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This study describes the association of non-esterified fatty acids (NEFA) and calcium concentrations at calving with early lactation disease, reproductive performance and culling in 646 dairy cows from 13 commercial grazing dairy herds in Uruguay. During one year, health events were recorded from calving to 30 days in milk (DIM). The first author visited each farm every 20 days. During each visit, body condition score (BCS) was recorded (scale 1-5), defining BCS < 3 as suboptimal and BCS > 3 as optimal, and a blood sample was taken from cows between 0 and 4 DIM for metabolite determination. To evaluate the association between health events (i.e., retained placenta-metritis and clinical mastitis) and risk factors (parity, BCS, high NEFA (> 0.6 mmol/L) and subclinical hypocalcemia (SCH) (< 2.10 mM)) data were analysed using multivariable logistic regression models. To evaluate the association of health events and risk factors with reproductive performance and culling, data were analysed using Cox proportional hazard regression models. A risk factor and an outcome of interest were assumed to be associated at P < 0.05 and a tendency to be associated was defined at P < 0.10. Overall, 47 % (n = 303) of the cows showed elevated NEFA concentration and 77 % (n = 499) had SCH. In addition, 21.5 % (n = 139) of the cows recorded at least one clinical disease. Cumulative incidence was 17 % (n = 109) for clinical mastitis, 4.2 % (n = 27) for retained placenta (RP)-metritis and 1.4 % (n = 7) for lameness. Clinical mastitis was associated with parity, with lower odds in primiparous (PP) cows (OR = 0.42, P < 0.01). Cows in an optimal BCS also tended to have lower odds (OR = 0.66, P = 0.07). Moreover, high NEFA and SCH cows had higher odds of CM (OR = 4.5, P = 0.01 and OR = 1.75, P = 0.04, respectively). Retained placenta-metritis tended to be associated with high NEFA concentration (OR = 2.2, P = 0.06). Primiparous cows with suboptimal BCS showed an increased first insemination rate (HR = 2.34; P < 0.01). The risk of culling was lower in PP cows (HR = 0.19; P < 0.01) and in cows with optimal BCS and low NEFA concentration (HR = 0.38; P = 0.03). Our data show that metabolic challenge (defined as peripartum suboptimal BCS, high NEFA or SCH) is associated with increased odds of clinical mastitis and RP-metritis, decreased probability of insemination and increased hazard of culling. Under grazing conditions, we suggest that farm management to improve the metabolic adaptation to lactation represents an opportunity to enhance cow performance in terms of health, fertility and longevity.

Assuntos

Cálcio , Doenças dos Bovinos , Ácidos Graxos não Esterificados , Lactação , Animais , Bovinos/fisiologia , Feminino , Ácidos Graxos não Esterificados/sangue , Lactação/fisiologia , Uruguai/epidemiologia , Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/sangue , Cálcio/sangue , Gravidez , Fatores de Risco , Fertilidade/fisiologia , Mastite Bovina/epidemiologia , Indústria de Laticínios , Hipocalcemia/veterinária , Hipocalcemia/epidemiologia , Endometrite/veterinária , Endometrite/epidemiologia , Placenta Retida/veterinária , Placenta Retida/epidemiologia , Placenta Retida/sangue

RESUMO

Introduction: Surgical campaigns for thyroid surgery in low-income environments are very efficient, but there is little literature reporting results. These campaigns are complex due to multiple particularities: highly evolved cases, the need for professionals to travel or an obvious socio-cultural barrier influence towards the surgical act. We describe a surgical campaign in Cameroon to treat patients with goiter and issue some medical and sociocultural recommendations in view of our experience for its implementation with guarantees. Material and methods: An experienced group carried out an 11-day campaign at the Saint Martin de Porres Dominican Hospital, Yaounde, Cameroon. Demographic data, TSH values, surgery and complications after a 12-month follow-up were analyzed. Results: Thirty-eight patients with goiter were selected for the campaign and 32 patients (mean age, 40-years-old; 30 females) were operated. Bilateral goiter, as assessed with echography, was diagnosed in 13 patients (41%). Ten patients (31%) had a WHO grade II goiter (visible with the neck in a normal position). The surgical procedures were 18 unilateral thyroidectomy with isthmectomie, 13 total thyroidectomy, and 1 totalizing thyroidectomy, due to previous unilateral thyroidectomy (cancer recurrence). A pathological study in 13 patients (40%, extra cost 60 €) showed benign multinodular goiter/thyroid nodule (12 patients) and an extensive papillary carcinoma (one patient). Six months postoperatively, 3 patients had a slight dysphonia and one patient had persistent hypocalcemia. Follow-up was completed in all patients, either face to face (75%, 24 patients) or by phone (25%, 8 patients who failed to have a TSH test because of its cost, 23 €). Conclusions: Surgical campaigns to treat thyroid pathology can be carried out with guarantees if a series of important steps are followed: active participation of the patient's environment, thyroid ultrasound by the surgical team to decide which technique, intense awareness about monitoring and hormone replacement therapy, and the participation of local personnel for long-term follow-up.

