A Study Of Electrolyte Abnormalities In Acute Exacerbation Of Chronic Obstructive Pulmonary Diseases

Background:Chronic obstructive pulmonary disease / COPD is a multifactorial disease involving various electrolyte abnormalities. This study aimed at evaluating serum electrolyte levels in patients with acute exacerbation of COPD. Material And Methods:This study aimed at evaluating serum electrolyte levels in patients with acute exacerbation of COPD. This study included 100 cases & 100 controls with acute exacerbation of COPD admitted in intensive care unit. All the patients from the cases group were screened for Ca+2 & Mg+2 abnormalities during their intensive care unit stay. In group 1 (cases) correction for abnormal electrolytes were given on the day of admission. Treatment, antibiotics selection, metabolic parameters correction & acid base correction were considered equally in both the groups as per GOLD (Global initiative for chronic obstructive lung disease) guidelines. Symptomatic patients after 48 hours of intensive care unit admission were screened for calcium & magnesium levels & prevalence of hypocalcemia & hypomagnesemia was calculated.Result:It was found out that average duration of intensive care unit stay was reduced significantly in group 1 (cases) in whom the correction of electrolyte imbalance was considered at the time of admission. Also, in the control group, who were still symptomatic after 48 hours of intensive care unit treatment, a significant proportion was found to have hypocalcaemia and hypomagnesaemia (Electrolytes measured after 48 hours).Conclusion:In stable COPD patients there are abnormal serum electrolytes that may get further deranged during acute exacerbations. Thus serum electrolytes level should be monitored routinely in these patients & an attempt should be made to correct them at the earliest to avoid poor outcomes.

Value of hypocalcaemia for predicting trauma-induced coagulopathy in elderly trauma patients / 中华急诊医学杂志

Objective:To investigate the value of hypocalcaemia for predicting trauma-induced coagulopathy (TIC) in elderly trauma patients.Methods:The clinical data of elderly trauma patients in emergency ICU of the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2015 to September 2020 were retrospectively analyzed, including age, sex, site of injury, injury severity score (ISS), Glasgow coma scale (GCS), admission arterial blood gas analysis (Ca 2+, K +), venous blood biochemical electrolyte (Ca 2+, K +, Na +); international normalized ratio (INR), activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB), use of blood products, length of stay, length of stay in ICU, total cost, and clinical prognosis. Receiver operating characteristic (ROC) curves and multivariate logistic regression analysis were performed to estimate the contribution of hypocalcaemia to triggering TIC in elderly trauma patients. Results:Totally 371 elderly trauma patients were included with a mean age of (72.5±6.8) years, and 248 (66.8%) were male. ISS score of the TIC group was higher than that of the non-TIC group [25(20, 34) vs. 21(16, 29)]. Compared with the non-TIC group, the incidence of chest injury, abdominal injury and limb injury were significantly higher , while the incidence of head and neck injury were significantly lower in the TIC group (all P<0.05). The biochemical blood calcium in the TIC group was significantly lower than that in the non-TIC group [(1.97±0.19) mmol/L vs. (2.15±0.16) mmol/L, P<0.001], but there was no significant difference in blood gas calcium between the two groups. The APTT value of the TIC group [(47.6±21.8) s vs. (33.8±4.1) s], PT value [(18.0±3.9) s vs. (13.7±0.8) s] were significantly higher than that of the non-TIC group, and FIB level was significantly lower than that of the non-TIC group[(1.7±0.8) g/L vs. (2.8±0.9) g/L] (all P<0.01). The utilization rate of blood products and the total cost in the TIC group were higher than that in the non-TIC group, while the recovery rate in the TIC group was lower than that in the non-TIC group (69.8% vs. 86.4%, P<0.001). Multivariate logistic regression analysis showed that hypocalcaemia was an independent risk factor for TIC in elderly trauma patients ( OR=5.830, 95% CI: 3.295-10.314). The area under ROC curve of correlation between biochemical calcium and TIC was 0.779 (95% CI: 0.728-0.831). The optimal diagnostic cut-off value was 2.06 mmol/L. Conclusions:The decrease of biochemical serum calcium level is an independent risk factor for TIC in elderly trauma patients. Positive correction of TIC in elderly trauma patients contributes to continuous improvement of clinical prognosis.

