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

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

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

relationship of hypocalcemic convulsions related to nutritional rickets with age, gender, season, and serum phosphorus levels

To retrospectively evaluate the epidemic characteristics of children with hypocalcemic convulsion related to nutritional rickets in the province of Kars, Turkey. In this study, clinical and laboratory findings of 93 infants, aged between 1-24 months, who were diagnosed as hypocalcemic convulsive resulting from nutritional rickets between January 2000 and June 2005 in Kars Maternity and Child Hospital, were investigated. The data of the cases with hypocalcemic convulsive rickets were collected from the hospital archive file. The mean and median ages of the cases were 8.93 and 6 [1-24] months, and 66 [71%] were male. Most of the patients were admitted to hospital in February and March, whereas 46% were admitted in winter, 44% in spring, 8% in autumn, and 2% in summertime. Serum calcium levels of all cases were low [mean: 5.4 +/- 0.84 mg/dl] and serum alkaline phosphate levels were high [mean: 1286 +/- 528 IU/L], while serum phosphorus levels were low in 19 [20.4%], high in 8 [8.6%], and normal in 66 [71%] patients. While evaluating the causes of convulsion, hypocalcemic convulsion related to nutritional rickets should be considered among the causes as well as age, gender, and season of the year, and diagnosis, and treatment should be initiated without delay. In addition, serum phosphorus level should also be questioned in the diagnosis of nutritional rickets

Reasons for Zahedan's women for not referring to delivery ward for child delivery

Maternal and infantile mortality are important health indicators of every society due to pregnancy incidents. Maternal and infant mortality and also neonatal tetanus incidents have direct relation with delivery condition. Neonatal tetanus and mortality among mothers and newborns have direct relation with delivery in non-hygienic condition. Non-hygienic delivery rate is very high in Sistan and Baluchestan province. Even in the city of Zahedan with a population of 450000, where as access to maternity hospital is possible for all residents of this city, 50-60% deliveries take place at home. In this study, the reasons of women were investigated for not referring to maternity hospital for delivery. The method of research was case control. Case group was selected from those women whose last deliveries had not taken place in maternity hospital and referred to health centers to vaccinate their children [no. 482]. Control group was selected randomly among women who referred to hospital to give birth [no. 198]. Hospital's high fee [38%], easy delivery at home [19%], fear from cesarean and drugs adverse reaction [13%] were the most prevalent reason for not giving birth at hospital. Employment and literacy rates of those women who had given birth at home were lower than control group. They were mainly from Suni and Baluch ethnic. In order to minimize the cultural barriers of referring to maternal hospital, we advise the respectful officers, to make insurance public, lower the treatments fee, held training programs and provide hygienic conditions with low cost for out of hospital deliveries

Doença celíaca: diagnóstico tardio por problemas sociais / Celiac disease: late diagnosis by social problems

Os autores relatam um caso de doença celíaca, de diagnóstico tardio, responsável pelo agravo nutricional importante para o paciente, apresentando clinicamente baqueteamento dos dedos e episódios de tetania. O objetivo é enfatizar a importância do diagnóstico precoce desta entidade, devendo sempre fazer parte do diagnóstico diferencial das formas crônicas diarréicas associadas à desnutriçäo

Tetania secundária a hipocalemia / Tetany secondary to hypokalemia

Os autores descrevem caso de tetania em paciente adulta que näo apresentava as causas comuns desse sintoma: hipocalcemia, hipomagnesemia e alcalose. Detectou-se severa hipocalemia secundária ao uso de diuréticos. O quadro clínico desapareceu com a correçäo do distúrbio metabólico

Di-George's syndrome with multiple infections (an autopsy report).

Di-George's syndrome is a rare condition of congenital immunodeficiency. An infant presented as hypocalcemic tetany with multiple infections. Autopsy confirmed the hypoplasia of thymus and thyroid associated with other anomalies. A brief of the relevant literature is presented.