Assuntos

Tireoidectomia , Humanos , Feminino , Camarões , Masculino , Adulto , Pessoa de Meia-Idade , Bócio/cirurgia , Recursos em Saúde , Adulto Jovem , Hospitais

RESUMO

Introduction The most common postoperative complication of total thyroidectomy is hypocalcemia, usually monitored using serum parathyroid hormone and calcium values. Objective To identify the most accurate predictors of hypocalcemia, construct a risk assesment algorithm and analyze the impact of using several calcium correction formulas in practice. Methods A prospective, single-center, non-randomized longitudinal cohort study on 205 patients undergoing total thyroidectomy. Parathyroid hormone, serum, and ionized calcium were sampled post-surgery, with the presence of symptomatic or laboratory-verified asymptomatic hypocalcemia designated as primary outcome measures. Results Parathyroid hormone sampled on the first postoperative day was the most sensitive predictor of symptomatic hypocalcemia development (sensitivity 80.22%, cut-off value ≤2.03 pmol/L). A combination of serum calcium and parathyroid concentration sampled on the first postoperative day predicted the development of hypocalcemia during recovery with the highest sensitivity and specificity (94% sensitivity, cut-off ≤2.1 mmol/L, and 89% specificity, cut-off ≤1.55 pmol/L, respectively). The use of algorithms and correction formulas did not improve the accuracy of predicting symptomatic or asymptomatic hypocalcemia. Conclusions The most sensitive predictor of symptomatic hypocalcemia present on the fifth postoperative day was PTH sampled on the first postoperative day. The need for algorithms and correction formulas is limited.

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PURPOSE: This study aimed to evaluate the ability of the percentage of decrease in serum PTH level in the first 8 h after total thyroidectomy (TT) to predict hypocalcemia requiring Ca supplementation and develop a tool to predict it. METHODS: 97 patients who underwent TT with measurement of preoperative parathyroid hormone (PTH) levels were prospectively evaluated 1 and 8 h after TT; postoperative magnesium (Mg2PO) and phosphorus levels were evaluated on the 2nd day after surgery. The percentage of decrease in PTH level 1 h (%dPTH1h) and 8 h (%dPTH8h) postoperatively and predictors of hypocalcemia requiring Ca supplementation were evaluated and an equation was developed to predict this outcome. RESULTS: %dPTH1h (p = 0.002), %dPTH8h (p = 0.001) and (Mg2PO) (p < 0.01) were isolated predictors of postoperative hypocalcemia requiring Ca supplementation. The data obtained led to the development of two tools to predict this complication. CONCLUSIONS: The percentage of decrease in PTH level 1 h and 8 h postoperatively and the magnesium level on the 2nd day after surgery were predictors of more severe hypocalcemia, and an auxiliary tool for predicting this complication was developed.

Assuntos

Hipocalcemia , Humanos , Hipocalcemia/epidemiologia , Hipocalcemia/etiologia , Estudos Prospectivos , Tireoidectomia/efeitos adversos , Magnésio , Probabilidade

RESUMO

Abstract Introduction The most common postoperative complication of total thyroidectomy is hypocalcemia, usually monitored using serum parathyroid hormone and calcium values. Objective To identify the most accurate predictors of hypocalcemia, construct a risk assesment algorithm and analyze the impact of using several calcium correction formulas in practice. Methods A prospective, single-center, non-randomized longitudinal cohort study on 205 patients undergoing total thyroidectomy. Parathyroid hormone, serum, and ionized calcium were sampled post-surgery, with the presence of symptomatic or laboratory-verified asymptomatic hypocalcemia designated as primary outcome measures. Results Parathyroid hormone sampled on the first postoperative day was the most sensitive predictor of symptomatic hypocalcemia development (sensitivity 80.22%, cut-off value ≤ 2.03 pmol/L). A combination of serum calcium and parathyroid concentration sampled on the first postoperative day predicted the development of hypocalcemia during recovery with the highest sensitivity and specificity (94% sensitivity, cut-off ≤2.1 mmol/L, and 89% specificity, cut-off ≤1.55 pmol/L, respectively). The use of algorithms and correction formulas did not improve the accuracy of predicting symptomatic or asymptomatic hypocalcemia. Conclusions The most sensitive predictor of symptomatic hypocalcemia present on the fifth postoperative day was PTH sampled on the first postoperative day. The need for algorithms and correction formulas is limited.