Calcium, Vitamin D, and Bone Derangement in Nephrotic Syndrome / Journal of the ASEAN Federation of Endocrine Societies

Introduction@#Derangement in calcium homeostasis is common in nephrotic syndrome (NS). It is postulated that low serum total calcium and vitamin D levels are due to loss of protein-bound calcium and vitamin D. It is unclear if free calcium and free vitamin D levels are truly low. The guideline is lacking with regards to calcium and vitamin D supplementation in NS. This study aims to examine calcium and vitamin D homeostasis and bone turnover in NS to guide practice in calcium and vitamin D levels supplementation.@*Methodology@#This is a prospective pilot study of ten patients diagnosed with NS, and eight healthy controls. Calcium, vitamin D, and bone turnover-related analytes were assessed at baseline, partial and complete remission in NS patients and in healthy controls.@*Results@#NS patients had low free and total serum calcium, low total 25(OH)D, normal total 1,25(OH)D levels and lack of parathyroid hormone response. With remission of disease, serum calcium and vitamin D metabolites improved. However, nephrotic patients who do not attain complete disease remission continue to have low 25(OH)D level.@*Conclusion@#In this study, the vitamin D and calcium derangement observed at nephrotic syndrome presentation trended towards normalisation in remission. This suggested calcium and vitamin D replacement may not be indicated in early-phase nephrotic syndrome but may be considered in prolonged nephrotic syndrome.

A comparative study of postoperative hypocalcaemia following total thyroidectomy in patients with Hashimoto’s thyroiditis and multinodular goitre in a rural tertiary care hospital

Background: Recurrent laryngeal nerve injury, hypothyroidism and hypocalcaemia have long been recognized as the three main sequalae of thyroidectomy. Persistent hypocalcaemia may cause intracranial lesions and cardiac arrhythmias. As the definitive diagnosis of Hashimoto’s thyroiditis was not always possible with clinical and cytological parameters when antibody testing was not done, surgery was planned with the diagnosis of multinodular goitre. This study was conducted to find out the incidence of post-operative hypocalcaemia following total thyroidectomy by skilled surgeons in patients with multinodular goitre and Hashimoto’s thyroiditis.Methods: This was a cross-sectional study to compare the incidence of hypocalcaemia in patients with biopsy-proven Hashimoto’s thyroiditis and multinodular goitre. After obtaining approval from the institutional review board and ethics committee, data was collected serially, from the surgical records of 123 patients who underwent total thyroidectomy in this tertiary care centre, during the past two years.Results: The incidence of post-operative hypocalcaemia (71.1%) in patients undergoing total thyroidectomy with Hashimoto’s thyroiditis was significantly higher than in patients with multinodular goitre (56.4%). Of the 45 patients who had a biopsy report of Hashimoto’s thyroiditis, 8 (17.8 %) developed permanent hypocalcaemia while only 8 (10.3%) of the 78 patients with histopathological diagnosis of multinodular goitre developed persistent hypocalcaemia needing supplementation following total thyroidectomy in this rural tertiary care hospital.Conclusions: The significant risk of post-operative hypocalcaemia should be kept in mind before opting for total thyroidectomy for benign lesions of the thyroid and pre-operative antibody studies must be done to diagnose Hashimoto’s thyroiditis.

Variación en los niveles séricos de Calcio, Fósforo, Magnesio, Cobre y Zinc durante las distintas etapas productivas en cabras de leche en un tambo caprino del noroeste argentino / Variation in serum levels of Calcium, Phosphorous, Magnesium, Copper and Zinc across productive stages of dairy goats in northwestern Argentina

Resumen El objetivo de este trabajo fue evaluar los niveles séricos de calcio (Ca), fósforo (P), magnesio (Mg), cobre (Cu), y zinc (Zn) en cabras lecheras en diferentes etapas productivas. Se seleccionaron 20 cabras de raza Saanen en diferentes estadios productivos: preparto (1 a 2 semanas previas al parto), posparto (1 a 2 semanas de lactancia), pico de lactancia (6 a 8 semanas de lactancia posparto) y período de seca (15 a 30 días de finalizada la lactancia) de un establecimiento lechero del valle de Lerma, Salta. Se colectaron muestras de sangre y se midieron los niveles séricos de Ca, Mg, Cu, y Zn empleando espectrofotometría de absorción atómica y P por colorimetría. Se identificó hipocalcemia (7,7±0,2 mg/dL) e hipofosfatemia (3,4±0,4 mg/dL) durante todas las etapas productivas. El Mg, por el contrario, presentó niveles adecuados durante todo el ensayo (2,5±0,06 mg/dL). Con respecto a los microminerales evaluados, solo los niveles séricos de Zn fueron inferiores a los recomendaros en todos los periodos productivos (53±4 µg/dL). Los niveles de Cu estuvieron dentro de los límites normales (53±4 µg/dL). Estos resultados permitieron identificar anormalidades en los niveles de Ca, P y Zn durante los periodos productivos evaluados. La información sobre deficiencias minerales en cabras es escasa y debe estudiarse más al respecto.

