Correlation of hypocalcemia with serum parathyroid hormone and calcitonin levels in pediatric intensive care unit

The Utility of Bedside Assessment Tools and Associated Factors to Avoid Antibiotic Overuse in an Urban PICU of a Diarrheal Disease Hospital in Bangladesh

BACKGROUND

Antibiotic exposure in the pediatric intensive care unit (PICU) is very high, although 50% of all antibiotics may be unnecessary. We aimed to determine the utility of simple bedside screening tools and predicting factors to avoid antibiotic overuse in the ICU among children with diarrhea and critical illness.

METHODS

We conducted a retrospective, single-center, case-control study that included children aged 2-59 months who were admitted to PICU with diarrhea and critical illness between 2017 and 2020.

RESULTS

We compared young children who did not receive antibiotics (cases, n = 164) during ICU stay to those treated with antibiotics (controls, n = 346). For predicting the 'no antibiotic approach', the sensitivity of a negative quick Sequential Organ Failure Assessment (qSOFA) was similar to quick Pediatric Logistic Organ Dysfunction-2 (qPELOD-2) and higher than Systemic Inflammatory Response Syndrome (SIRS). A negative qSOFA or qPELOD-2 score calculated during PICU admission is superior to SIRS to avoid antibiotic overuse in under-five children. The logistic regression analysis revealed that cases were more often older and independently associated with hypernatremia. Cases less often had severe underweight, altered mentation, age-specific fast breathing, lower chest wall in-drawing, adventitious sound on lung auscultation, abdominal distension, developmental delay, hyponatremia, hypocalcemia, and microscopic evidence of invasive diarrhea (for all, p < 0.05).

CONCLUSION

Antibiotic overuse could be evaded in PICU using simple bedside screening tools and clinical characteristics, particularly in poor resource settings among children with diarrhea.

A Meta-Analysis of Risk Factors for Transient and Permanent Hypocalcemia After Total Thyroidectomy

Background

As hypocalcemia is the most common complication of total thyroidectomy, identifying its risk factors should guide prevention and management. The purpose of this study was to determine the risk factors for postthyroidectomy hypocalcemia.

Methods

We searched PubMed, Web of Science and EMBASE through January 31, 2019, and assessed study quality using the Newcastle–Ottawa Scale.

Results

Fifty studies with 22,940 patients met the inclusion criteria, of which 24.92% (5716/22,940) had transient hypocalcemia and 1.96% (232/11,808) had permanent hypocalcemia. Significant (P < 0.05) predictors of transient hypocalcemia were: younger age, female, parathyroid autotransplantation (PA), inadvertent parathyroid excision (IPE), Graves’ disease (GD), thyroid cancer, central lymph node dissection, preoperative severe Vitamin D deficiency, preoperative Vitamin D deficiency and a lower postoperative 24 h parathyroid hormone (PTH) level. Preoperative magnesium, preoperative PTH and Hashimoto’s thyroiditis were not significant predictors of transient hypocalcemia. IPE, GD, and thyroid cancer were associated with an increased rate of permanent hypocalcemia, but gender and PA did not predict permanent hypocalcemia.

Conclusion

Important risk factors for transient and permanent hypocalcemia were identified. However, given the limited sample size and heterogeneity of this meta-analysis, further studies are required to confirm our preliminary findings.

Vitamin D levels in paediatric intensive care unit patients and its relation to severity of illness: An Indian experience

 Vitamin D deficiency is a common disorder that is associated with morbidity and mortality in the general population. We conducted a cross-sectional study of 384 children admitted to paediatric intensive care to determine its prevalence and association with severity of illness and outcome in critically ill children. The severity of illness was evaluated using the paediatric risk of mortality score (PRISM III), on admission, at 24 and 48 h. Vitamin D deficiency was observed in 175 children (45.6%) and was associated with higher severity of illness, need for mechanical ventilation and increased mortality.

COVID-19: the endocrine opportunity in a pandemic

The 2019 Coronavirus disease (COVID-19) pandemic has disrupted the social, economical and medical system worldwide. Although it is strictly an infectious disease, its intricate bidirectional relationship with various non-communicable metabolic diseases and endocrinological factors has been observed. While diabetes, hypertension, obesity have been found to be independent risk factors for COVID-19 disease severity and mortality, more inclination towards sedentary lifestyle, psychosocial stress at this critical time may be the harbingers of metabolic syndrome. Thus, endocrinologists have a great opportunity to play their role to combat this pandemic. This paper examines how various endocrinological disorders influence the dynamics of COVID-19 and vice versa. Moreover, it also intends to review the clinical guidelines to be adopted in practice of endocrinology in this trying time.

Calcemia and Inflammatory Markers in Early-Onset Neonatal Infection

INTRODUCTION

Ionised hypocalcemia (S-Ca2+) has been repeatedly observed in neonates with sepsis. Our aim was to evaluate total calcemia (S-Ca) and its relationship to laboratory markers of infection.

METHODS

We retrospectively evaluated total calcemia (S-Ca) and its relationship to laboratory markers of sepsis/infection (serum levels of C-reactive protein - S-CRP and procalcitonin - S-PCT) in 29 full-term neonates with early-onset neonatal infection hospitalized at our neonatology ward between 2012 and 2016. The control group consisted of 705 neonates without infection.

RESULTS

In neonates with early-onset infection , the S-Ca on day 1, 2 and 3 was significantly lower (p < 0.0001; p < 0.0001; p = 0.05 versus controls) same as the pooled S-Ca (p < 0.0001 versus controls). There was a weak negative correlation between pooled S-Ca and S-PCT, or pooled S-Ca and S-CRP (r = -0.22, p = 0.06; r = -0.19, p = 0.09).

CONCLUSION

S-Ca was decreased in neonates with early-onset infection and did show a slight tendency to inverse correlation with S-CRP and S-PCT. Pediatricians must be aware of the fact that a drop in total S-Ca should alert their attention to the risk of neonatal infection, and, likewise, that the children with neonatal infection are at a higher risk of hypocalcemia with all its consequences.