RESUMO

SUMMARY OBJECTIVE: Thyroidectomy is a relatively uncommon procedure in pediatric patients. We aimed to review our 20-year experience of thyroid surgery. METHODS: A total of 39 patients who underwent thyroid surgery from 2003 to 2023 were retrospectively evaluated. All patients were followed preoperatively and postoperatively by our institutional multidisciplinary board. Patients were divided into two groups based on their pathologies: benign and malignant. RESULTS: In total, 39 patients (27 girls and 12 boys) underwent 47 thyroid surgeries (total thyroidectomy in 19 patients and subtotal thyroidectomy in 20 patients, with 8 of them having completion thyroidectomy). Notably, 20 (51%) patients had benign and 19 (49%) patients had malignant pathologies. Median age at operation was 157 (9-223) months in the benign group and 182 (1-213) months in the malignant group. In the benign group, 12 (60%) patients had colloidal goiter and 8 (40%) patients had other conditions. In the malignant group, 12 (63%) patients had papillary thyroid carcinoma, 3 (16%) patients had follicular thyroid carcinoma, 2 (11%) had medullary thyroid carcinoma, and 2 patients had other thyroid malignancies. Overall permanent complication rate was 2 out of 39 (5%), which was similar for both groups (1 hypocalcemia in each group). The median follow-up was 38 months (1-179 months) with no local recurrence or distant metastasis. CONCLUSION: Pediatric thyroidectomies are performed on a heterogeneous group of pediatric patients due to a diverse group of pathologies. A multidisciplinary approach is required for proper initial management and surgical strategy with decreased complication rate and event-free survival of these patients in experienced tertiary centers.

RESUMO

Introducción: El síndrome de hueso hambriento (SHH) es una complicación asociada a la realización de una paratiroidectomía, definido por la persistencia de más de 4 días de hipocalcemia (Calcio sérico menor a 8,5 mg/dl) con requerimiento de suplementación de calcio endovenoso. Este es el primer estudio realizado en Colombia, que tiene el objetivo de precisar la prevalencia de SHH en un Hospital de referencia en Latinoamérica. Metodología: Se realizó un estudio de corte transversal retrospectivo, se revisaron los registros de historias clínicas de pacientes con antecedente de hiperparatiroidismo primario, secundario y terciario que requirieron paratiroidectomía parcial o total en el Hospital de San José de Bogotá, entre Enero del 2013 y Diciembre de 2021. Resultados: Se identificaron 247 pacientes con diagnóstico de hiperparatiroidismo, la mayoría de los pacientes (65,1%) fueron hombres, con una edad mediana de 50,9 años (rango de 25 a 71 años). La prevalencia del SHH fue del 11,7%, con una relación mujer-hombre de 1.5:1, no hubo casos de patología maligna. Los niveles de hormona paratiroidea séricos preoperatorios tuvieron una correlación estadísticamente significativa con los niveles de hormona paratiroidea postquirúrgica. Conclusiones: El síndrome de hueso hambriento es una complicación que puede presentarse posterior a la realización de una paratiroidectomía. Este estudio presenta una prevalencia más baja que la descrita en la literatura.

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Introduction: The Hungry Bone Syndrome (HBS) is a rare complication associated with parathyroidectomy, defined as hypocalcemia (serum calcium less than 8,5 mg/dl) that persist more than 4 days and requires intravenous calcium supplementation. This is the first study made in Colombia with the objective to determine the prevalence of HBS in a reference hospital in Latin America. Methods: A retrospective cross-sectional study was conducted; medical records were reviewed from patients with medical history of primary, secondary, and tertiary hyperparathyroidism that require partial or total parathyroidectomy in San Jose Hospital in Bogota, between January 2013 and December 2021. Results: 247 patients were identified with hyperparathyroidism, most patients were males (65.1%), with a mean age of 50.9 years old (range 25-71 years old). The prevalence of HBS was 11.7%, with a ratio women-men 1.5:1, no malignant pathology was described. Preoperative parathyroid hormone levels and postoperative parathyroid hormone levels were statistically significant. Conclusions: The Hungry Bone Syndrome is a complication that can be present after a parathyroidectomy. This study presents a lower prevalence than the literature described.

RESUMO

Aim: To describe the clinical picture and diagnosis of an episode of severe hypocalcemia in a patient with systemic lupus erythematosus (SLE) in remission, with chronic diarrhea that led to the diagnosis of celiac disease (CD). Case presentation: 22-year-old patient, diagnosed with SLE at age 10, in remission. He consulted for a two-month history of paresthesias, muscle spasms, myalgias, and episodes of tetany in the previous week, associated with malabsorptive postprandial diarrhea. His laboratory tests showed severe hypocalcemia, vitamin D deficiency, severe hypomagnesemia, and mild hypokalemia. In the study for CD, serology reported normal anti-tissue transglutaminase IgA, antigliadin IgA, and IgG and low total IgA levels. Enteroscopy revealed erosive bulbo-duodenitis, with villous atrophy and increased intraepithelial lymphocytes in the pathology, which, together with the immunohistochemical study, allowed the diagnosis of CD, Marsh 3a type. Management was initiated with a gluten-free diet, with a positive clinical response. Conclusion: CD should be suspected in patients with SLE who present with diarrhea, abdominal pain, nausea/vomiting, recurrent oral aphthosis, and anemia. In rare seronegative CD cases, other causes of villous atrophy, mainly infectious, toxic, and immunological, must be ruled out. There is an association between CD and SLE, so diagnosis must be early and timely with the best testing scheme available to achieve effective treatment before complications occur.