Abstract The aim of this study was to evaluate the serum levels of calcium (Ca), phosphorus (P), magnesium (Mg), copper (Cu), and zinc (Zn) in dairy goats in different productive periods. Twenty Saanen breed goats were selected at different productive stages: prepartum (1 to 2 weeks before partum), postpartum (1 to 2 weeks of lactation), peak of lactation (6 to 8 weeks postpartum) and dry period (15 to 30 days of the final lactation) of a dairy farm in the Valle de Lerma, in the province of Salta. Blood samples were collected and then, Ca, Mg, Cu and Zn levels were measured using atomic absorption spectrophotometry, and P was measured by colorimetric. Hypocalcaemia (7,7±0,2 mg/dL) and hypophosphatemia (3,4±0,4 mg/dL) were found in all production stages. In contrast, Mg levels did not present variation during all the samplings (2.5 ± 0.06 mg / dL). In evaluated micro-minerals, only the serum levels of Zn were lower than those recommended in all the productive periods (53 ± 4 µg / dL). Serum cupper levels were within normal limits (53 ± 4 µg / dL). The obtained results allowed identifying abnormalities in Ca, P and Zn levels during the evaluated productive periods. Information about mineral deficiency in goats is restricted and it is needed to study more about it.

Retrospective Inspection and Dissemination Pattern of Common Metabolic Ailments among Hilly and Tarai Region Goats of Uttarakhand

Goats are considered as an important animal not in present scenario but also from ancient time. Due to increasing frugal interest of goat farming globally, profound animal husbandry practices are attaining importance under the target of obtaining quality products along with good animal health and welfare. During the transition phase of life, noticeable alterations in the endocrine and metabolic status of the dairy ruminants were registered. Among small ruminants i.e. goat’s hypocalcaemia, hypoglycemia/Pregnancy toxemia and hypomagnesaemia are the common metabolic disorders which normally precipitated during metabolic anxiety phase. The present study was conducted during the period of 1st January 2019 to 31st December 2019. During this period we had registered total 957 goats at Kalsi, Chakrata areas of district Dehradun, Chorgalia, Kotabagh, Kaladhungi areas of district Nainital and Shetlai, Pantnagar, Bazpur areas of district Uddham Singh Nagar beside this we had also included the concerned cases from Government Veterinary Hospital Outpatient departments (OPDs) of the above said areas in Uttarakhand. In the present study, we had performed a prevalence study over common occurring metabolic diseases of goats like hypocalcaemia, hypoglycemia/pregnancy toxemia and hypomagnesaemia. Besides this, we had also studied the dissemination pattern of common occurring metabolic diseases on the basis of their age groups and parity

Comparative study of serum electrolytes Na+, K+, Ca++ in patients of chronic kidney disease in relation to its severity

Background: Chronic kidney disease (CKD) is a worldwide public health problem. Globally, CKD is the 12th cause of death and the 17th cause of disability, respectively. Yearly incidence of ESRD in India is approximately 150-200 pmp.Methods: The observational study was conducted in Department of General Medicine, Pandit Raghunath Murmu Medical College Hospital, Baripada between May 2018 and January 2019. 244 patients of Chronic Kidney Disease above 15 years of age satisfying the inclusion and exclusion criteria were included in the study.Results: Study group constitutes 64.34% (157) of male and 35.66% (87) of female patients with M:F of 1.8:1. The average age of the patients in the study was 55.91±12.49 yrs. 42.21% (103) of the patients were between 46 and 60 years of age. Maximum number of cases (190 cases) (77.87%) are in stage 4 and 5 with e-GFR <30 ml/ min. The average serum electrolytes in this study group for serum sodium, potassium, calcium are 137.31±10.05 mEq/L, 4.12±1.48 mEq/L and 1.10±0.19 mmol/L respectively. When association of hypokalemia with risk factor (known and unknown) is compared, chi-square value found to be 13.664 (p=0.0002) which is statistically extremely significant.Conclusions: Authors found significant number of cases, more commonly younger patients, presented with atypical manifestations having no specific etiology; the cause may be defect in rennin-angiotensin system or, may be genetic or, may be environmental.

