementation and ionised hypocalcaemia among term pregnant women in a developing world setting. Maternofoetal outcomes associated with hypocalcaemia will be determined as well as the sensitivity and specificity of total and albumin-corrected calcaemia in diagnosing hypocalcaemia. Our findings will contribute significantly to designing or strengthening interventions to control this electrolyte imbalance.

Hypocalcemia is a common and clinically significant side effect of etelcalcetide therapy. The aim of this study was to evaluate the utility of ionized calcium (iCa) measurements with a point-of-care ionometer compared to albumin-corrected total calcium and to assess the incidence of hypocalcemia in patients receiving etelcalcetide therapy using pre-dialysis iCa values. This was a phase IV, non-interventional, prospective, single-arm, observational study. A total of 20 chronic hemodialysis patients were included in the study. The iCa concentration was determined before dialysis using a point-of-care ionometer (GEM Premier 3000) at the patient's bedside. Hypocalcemia was defined by a pre-dialysis iCa concentration of less than 0.90 mmol/L. Pre-dialysis corrected total calcium and iCa decreased over time during treatment with etelcalcetide. A statistically significant linear association was observed between point-of-care iCa and albumin-corrected calcium (r = 0.532, p = 0.019; R  = 0.283). Visual comparisons generally showed parallel behavior, but only a moderate correlation. Of 240 iCa values measured, 3 cases (1.25%) were < 0.90 mmol/L and 20 cases (8.3%) were between 0.90 and 0.96 mmol/L. Our results highlight the value of direct iCa monitoring as a practical and sensitive tool for detecting hypocalcemia and guiding etelcalcetide therapy. Bedside measurement enabled timely dialysate calcium adjustments, preventing clinically significant hypocalcemia and treatment discontinuation. Point-of-care iCa monitoring offers a safer, more responsive strategy for optimizing calcium management in hemodialysis patients.