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Objetivo: Describir la presentación clínica y diagnóstico de un episodio de hipocalcemia grave en un paciente con lupus eritematoso sistémico (LES) en remisión, con diarrea crónica que condujo al diagnóstico de enfermedad celíaca (EC). Presentación del caso: Paciente de 22 años, con diagnóstico de LES a los 10 años, en remisión. Consultó por 2 meses de evolución de parestesias, espasmos musculares, mialgias y episodios de tetania en la semana previa, asociado a diarrea posprandial malabsortiva. Sus laboratorios mostraron hipocalcemia grave, déficit de vitamina D, hipomagnesemia grave e hipopotasemia leve. En el estudio para EC la serología reportó antitransglutaminasa tisular IgA, antigliadina IgA e IgG normales y niveles de IgA total bajos. La enteroscopia evidenció bulboduodenitis erosiva, con atrofia de las vellosidades y aumento de linfocitos intraepiteliales en la patología, que junto al estudio inmunohistoquímico permitieron concluir el diagnóstico de EC, tipo Marsh 3a. Se inició el manejo con una dieta libre de gluten, con una respuesta clínica positiva. Conclusión: La EC debe sospecharse en pacientes con LES que inicien con diarrea, dolor abdominal, náuseas/vómitos, aftosis oral recurrente y anemia. En los casos de EC seronegativa, los cuales son poco comunes, se deben descartar otras causas de atrofia de las vellosidades principalmente infecciosas, tóxicas e inmunitarias. Existe una asociación entre EC y LES, por lo cual el diagnóstico debe ser precoz y oportuno con el mejor esquema de pruebas disponible para lograr realizar un tratamiento efectivo antes de que se presenten las complicaciones.

RESUMO

Se ha propuesto la medición de PTH como predictor de hipocalcemia postoperatoria transitoria y permanente. No hay un estándar de punto de corte o tiempo de toma de muestra. El OBJETIVO es reportar la incidencia de hipocalcemia post tiroidectomía en un grupo quirúrgico de alto volumen y proponer un protocolo de manejo ambulatorio (esquemas de I a V) según niveles postoperatorios (PO) de calcemia, PTHi (normal, baja o indetectable) y síntomas. Y determinar valores de PTH postoperatoria como predictores de hipocalcemia. En 106 pacientes con tiroidectomía total entre 2019 y 2021 se realiza medición de niveles pre y postoperatorios de calcio, magnesio, fosforo y PTHi. Se observó 29% y 1% de hipocalcemia transitoria ( 12 meses). Los puntos de corte para predecir hipocalcemia fueron PTH < 8,8 pg/ml y < 80% de descenso de % de PTH (d % PTH) al día siguiente. Con el manejo propuesto se indica el alta precoz (promedio 1.05 días) y el costo de la prescripción es acotado. No hay asociación significativa de hipomagnesemia e hiperfosfemia PO con la hipocalcemia PO. El tratamiento más utilizado es de carbonato de calcio exclusivo (esquemas I y II). Los pacientes se mantienen con síntomas leves a las 2 semanas PO en 5% y logran suspender el tratamiento vía oral en 93% en este mismo período. Los protocolos de medición de PTH como predictor de hipocalcemia son muy variados. Cada centro debe conocer y establecer sus propios protocolos de manejo. Con esta experiencia demostramos la utilidad y seguridad de un esquema de manejo basado en calcemia, PTH (normal, baja o indetectable) y síntomas, con indicación de tratamiento profiláctico para todos los pacientes y ajuste ambulatorio seguro y de menor costo que una hospitalización prolongada.

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INTRODUCTION: PTH measurement has been proposed to predict transient and permanent postoperative hypocalcemia. There is no standard cut-off point or time for sampling. Aim: To report the incidence of post-thyroidectomy hypocalcemia in a high-volume surgical group and propose an outpatient management protocol according to postoperative (PO) calcium levels, iPTH (normal, low, or undetectable), and symptoms. Furthermore, determine postoperative PTH values as predictors of hypocalcemia. Methods: In 106 patients with total thyroidectomy between 2019 and 2021, pre-and postoperative levels of calcium, magnesium, phosphorus, and iPTH were measured. Results: Transient ( 12 months) hypocalcemia was observed in 29% and 1%. Cut-off points to predict hypocalcemia were PTH < 8.8 pg/mL and < 80% decrease in % PTH (d% PTH) the day after surgery. With the proposed management, early discharge is indicated (an average of 1.05 days), and the prescription cost is limited. There is no significant association between PO hypomagnesemia and hyperphosphatemia with PO hypocalcemia. The most widely used treatment is exclusive calcium carbonate (schemes I and II). Patients remain with mild symptoms at two weeks PO in 5% and discontinue oral treatment in 93% in this period. Conclusions: Protocols for measuring PTH as a hypocalcemia predictor vary. Each center must know and establish its management protocols. With this experience, we demonstrate the usefulness and safety of a management scheme based on calcium, PTH (normal, low, or undetectable), and symptoms with an indication of prophylactic treatment for all patients and a safe outpatient setting at a lower cost than prolonged hospitalization.