Role of Intact Parathormone Levels as Early Predictor of Asymptomatic Hypocalcaemia after Total Thyroidectomy.

Asymptomatic hypocalcemia is one of the complications of total thyroidectomy. The symptoms of low calcium levels are sometimes evident only after about 48-72 hours after surgery. Serum calcium levels are not reliable in identifying these patients, because a large number of them are only those with transient hypocalcemia. This study was carried out to evaluate the role of intact parathormone levels in predicting asymptomatic hypocalcemia.METHODSThis cohort study was carried out among 43 patients, who underwent total or completion thyroidectomy. The serum ionized calcium & creatinine levels were measured preoperatively, to rule out pre-operative hypoparathyroidism. Following surgery (one-hour post operatively), the patients’ serum PTH levels and serum ionized calcium levels were measured. Simultaneously, hypocalcemia was clinically evaluated.RESULTSOut of 43 patients, 30 patients had low hypocalcemia (<1.1 mmol/l) one hour postoperatively. The incidence of initial asymptomatic hypocalcaemia post-surgery was 70.5%. All patients with low iPTH, except one, also had hypocalcaemia initially. The patient with normal calcium subsequently had hypocalcaemia at 6 hours.CONCLUSIONSWith the prediction of asymptomatic hypocalcemia in the early post-operative period, it is possible to start timely treatment and thereby prevent the complications of hypocalcemia.

The Perilous PPI: Proton Pump Inhibitor as a Cause of Clinically Significant Hypomagnesaemia / Journal of the ASEAN Federation of Endocrine Societies

@#Proton pump inhibitors (PPIs) are the mainstay of therapy for all gastric acid related diseases and are commonly used in current clinical practice. Although widely regarded as safe, PPIs have been associated with a variety of adverse effects, including hypomagnesaemia. The postulated mechanism of PPI-related hypomagnesaemia involves inhibition of intestinal magnesium absorption via transient receptor potential melastin (TRPM) 6 and 7 cation channels. PPI-induced hypomagnesaemia (PPIH) has become a well recognized phenomenon since it was first reported in 2006. Clinical concerns arise from growing number of case reports presenting PPIH as a consequence of long-term PPI use, with more than 30 cases published to date. In this article, we report 2 cases of PPIH associated with the use of pantoprazole. Both patients presented with severe hypomagnesaemia and hypocalcaemia. One of them had associated hypokalemia and cardiac arrhythmia. A casual relation with PPIs postulated and supported by resolution of electrolyte abnormalities after discontinuation of PPIs.

Clinico-epidemiological study of neonatal seizures from a tertiary care hospital of Western Rajasthan, India

Background: Neonatal Seizures are frequent may be either symptoms of an underlying disorder and malfunction of the developing CNS or due to a primary epileptic condition. Their varied clinical presentations, delay in recognition and treatment results in poor neurological outcome. This study attempts to find out the clinical and etiologic profile of neonatal seizures and associated biochemical abnormalities in this geographical part of India.Methods: A hospital based prospective observational study undertaken in a tertiary care pediatric hospital of Medical College Jodhpur India, on 202 consecutive neonates who presented with seizures during period of one year. A detailed antenatal history and baseline characteristics of convulsing neonate at admission and clinical details of each seizure episode reported by the mother and subsequently observed by doctors on duty were recorded. Venous blood sample was analyzed as soon as possible for blood glucose, total serum calcium levels and electrolytes, before instituting any treatment. Data were managed on Microsoft Excel spreadsheet, and analysis was performed using SPSS version.Results: The overall frequency of neonatal seizures in our set up was recorded as 4.08%. Perinatal asphyxia with subsequent HIE was the most common (40.09%) cause of neonatal seizures while hypoglycemia was the most common metabolic cause (11.38%) observed specially in VLBW babies. Subtle seizures were the most common type (34.65%) and tonic seizures were the second most common (33.66%) type of seizures encountered. Hypocalcemia was the second commonest biochemical abnormality found in primary metabolic seizures. HIE, ICH and Hypoglycemia were the common seizure etiology in preterm neonates.Conclusions: Perinatal asphyxia and subsequent HIE was the commonest etiology with subtle, tonic and multifocal seizures being the commonest clinical types encountered. Hypoglycemia and hypocalcemia were the most frequent biochemical abnormality found.

