Vitamin D repletion in primary hyperparathyroid patients undergoing parathyroidectomy leads to reduced symptomatic hypocalcaemia and reduced length of stay: a retrospective cohort study.

INTRODUCTION: Vitamin D deficiency co-exists with and can confuse the diagnosis of primary hyperparathyroidism (PHPT). Vitamin D replete (VDR) status may prevent significant postparathyroidectomy hypocalcaemia; however, reports from previous studies are conflicting. This study aimed to assess differences in early and/or late postoperative hypocalcaemia and length of stay (LOS) postparathyroidectomy between VDR and vitamin D non-replete (VDNR) PHPT patients. METHODS: This was a retrospective cohort study of a prospectively maintained single surgeon operative database. All records of patients who underwent parathyroidectomy over a four-year period (July 2014 to December 2018) were extracted. Data were collected on vitamin D and corrected calcium levels pre- and postoperatively as well as postoperative complications and LOS. RESULTS: On presentation, there were 91 (47.9%) VDR and 99 (52.1%) VDNR patients. Following vitamin D therapy there were 148 (77.9%) VDR and 42 (22.1%) VDNR. The multivariate analysis showed that vitamin D status was the only significant factor impacting on the hypocalcaemia symptoms (OR 4.9, 95% CI 1.8-13.7, p = 0.002) and the most significant factor for the calcium supplementation (OR 6.5, 95% CI 2.1-19.4, p = 0.001). Bilateral neck exploration was associated with increased likelihood of transient hypocalcaemia (p = 0.007) but no other post-op complication. Median LOS was significantly shorter for VDR (1 day) versus VDNR (1.5 days) patients (p = 0.001). CONCLUSION: There is a statistically significant increased likelihood of postoperative hypocalcaemia symptoms, requirement for calcium supplements and increased LOS in VDNR patients. This study suggests optimising preoperative vitamin D status improves patient experience and could reduce healthcare costs.

Low-dose Bevacizumab Decreases Ocular Hypotensive Effect of Angiotensin II in Sprague Dawley Rats.

PURPOSE: Although the effectiveness of anti-VEGF agents in ophthalmology has been thoroughly documented, we do not fully comprehend the epidemiology and mechanistic background of their side effects, including intraocular and systemic hypertension. Here, we investigate the interference of a low-dose bevacizumab with key neuronal and humoral mechanisms maintaining blood and intraocular pressure homeostasis. MATERIALS AND METHODS: Intraocular pressure (IOP), blood pressure (BP), and heart rate (HR) were measured in SPRD rats pretreated with bevacizumab or 0.9% NaCl at baseline and after infusion of angiotensin II, a humoral mediator involved in BP and IOP regulation. Superior cervical gangliectomy was performed to assess the effect of sympathetic nervous system on the analyzed parameters. Additionally, we studied the expression of a subset of genes related to renin-angiotensin system in the anterior segment of the eye. RESULTS: At baseline, there was no significant difference in IOP, BP, and HR between rats pretreated with 0.9% NaCl and bevacizumab. Infusion of angiotensin II lowered IOP in rats pretreated with 0.9% NaCl, but not in rats pretreated with bevacizumab (30 min: ∆4.22 ± 1.2 vs. baseline, p > .05; ∆0.83 ± 0.66 vs. baseline, p < .05) This effect was paralleled by an increased expression of angiotensin II type 1b and type 2 receptors in the anterior segment of the eye (AT1b: 1 ± 0.65 vs 7.35 ± 2.84, p < .05; AT2: 1 ± 0.05 vs. 12.8 ± 0.1, p < .05). Angiotensin II infusion increased BP in both groups (10 min: bevacizumab ∆44.6 ± 3.2, p < .05; 0.9%NaCl ∆37.1 ± 5.1, p < .05), whereas did not have any effect on HR. Sympathetic ocular denervation did not affect any of the analyzed parameters. CONCLUSIONS: We found that low-dose bevacizumab interferes with IOP-lowering properties of angiotensin II. This effect might be related to increased expression of angiotensin II receptors in the anterior segment of the eye.

Defining sepsis on the wards: results of a multi-centre point-prevalence study comparing two sepsis definitions.

Our aim was to prospectively determine the predictive capabilities of SEPSIS-1 and SEPSIS-3 definitions in the emergency departments and general wards. Patients with National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled over a 24-h period in 13 Welsh hospitals. The primary outcome measure was mortality within 30 days. Out of the 5422 patients screened, 431 fulfilled inclusion criteria and 380 (88%) were recruited. Using the SEPSIS-1 definition, 212 patients had sepsis. When using the SEPSIS-3 definitions with Sequential Organ Failure Assessment (SOFA) score ≥ 2, there were 272 septic patients, whereas with quickSOFA score ≥ 2, 50 patients were identified. For the prediction of primary outcome, SEPSIS-1 criteria had a sensitivity (95%CI) of 65% (54-75%) and specificity of 47% (41-53%); SEPSIS-3 criteria had a sensitivity of 86% (76-92%) and specificity of 32% (27-38%). SEPSIS-3 and SEPSIS-1 definitions were associated with a hazard ratio (95%CI) 2.7 (1.5-5.6) and 1.6 (1.3-2.5), respectively. Scoring system discrimination evaluated by receiver operating characteristic curves was highest for Sequential Organ Failure Assessment score (0.69 (95%CI 0.63-0.76)), followed by NEWS (0.58 (0.51-0.66)) (p < 0.001). Systemic inflammatory response syndrome criteria (0.55 (0.49-0.61)) and quickSOFA score (0.56 (0.49-0.64)) could not predict outcome. The SEPSIS-3 definition identified patients with the highest risk. Sequential Organ Failure Assessment score and NEWS were better predictors of poor outcome. The Sequential Organ Failure Assessment score appeared to be the best tool for identifying patients with high risk of death and sepsis-induced organ dysfunction.

Developing a digital data collection platform to measure the prevalence of sepsis in Wales.

OBJECTIVE: To develop a secure, efficient, and easy-to-use data collection platform to measure the prevalence of sepsis in Wales over 24 hours. MATERIALS AND METHODS: Open Data Kit was used on Android devices with Google App Engine and a digital data collection form. RESULTS: A total of 184 students participated in the study using 59 devices across 16 hospitals, 1198 datasets were submitted, and 97% of participants found the Open Data Kit form easy to use. DISCUSSION: We successfully demonstrated that by combining a reliable Android device, a free open-source data collection framework, a scalable cloud-based server, and a team of 184 medical students, we can deliver a low-cost, highly reliable platform that requires little training or maintenance, providing results immediately on completion of data collection. CONCLUSION: Our platform allowed us to measure, for the first time, the prevalence of sepsis in Wales over 24 hours.