Assuntos

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Hormônio Paratireóideo/sangue , Tireoidectomia/efeitos adversos , Cálcio/sangue , Hipocalcemia/etiologia , Hipocalcemia/sangue , Hipocalcemia/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/epidemiologia , Incidência , Valor Preditivo dos Testes , Magnésio/sangue

RESUMO

ABSTRACT Objective: Our aim was to assess the ability of serum magnesium (Mg), measured on the first postoperative day (Mg1PO), to predict the need for calcium (Ca) replacement in patients undergoing total thyroidectomy (TT). Subjects and methods: Eighty patients undergoing TT, with Mg1PO and PTH dosage in the first (PTH1h) and eighth (PTH8h) hours after TT, were evaluated for the need for Ca replacement. Data were evaluated by uni/multivariate logistic regression and Receiver Operating Characteristic (ROC) curve. Results: 32 patients (40%) required Ca replacement. Median PTH1h, PTH8h and Mg1PO were higher in the no replacement group: 17 versus (vs) 3 pg/mL (p < 0.001), 18.2 vs 3.0 pg/mL (p < 0.001) and 2 vs 1.6 mg/dL (p < 0.001), respectively. Mg1PO was the isolated predictor for this replacement (odds ratio = 0.0004, 95% confidence interval: 0.000003-0.04; p = 0.001), with the cut-off value of 1.8 mg/dL showing sensitivity and specificity of 78.1% and 87.5%, respectively. Conclusions: In this group of patients, serum Mg1PO was the isolated predictor for the need for Ca replacement.

RESUMO

Objective: Our aim was to assess the ability of serum magnesium (Mg), measured on the first postoperative day (Mg1PO), to predict the need for calcium (Ca) replacement in patients undergoing total thyroidectomy (TT). Subjects and methods: Eighty patients undergoing TT, with Mg1PO and PTH dosage in the first (PTH1h) and eighth (PTH8h) hours after TT, were evaluated for the need for Ca replacement. Data were evaluated by uni/multivariate logistic regression and Receiver Operating Characteristic (ROC) curve. Results: 32 patients (40%) required Ca replacement. Median PTH1h, PTH8h and Mg1PO were higher in the no replacement group: 17 versus (vs) 3 pg/mL (p < 0.001), 18.2 vs 3.0 pg/mL (p < 0.001) and 2 vs 1.6 mg/dL (p < 0.001), respectively. Mg1PO was the isolated predictor for this replacement (odds ratio = 0.0004, 95% confidence interval: 0.000003-0.04; p = 0.001), with the cut-off value of 1.8 mg/dL showing sensitivity and specificity of 78.1% and 87.5%, respectively. Conclusion: In this group of patients, serum Mg1PO was the isolated predictor for the need for Ca replacement.

Assuntos

Cálcio , Hipocalcemia , Humanos , Hipocalcemia/etiologia , Hormônio Paratireóideo , Estudos Prospectivos , Magnésio , Tireoidectomia , Complicações Pós-Operatórias

RESUMO

BACKGROUND: The standard clinical treatment for hypoparathyroidism, replacement of calcium and vitamin metabolites (calcitriol), has been used for decades; however, evidence points to its inefficiency in acting on the pathophysiology of the disease, which may precipitate or aggravate conditions already related to hypoparathyroidism. Therapies based on recombinant human parathyroid hormone have emerged in recent years but still have low availability due to their high cost. Parathyroid allotransplantation (Pt-a) has been reported as a strategy for treating more severe cases. METHODS: This narrative review highlights relevant aspects of conventional permanent hypoparathyroidism treatment and provides a comprehensive and critical review of the reports of applications of Pt-a, especially those carried out in recent years. Particular focus is placed on the following key points: parathyroid immunogenicity, immunosuppression regimens (short-term or chronic), techniques to reduce the expression of immunogenic molecules, follow-up time, and reductions in calcium and vitamin D supplementation. CONCLUSION: Pt-a has been considered a safe and relatively low-cost therapy and is believed to have the potential to cure the disease, in addition to treating symptoms. However, there is considerable heterogeneity in treatment protocols; therefore, more studies are required to improve the standardization of the procedure and thus improve the consistency of outcomes.

Assuntos

Hipocalcemia , Hipoparatireoidismo , Humanos , Cálcio/uso terapêutico , Hipocalcemia/tratamento farmacológico , Hormônio Paratireóideo/uso terapêutico , Hipoparatireoidismo/tratamento farmacológico , Hipoparatireoidismo/diagnóstico , Glândulas Paratireoides/cirurgia , Calcitriol/uso terapêutico

RESUMO

The objective of this study was to identify the effect of pre and postpartum DCAD on serum levels of calcium, phosphorus, and magnesium in peripartum Holstein cows. Blood samples were collected from 56 cows (18 primiparous and 38 multiparous) on days -7, +7, +14 and +28 relative to parturition, to determine serum levels of total and ionized calcium, phosphorus, magnesium, and albumin; diet samples for determination of calcium, phosphorus, magnesium and DCAD were collected at the same moments and urine samples were collected at day -7 for measurement of urinary pH. Prepartum DCAD was positively correlated with total calcium (p = 0.02) and with corrected total calcium (p = 0.01) at day -7. There was a negative correlation between prepartum DCAD and magnesium levels at day -7 (p = 0.02). No influence of prepartum DCAD on phosphataemia was observed. Postpartum DCAD did not correlate with serum mineral levels at any time point. Our results demonstrate that prepartum DCAD can influence calcium and magnesium homeostasis, but not phosphorus. In addition, parity and time period should be considered when evaluating serum levels of these minerals in Holstein cows during transition period.