A seven year experience in patients undergoing total thyroidectomy for benign diseases in a single unit of tertiary care centre: a retrospective case study

Background: Thyroidectomy is a common surgical procedure performed worldwide by surgeons with varied training. It is the experience and the skills by which a surgeon performs, the indication of surgery and the extent of surgery which determines the outcome and the complication rates.Method: This study is a retrospective study performed from January 2012 to December 2018 when a total of 170 patients underwent total thyroidectomy via kocher’s incision for benign diseases with clinically in hypothyroid state at Safdarjung Hospital, New Delhi in a single unit of a tertiary care hospital.Results: The male: female ratio was 1:7.09 with average age of patients being 40years. The overall complication rate was 18.82% (32 patients). Postoperative transient hypocalcaemia being the most common complication. There was no case of permanent hypocalcaemia. There was no injury to any nerve (recurrent or superior laryngeal). Transient recurrent laryngeal paresis was noted in 4(2.35%) which resolved with conservative management. Complications like wound infection, sympathetic chain injury were not noted. The characteristic feature of this study was five cases of giant secondary retrosternal goitre which had average weight of greater than 500 grams which were operated using kocher’s incision. The average weight of other 165 patients was 70grams +/- 12 grams. There were no major post-operative complications except for post-operative recurrent laryngeal nerve paresis and seroma formation which was evacuated after 3 weeks of surgery.Conclusion: Hence, from this it is concluded that it is the surgical experience and skills of the surgeon which make total thyroidectomy a safe procedure providing permanent cure with a low post-operative morbidity risk even with large sized retrosternal thyroid glands which can be operated via neck incision.

Early predictors of early onset neonatal hypocalcaemia in infants of diabetic mother

Background: The objective of this study was the magnitude of hypocalcemia and to assess the predictors for early onset neonatal hypocalcemia in infants of diabetic mother.Methods: Total 100 infants of diabetic mother were followed for development of hypocalcaemia. weight length, gestational age, Apgar score, cord calcium was correlated for serum calcium at 48 hours of life.Results: In present study 91% babies were term and 9% babies were preterm, the incidence of hypocalcemia was high in preterm babies i.e.22% when compared to term babies i.e. 4.3% was not significant and incidence of hypocalcemia was high in babies with Apgar <7 at 1 min (27.27%) was significant statistically. The association of hypocalcemia with cord calcium is not significant statistically.Conclusions: The incidence of hypocalcaemia is more among preterm babies and babies with risk factors, so these babies need close monitoring for hypocalcaemia. No need of regular monitoring of calcium for healthy term babies unless they are symptomatic.

Two cases of hereditary hypomagnesaemia with secondary hypocalcaemia and 4 novel mutations on TRPM6 gene / 中华实用儿科临床杂志

Objective To investigate the clinical,biochemical and genetic features of hereditary hypomagnesaemia with secondary hypocalcaemia.Methods Two boys came from different Chinese families.They were hospitalized at the Peking University First Hospital between 2014 and 2016 at the age of 9 years and 1 year and 2 months because of epilepsy and psychomotor retardation.Clinical investigation,laboratory examination,and medical imaging were performed for the etiological study.Whole-genome sequencing was used for the genetic analysis of the patients.Mutations of TRPM6 gene were confirmed by means of Sanger sequencing.Results Patient 1 presented with recurrent seizures and psychomotor retardation from the age of 3 months.Vision loss and psychomotor regression were noticed from the age of 9 years,accompanied with hypertension.Serum magnesium and total calcium were significandy decreased to 0.13-0.15 mmol/L and 1.43-2.00 mmol/L,respectively in patient 1.Serum potassium was reduced to 1.85-3.25 mmol/L.Blood parathyroid hormone was also decreased.On the TRPM6 gene of patient 1,2 novel non-sense mutations,c.2771G ＞ A (p.Trp924Ter) and c.115C ＞ T (p.Gln39Ter) were identified.Patient 2 presented with seizures and psychomotor retardation at the age of 2 weeks.Both of his serum magnesium (0.17-0.35 mmol/L) and serum total calcium (1.32-1.34 mmol/L) were significantly decreased.Blood parathyroid hormone was decreased.Two novel mutations (c.1239G ＞ A,p.W413X and c.146G ＞ A,p.C49Y) were found in the TRPM6 gene of patient 2.Severe hypomagnesaemia,hypocalcaemia and TRPM6 gene mutations confirmed the diagnosis of hereditary hypomagnesaemia with secondary hypocalcaemia in the 2 patients.After the large-dose supplement of magnesium sulfate,progressive clinical improvements were observed in the 2 patients.However,because of the severe brain damage,patient 1 still had psychomotor retardation.Patient 2 completely recovered.Conclusions Hereditary hypomagnesaemia with secondary hypocalcaemia is a severe inherited metabolic disease.Early diagnosis and large-dose magnesium supplement are the key to the good prognosis of the patients.In this study,2 Chinese children with the clinical onset of epilepsy and psychomotor retardation are reported.The diagnosis is made by way of blood biochemical assay and gene analysis.Four novel mutations on their TRPM6 gene are identified.

