RESUMEN
Aim of the work: studies mentioning etiological distribution of tetany are rare and responsiveness concerning it is poor among physicians so, we tried to describe different causes of tetany beyond the decrease in total serum calcium level
Methods: patients with overt or latent tetany were assessed clinically and from laboratory investigations. Initial examinations completed were serum calcium, potassium and arterial blood gas analysis. Both ionized and total calcium were evaluated and corrected according to serum albumin level. Depending on initial reports, additional tests were completed for example, alkaline phosphatase, serum phosphate, parathyroid hormone and magnesium levels; and urine potassium, calcium and chloride levels
Results: Gitelman's syndrome [GS], Bartter's syndrome [BS], recurrent vomiting, anxiety hyperventilation, vitamin D3 deficiency [VDD], idiopathic hypoparathyroidism [IHP], postoperative hypoparathyroidism [PHP], acute pancreatitis, tumor lysis syndrome [TLS] and hypomagnesemia were the different causes of tetany identified. Out of 106 patients, total serum calcium was normal in 82 patients with metabolic or respiratory alkalosis [GS, BS, recurrent vomiting, and anxiety hyperventilation]. Total calcium was low only in 24 patients [in VDD, IHP, PHP, acute pancreatitis, TLS and hypomagnesemia]. Ionized calcium was low in all patients. GS was the most common [38%]. Recurrent vomiting [19%], anxiety hyperventilation [13%], and VDD [11%] were also common. PHP was less common [4%]; acute pancreatitis, TLS, hypomagnesemia and IHP were uncommon
Conclusion: tetany has diverse etiologies. Both metabolic and respiratory alkalosis caused a decrease in ionized calcium and are responsible for the majority of cases of tetany. Causes other than decreased total calcium should be kept in mind for early etiological diagnosis of tetany
RESUMEN
Background: Earlier studies have recommended that asthmatic patients regularly have comorbid depression; nonetheless, temporal associations remain uncertain
Objectives: To determine whether depression predicts asthma and, on the other hand, whether asthma expects depression
Methods: A literature search was conducted without language restrictions using Pubmed, Embase, Cochrane and PsycINFO for studies published before April, 2017. Papers referenced by the obtained articles were correspondingly reviewed. Only comparative prospective studies with reported risk estimates of the association between depression and asthma were included. In order to examine whether one of these conditions was predictive of the other, studies were excluded if enrolled participants had pre-existing depression or asthma. A random effects model was used to calculate the pooled risk estimates for two outcomes: depression predicting asthma and asthma predicting depression
Results: Seven citations, derived from 8 cohort studies, met our inclusion criteria. Of these, six studies reported that depression predicted incident adult-onset asthma, including 83,684 participants and 2,334 incident cases followed for 8 to 20 years. Conversely, two studies reported that asthma predicted incident depression. These studies involved 25,566 participants and 2,655 incident cases followed for 10 and 20 years, respectively. The pooled adjusted relative risks [RRs] of acquiring asthma associated with baseline depression were 1.43 [95% CI, 1.28-1.61] [P<0.001]. The adjusted RRs for acquiring depression associated with baseline asthma was 1.23 [95% CI, 0.72-2.10] [P = 0.45]
Conclusions: Depression was associated with a 43% increased risk of developing adult-onset asthma. However, asthma did not increase the risk of depression based on limited studies. Further prospective studies confirming the true association between asthma and subsequent risk of depression are warranted