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Objetivou-se identificar o efeito da DCAD pré e pós-parto nos níveis séricos de cálcio, fósforo e magnésio, em vacas Holandesas em periparto. Foram coletadas amostras de sangue de 56 vacas (18 primiparas e 38 multiparas) nos dias -7, +7, +14 e +28 em relação ao parto, para determinação dos níveis séricos de cálcio total e ionizado, fósforo, magnésio e albumina; amostras de alimento foram coletadas nos mesmos momentos para determinação dos níveis cálcio, fósforo, magnésio e DCAD dietético; e amostras de urina foram coletadas no dia -7, para mensuração do pH urinário. A DCAD pré-parto foi positivamente correlacionada com cálcio total (P = 0,02) e com cálcio total corrigido (P = 0,01) no dia -7. Houve correlação negativa entre a DCAD pré-parto e os níveis de magnésio no momento -7 (P = 0,02). Não houve influência da DCAD pré-parto na fosfatemia. A DCAD pós-parto não se correlacionou com os níveis séricos de minerais em nenhum momento. Os resultados demonstram que a DCAD pré-parto pode influenciar na homeostase do cálcio e do magnésio, mas não do fósforo. Além disso, as variáveis paridade e tempo devem ser consideradas ao se avaliarem os níveis séricos desses minerais em bovinos leiteiros da raça Holandesa em transição.

Assuntos

Animais , Feminino , Bovinos , Cátions/análise , Dieta , Hipocalcemia/veterinária , Ração Animal/análise , Ânions/análise , Valores de Referência

RESUMO

BACKGROUND: Hypocalcemia is a common complication of total thyroidectomy; transient hypocalcemia has been reported in up to 68% of the patients. MATERIALS AND METHODS: Chart review of all patients undergoing total thyroidectomy from 2016 to 2020. Clinical, biochemical, and pathological information was registered. We sought correlations between the different variables and the occurrence of post-operative hypocalcemia. This is a retrospective study carried out at a tertiary care teaching hospital. OBJECTIVES: The aim of the study was to ascertain the incidence of hypocalcemia after thyroidectomy and to establish potential clinical and pathological risk factors for its development. RESULTS: Three hundred and thirty-seven patients were included in this study (78% female), with a median age of 47 years. The majority (75%) harbored thyroid neoplasms. Post-operative hypocalcemia developed in 43 patients (12.7%). On bivariate analysis, the most significant risk factor was an intraoperative injury of the parathyroid glands (OR = 2.49, 95% CI = 1.11-5.59), followed by a surgical time > 2.5 h (OR = 2.0, 95% CI = 1.03-4.19), concomitant lymph node dissection (OR = 2.45, 95% CI = 1.2-4.9), and placement of drains (OR = 2.40, 95% CI = 1.19-4.87). Only parathyroid injury remained statistically significant on multivariable analysis. CONCLUSIONS: The most significant risk factor for the development of post-operative hypocalcemia after thyroidectomy is injury of the parathyroid glands, which is usually noticed by the surgeon.

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INTRODUCCIÓN: La hipocalcemia es una complicación común después de una tiroidectomía; la hipocalcemia transitoria ha sido reportada hasta en el 68% de los pacientes posoperados. MATERIALS Y MÉTODOS: Revisión de expedientes de pacientes a los cuales se les realizo una tiroidectomía total entre el 2016 y 2020. La información clínica, bioquímica y patológica fue recopilada. Se busco una correlación entre las variables y el desarrollo de hipocalcemia. Es un estudio retrospectivo en un hospital escuela de atención terciaria. OBJETIVOS: Determinar la incidencia de hipocalcemia pos-tiroidectomía y establecer posibles factores de riesgo clínicos y patológicos para desarrollarlo. RESULTADOS: Se incluyeron 337 pacientes en este estudio (78% mujeres), con edad media de 47 años. La mayoría (75%) presentaron neoplasias tiroideas. Cuarenta y tres pacientes desarrollaron hipocalcemia (12.7%). En el análisis bivariado el factor de riesgo mas importante fue la lesión de paratiroides (RM = 2.49, IC95% = 1.11-5.59), seguido por un tiempo quirúrgico > 2.5 horas (RM = 2.0, IC 95% = 1.03­4.19), disección linfática (RM = 2.45, IC95% = 1.2-4.9) y la colocación de drenajes (RM = 2.40, IC95% = 1.19-4.87). Únicamente la lesión de paratiroides mantuvo significancia en el análisis multivariado. CONCLUSIONES: La lesión de paratiroides es el factor de riesgo mas grande para desarrollar hipocalcemia y generalmente es identificado por el cirujano.