Electrolyte disorders in a young female following short-term omeprazole therapy

A 29 years old female presented to us in the metabolic clinic of the University of Port Harcourt Teaching Hospital (UPTH) on account of a week history of easy fatigability, weakness, and lower extremity muscle cramps associated with numbness and tingling sensation in the peri-oral area, fingers and toes. Two weeks prior to the onset of her presenting symptoms, she had visited a local pharmaceutical shop on account of a distressing epigastric discomfort and was subsequently placed on daily oral omeprazole 20mg daily for a month by a pharmacist. She had been on the omeprazole medication for two weeks before her present symptoms manifested. Her past medical history was not suggestive of hypoparathyroidism nor pancreatitis. She was married with three children and has an uneventful family, social and obstetric histories. On examination, she was a healthy well-oriented young female with positive Trousseau’s, Chvostek’s and epigastric tenderness signs. Further Laboratory evaluation revealed she had low plasma magnesium, low plasma albumin-corrected calcium, and low serum parathyroid hormone levels, while other laboratory parameters were essentially normal. A diagnosis of omeprazole-induced electrolyte disorders (hypomagnesaemia and hypocalcaemia) associated with hypoparathyroidism was made following the review of her clinical examination and laboratory findings. She was subsequently managed with oral magnesium supplements following the withdrawal of the omeprazole medication (replaced with oral ranitidine), monitored weekly, and full recovery was achieved after three weeks.

A Study On Impact Of Covering The Heads Of Icteric Neonates During Phototherapy On The Prevalence Of Hypocalcaemia

Background: Jaundice is one of the most common causes for hospital admission in the newborn period. If left untreated it can progress to kernicterus, which can affect the neuro developmental outcome in babies and may also lead to death. Phototherapy is one of the most reliable, safe methods to treat hyperbilirubinemia and one of the commonest side effect is hypocalcaemia. There is some evidence that the use of a stockinet cap to cover the head prevents phototherapy-induced hypocalcaemia. In this present study we examine the effect of head cover on the prevalence of hypocalcaemia during photo therapy. Methods: This single blind randomized controlled study, with 150 term neonates admitted in NICU at GKMC, for a period of six months. The study group was divided into Group A and Group B with 75 each. Group A underwent Phototherapy without head cap (Control) and Group B underwent Phototherapy with head covered with cap (Intervention). The serum calcium level of each newborn was tested at baseline and 48 hours after phototherapy. Results: Out of 75 neonates in group A34 had serum total calcium less than 7mg/dl (hypocalcaemia), whereas in group B only 15 had serum total calcium less than 7mg/dl. Conclusion: Simple intervention like covering the head of neonates with cap reduces the incidence of hypocalcaemia.

A Clinical Prospective Study of Hypocalcaemia Following Thyroid Surgery.