Assuntos

Estudos Retrospectivos , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Correlação de Dados , Fatores de Risco

RESUMO

Introduction: Pseudohypoparathyroidism (PHP) is a heterogeneous group of rare endocrine disorders characterized by resistance to the parathyroid hormone. There are few reports on PHP in Colombia, so the publication of the present case contributes to increase the interest in its research in the clinical setting. Case presentation: An 18-year-old male with a history of hypothyroidism diagnosed at 4 months of age, stunted growth, delayed puberty, obesity, brachydactyly, pathologic fractures, femoral osteochondroma, insomnia, paresthesia, and chronic constipation was referred to the endocrinology service of a tertiary care center in Bogotá (Colombia) after being hospitalized following a seizure episode. On admission, laboratory tests revealed hypocalcemia, hyperphosphatemia, 25-hydroxy vitamin D in the range of insufficiency and elevated PTH. Imaging studies showed heterotopic ossifications and calcifications of the basal ganglia. A genetic study confirmed the diagnosis of PHP1A, so treatment was started with calcium, cholecalciferol and phosphorus chelators, leading to a satisfactory course. Both the patient and his first-degree relatives received genetic counseling and interdisciplinary assessment. Conclusion: Although PHP type 1A is an unrecognized complex genetic disorder, it has a critical clinical importance within the differential diagnoses of hypocalcemia. Without prompt diagnosis and treatment, patients may experience serious and potentially fatal metabolic consequences.

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Introducción. El seudohipoparatiroidismo (SPT) es un trastorno genético poco frecuente que se caracteriza por la resistencia a la hormona paratiroidea (PTH). En Colombia existen pocos reportes sobre esta enfermedad, por lo que la publicación del presente caso contribuye a aumentar el interés en su búsqueda en el ámbito clínico. Presentación del caso. Hombre de 18 años con antecedente de hipotiroidismo (diagnosticado a los 4 meses de nacido), retraso del crecimiento, desarrollo puberal tardío, obesidad, braquidactilia, fracturas patológicas, osteocondroma femoral, insomnio, parestesias y estreñimiento crónico, quien asistió al servicio de endocrinología de un hospital de tercer nivel de Bogotá (Colombia) remitido luego de haber estado hospitalizado por un episodio convulsivo. En dicha hospitalización los laboratorios evidenciaron hipocalcemia, hiperfosfatemia y 25-OH vitamina D en rango de insuficiencia con niveles elevados de PTH, y los estudios imagenológicos demostraron osificaciones heterotópicas y calcificaciones de ganglios basales del cerebro. Al paciente se le realizó un estudio genético que confirmó el diagnóstico de SPT1A, por lo que se le inició manejo con suplencia de calcio, colecalciferol y quelantes de fósforo, con lo cual evolucionó satisfactoriamente. Tanto el paciente como sus familiares de primer grado recibieron asesoramiento y valoración interdisciplinaria. Conclusiones. El SPT1A es un trastorno genético complejo poco conocido pero de alta importancia clínica dentro de los diagnósticos diferenciales de hipocalcemia que debe considerarse ya que sin el diagnóstico y tratamiento oportunos, los pacientes pueden presentar consecuencias metabólicas graves y potencialmente fatales.

RESUMO

Introducción: La hipocalcemia por hipoparatiroidismo es la complicación más frecuente tras tiroidectomía total. Un factor predictor importante de hipocalcemia es la parathormona postoperatoria, pero el momento en el que otorga mejores resultados predictivos aún se discute. Objetivo: El objetivo es analizar el valor pronóstico de la parathormona postoperatoria a las 24 horas como indicador de hipocalcemia, en comparación con la seriación de los niveles de calcio. Metodología: Estudio observacional retrospectivo y descriptivo de 297 pacientes intervenidos de tiroidectomía total durante ocho años. Los pacientes fueron clasificados en tres grupos de riesgo según la parathormona postoperatoria (alto, medio y bajo riesgo). Para comparar la parathormona frente al calcio postoperatorio como predictor de hipocalcemia, se obtuvieron curvas ROC y áreas debajo de la curva. Resultados: El riesgo relativo de tener hipocalcemia con parathormona ≤15 pg/mL es de 353,4 (p = 0,00). La prueba de parathormona postoperatoria (≤15 pg/mL a las 24 h) obtuvo una sensibilidad del 96,25 % para la detección de hipocalcemia, especificidad del 94,06 % y precisión global del 95,03 %. El grupo de alto riesgo (parathormona ≤15 pg/mL) concentra la mayoría de los pacientes con hipocalcemia, y abarca la totalidad de los casos permanentes. Conclusiones: La parathormona postoperatoria a las 24 horas de la tiroidectomía total es un test con un valor pronóstico considerable, capaz de predecir el riesgo de hipocalcemia postquirúrgica. Se encontró que los pacientes con parathormona >15 pg/mL pueden ser dados de alta de manera segura.