Background: Hypocalcaemia is one of the acute and most feared complication following thyroidectomy. Depending upon the extent of parathyroid damage, post-operative hypocalcaemia may be temporary or permanent requiring lifelong calcium supplements. Aims and objectives: This study aims to prospectively study and analyse the demographics and possible causes of hypocalcaemia post thyroidectomy.Methods: This is a prospective study of 150 patients undergoing thyroidectomy surgery from January 2015 to December 2015 in Victoria hospital, Bangalore medical college and research institute, Bangalore. Patients demographics, intra operative and pathological aspects were correlated to our hypocalcaemic findings.Results: Out of 150 patients, 18 patients developed temporary hypocalcaemia (12%), none of them developed permanent hypocalcaemia. Mean age of patients developing hypocalcaemia was 45.16 years. 15 (83.33%) of them were females and 3 (16.66%) were male. Hypocalcaemia was found in 9% in multinodular goitre (9 out of 99 patients), 20% in papillary carcinoma (3 out of 15 patients) and 40 % in follicular neoplasm (6 out of 15 patients). Near total thyroidectomy was the procedure in 105(70%) patients, 3 from them (2.86%) developed hypocalcaemia and the other 15 out of 45 cases (30%) were after total thyroidectomy. Mean duration of surgery was 101 mins. Average no of parathyroid glands identified was 2. Conclusion: Risk factor for development of hypocalcaemia is multifactorial. The recommended surgical strategy is meticulous dissection and preservation of at least one parathyroid gland and their blood supply to prevent permanent hypocalcaemia.

Safety and efficacy of ligasure vessel sealing system for thyroidectomy: a Meta analysis / 中华内分泌外科杂志

Objective To evaluate the safety and efficacy of ligasure vessel sealing system (LVSS) and conventional ligation haemostasis in thyroidectomy.Methods Pubmed,EMBASE,Medline,and CNKI were performed to search for randomized controlled trial.Literature selection and data collection were completed by 2 researchers independently.The assessment of methodological quality was conducted with Cochrane Handbook 5.1.The Review Manager software 5.2 was used for Meta analysis.Results A total of 11 studies (934 patients) were involved.Meta-analysis indicated that the operation time was shorter in LVSS group [WMD=-12.47,95％ CI (-18.33,-6.61),P＜0.0001].No significant difference was found in intra-operative blood loss,incidence of hypocalcaemia,recurrent laryngeal nerve (RLN) injury,or hospitalization time between the 2 groups (P＞0.05).Conclusion LVSS can reduce the operation time without increasing intra-operative blood loss,incidence of hypocalcemia,RLN injury,or hospitalization time,which is a safe and effective haemostasis method.

Hipocalcemia e hipoparatiroidismo post-tiroidectomía / Hypocalcemia and hypoparathyroidism after thyroidectomy

Justificación: la hipocalcemia y el hipoparatiroidismo son complicaciones frecuentes tras la tiroidectomía. Sin embargo, su incidencia varía ampliamente en la bibliografía médica y sus factores de riesgo no están bien establecidos.Métodos:a través de una recolección prospectiva de datos, se identificó 35 pacientes tiroidectomizados entre junio y noviembre de 2012. La hipocalcemia se definió como un valor de calcio sérico en el primer día postoperatorio, menor de 7,5 mEq/l, sin síntomas, o menor de 8,5 mEq/l, con síntomas o signos asociados con hipocalcemia. El hipoparatiroidismo se definió como un calcio sérico a los 12 meses de la operación menor de 8,5 mEq/l, y/o el requerimiento de calcio y vitamina D. Se extrajeron variables adicionales como la edad del paciente, sexo, antecedente de cirugía tiroidea previa, estancia posoperatoria y cirujano principal de la operación.Resultados:catorce (42,4%) de los treinta y cinco pacientes sometidos a tiroidectomía desarrollaron hipocalcemia, y ocho (22,8%) sufrieron hipoparatiroidismo. En el procedimiento quirúrgico de tiroidectomía total, se presentó una mayor incidencia de hipocalcemia (50%) y de hipoparatiroidismo (28,6%) cuando se comparó con el procedimiento de tiroidectomía subtotal. Factores adicionales asociados significativamente con hipocalcemia e hipoparatiroidismo fueron el diagnóstico citológico prequirúrgico de malignidad (p = 0,014; p = 0,044), la linfadenectomía cervical (p = 0,024; p = 0,033) y un médico asistente especialista como cirujano principal (p = 0,030; p = 0,027). La hipocalcemia tras la tiroidectomía produjo 4,9 días más de estancia hospitalaria (8,0 vs 3,1 días; p = 0,018).Conclusión:la hipocalcemia y el hipoparatiroidismo son complicaciones frecuentes de la tiroidectomía, particularmente tiroidectomía total por cáncer o con linfadenectomía cervical o realizada por un médico asistente.