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Introduction: Hypocalcemia due to hypoparathyroidism is the most frequent complication after total thyroidectomy. An important predictive factor of hypocalcaemia is postoperative parathormone (PTH), but the optimal time for testing PTH levels is under discussion. Objectives: The objective is to analyze the prognostic value of postoperative PTH at 24 hours as an indicator of hypocalcaemia, compared to serum calcium levels. Methodology: Descriptive retrospective observational study of 297 patients who underwent total thyroidectomy over an 8-year period. The patients were classified into 3 risk groups according to postoperative parathormone (high, medium and low risk). To compare parathormone versus postoperative calcium as a predictor of hypocalcemia, ROC curves and areas under the curve (AUC) were obtained. Results: The relative risk of having hypocalcemia with parathormone ≤ 15 pg/mL is 353.4 (p = 0.00). The postoperative parathormone test (≤ 15 pg / mL at 24h) obtained a sensitivity of 96.25% for the detection of hypocalcemia, specificity of 94.06% and global precision of 95.03%. The high-risk group (parathormone ≤ 15 pg/mL) accounts for the vast majority of patients with hypocalcemia and covers all permanent cases. Conclusions: Postoperative levels 24 hours after total thyroidectomy is a test with considerable prognostic value, capable of predicting the risk of postsurgical hypocalcemia. Patients with levels over > 15 pg/mL can be safely discharged.

Assuntos

Humanos , Masculino , Feminino , Tireoidectomia , Hormônio Paratireóideo , Complicações Pós-Operatórias , Hipocalcemia , Hipoparatireoidismo , Tempo de Internação

RESUMO

The 2022 International Task Force guidelines for chronic hypoparathyroidism will be published within several months in the Journal of Bone and Mineral Research. These guidelines update the original guidelines published in 2016, and include new information from literature published since then. Chronic postsurgical hypoparathyroidism is now defined as lasting for at least 12 months after surgery, rather than 6 months. Chronic postsurgical hypoparathyroidism may be predicted by serum PTH <10 pg/mL in the first 12-24 hours after surgery. The most common symptoms and complications of chronic hypoparathyroidism based on the literature are summarized in detail. How to monitor and manage patients with hypoparathyroidism is described in detail where recommendations can be given. These guidelines are intended to frame the diagnosis and care of patients with chronic hypoparathyroidism for at least the next five years.

Assuntos

Hipocalcemia , Hipoparatireoidismo , Humanos , Cálcio , Hipoparatireoidismo/diagnóstico , Hipoparatireoidismo/etiologia , Hipoparatireoidismo/terapia , Osso e Ossos , Hormônio Paratireóideo

RESUMO

Vitamin D deficiency and insufficiency as well as low serum calcium levels can trigger negative health outcomes in women of childbearing age. Therefore, we aimed to estimate the prevalence of serum vitamin D and calcium deficiencies and insufficiencies and associated risk factors in Brazilian women of childbearing age and to assess whether there are differences in prevalence according to regions of the country and the presence or absence of pregnancy. The systematic literature review was performed using the following databases: PubMed, LILACS, Embase, Scopus, and Web of Science. Cross-sectional, cohort, and intervention studies were included. Among pregnant women, the prevalence of vitamin D deficiency ranged from 0% to 27% and of vitamin D insufficiency from 33.9% to 70.4%. Among non-pregnant women, the prevalence of vitamin D deficiency ranged from 0% to 41.7% and of vitamin D insufficiency from 38.5% to 69.3%. We found a high prevalence of vitamin D deficiency and insufficiency in women of childbearing age, with insufficiency affecting more than half of these women. The highest prevalence of vitamin D deficiency and insufficiency was observed in the South region. It was not possible to assess the prevalence and factors associated with calcium deficiency.

Assuntos

Distúrbios do Metabolismo do Cálcio , Desnutrição , Doenças das Paratireoides , Deficiência de Vitamina D , Gravidez , Feminino , Humanos , Vitamina D , Cálcio , Prevalência , Estudos Transversais , Deficiência de Vitamina D/epidemiologia , Vitaminas , Fatores de Risco

RESUMO

ABSTRACT The 2022 International Task Force guidelines for chronic hypoparathyroidism will be published within several months in the Journal of Bone and Mineral Research. These guidelines update the original guidelines published in 2016, and include new information from literature published since then. Chronic postsurgical hypoparathyroidism is now defined as lasting for at least 12 months after surgery, rather than 6 months. Chronic postsurgical hypoparathyroidism may be predicted by serum PTH <10 pg/mL in the first 12-24 hours after surgery. The most common symptoms and complications of chronic hypoparathyroidism based on the literature are summarized in detail. How to monitor and manage patients with hypoparathyroidism is described in detail where recommendations can be given. These guidelines are intended to frame the diagnosis and care of patients with chronic hypoparathyroidism for at least the next five years.