Background: Hypocalcaemia and hypoparathyroidism are common complications following thyroidectomy. However, their incidence varies widely in the literature and their risk factors are not well established.Methods:Thirty-five patients that had a thyroidectomy between June and November 2012 were identified prospectively. Hypocalcaemia was defined as a value of less than 7.5 meq/L of seric calcium in the first day after surgery without symptoms or of less than 8.5 meq/L with symptoms or signs associated with hypocalcaemia. Hypoparathyroidism was defined as a value of less than 8.5 meq/L of seric calcium 12 months after surgery and/or the need of calcium and vitamin D suplementation. Additional variables evaluated were age, sex, history of thyroid surgery, days at the hospital after surgery and main surgeon of the procedure.Results:Overall, 14 (42.4%) out of 35 patients who underwent thyroidectomy developed hypocalcaemia and 8 (22.8%) suffered from hypoparathyroidism. Total thyroidectomy resulted in a higher incidence (50%) of hypocalcaemia and hypoparathyroidism (28.6) when compared with unilateral thyroid lobectomy. Additional factors significantly associated with postoperative hypocalcaemia and hypoparathyroidism included pre-operative malignant cytology (p = 0.014; p= 0.044), cervical lymphadenectomy (p = 0.024; p = 0.033) and a consultant as main surgeon (p = 0.030; p = 0.027). Hypocalcaemia following thyroidectomy resulted in 4.9 days of extended hospital stay (8.0 versus 3.1 days p = 0.018).Conclusion:Hypocalcaemia and hypoparathyroidism are frequent complications of thyroidectomy, particularly total thyroidectomy associated with cancer or cervical lymphadenectomy or performed by a specialized physician as main surgeon.

Clinical and etiological profile of neonatal seizures: a tertiary care hospital based study.

Background: The most vulnerable period of life to develop seizures is the neonatal period. These events very often signify serious damage or malfunction of the immature developing central nervous system. Neonatal seizures may arise as a result of diverse etiologies and can have varied presentations. Objective: Our study was aimed at finding the incidence, etiological factors, and time of onset, clinical types and various biochemical abnormalities in neonatal seizures. Methods: A hospital based prospective observational study was undertaken in a tertiary care paediatric hospital of Government Medical College Srinagar. A total of 100 consecutive neonates presenting with seizures from September 2013 to August 2014 were enrolled in the study. Detailed antenatal history and baseline characteristics of convulsing neonate were recorded at admission. Clinical details of each seizure episode reported by the mother and subsequently observed by the resident doctors on duty were recorded. Venous blood was collected as soon as possible and blood glucose, total serum calcium levels, Na+, K+, Mg and P-levels were done immediately after baby had seizures and before instituting any treatment. Data was described as mean ± SE and %age. SPSS 16.0 and MS Excel software were used for data analysis. Results: Cumulative frequency of 3.9% was recorded in neonatal seizures in our setup. Hypoxic ischemic encephalopathy was the commonest etiology of neonatal seizures. Intracranial haemorrhage followed by Hypoxic ischemic encephalopathy was the commonest seizure etiology in preterm neonates. Majority of Hypoxic ischemic encephalopathy patients presented with seizures in the first 72 hrs. of life. Focal clonic and subtle seizures were the commonest seizure types encountered. 17 neonates (31%) had primary metabolic seizures. Hypocalcaemia was the commonest biochemical abnormality in primary metabolic seizures and was present in 70% neonates in this group. Hypoglycaemia was the next commonest abnormality and was present in 41% neonates within this group. Conclusions: Hypoxic ischemic encephalopathy was the commonest etiology with focal clonic and subtle seizures being the commonest clinical types encountered. Hypocalcaemia was the most frequent biochemical abnormality found.

Hypomagnesaemia Posing as Hypoparathyroidism.

Persistent hypocalcaemia usually is a presentation of hypoparathyroidism. When it is coupled with low parathormone levels the diagnosis seems almost certain. However, the fact that hypomagnesaemia can give rise to both hypocalcaemia and low parathormone levels gives us points to ponder. This case depicts a young woman soon after childbirth presenting with carpopedal spasm and biochemical abnormalities. Subsequent correction of hypomagnesaemia readjusts calcium, potassium and parathormone levels.