Approach to hypercalcemia

Hypercalcemia is a presentation commonly encountered in the clinical setting. Due to its vast differential diagnosis, a systematic approach is necessary when approaching patients with hypercalcemia. This article presents a simple, yet thorough approach to help clinicians determine the etiology of their patient's hypercalcemia. The main components of history taking, physical examination, and laboratory investigations for patients with hypercalcemia are highlighted. Emphasis is put on the importance of determining whether the hypercalcemia is associated with elevated or inappropriately normal parathyroid hormone (PTH) or not. The main etiologies of PTH-dependent hypercalcemia and PTH-independent hypercalcemia are explored. Primary hyperparathyroidism and hypercalcemia secondary to malignancy are highlighted as together, they make up 90% of hypercalcemia cases. A presentation of the management principles of hypercalcemia is also provided.

A New Method to Determine the Steel Fibre Content of Existing Structures—Test Setup and Numerical Simulation

The diagnostics of constructions built with steel fibre reinforced concrete are extremely difficult to conduct because, typically, no information on the actual amount and orientation of the fibres is available. Therefore, it is of great interest to engineers to have the possibility to determine the steel fibre content and, at best, also the orientation of the fibres in existing structures. For this purpose, an easy-to-use test setup was developed and tested, in the course of laboratory investigations. This method can be used for cylinders, for example drilling cores, that can later be taken of existing structures, to determine both the fibre content and orientation. Based on these results, a model for cylindrical specimens was derived, which can be used for varying concrete compositions with steel fibre contents of up to 80 kg/m3. In the case of missing information concerning the concrete composition, it allows an initial estimation for the fibre content. In case additional information about the concrete composition is available, a much higher accuracy of the projected steel fibre content and therefore, an assessment of the building’s condition is possible.

Newly diagnosed type 1 diabetes in a 93 year old

Type 1 diabetes is typically a disease of young but can present at any age. We present a case of a 93-year-old woman who presented with 10 days history of feeling lethargic, polydipsia and decreased appetite. Her capillary blood glucose was raised at 25 mmol/L with significant ketonaemia and venous blood gas showing metabolic acidosis. She had a background of primary hypothyroidism and vitamin B12 deficiency with weakly positive parietal cell antibodies. Laboratory investigations confirmed diabetes with HbA1c of 117 mmol/mol (12.9%). In view of high clinical suspicion of type 1 diabetes, her diabetes autoantibodies were checked which showed strongly positive anti-GAD antibody with titre of >2000 IU/mL (range<10) confirming our diagnosis. She was treated with diabetic ketoacidosis protocol with intravenous fluids and intravenous insulin. On recovery, she was discharged home on once daily insulin with aim to self-manage diabetes with support from district nurses and to avoid hypoglycaemia.

25-hydroxyvitamin D3 Levels and Their Clinical Associations in a Polish Cohort of Systemic Sclerosis Patients: A Cross-Sectional Study

Vitamin D exhibits immunomodulatory effects in autoimmune diseases. We aimed to evaluate the associations of vitamin D levels with clinical and laboratory features of systemic sclerosis (SSc) in a Polish cohort. The study was prospective in design. SSc patients who met ACR-EULAR 2013 criteria underwent comprehensive clinical and laboratory investigations using the European Scleroderma Trials and Research group (EUSTAR) methodology. We assessed patients’ sera for 25(OH)D3 using a radioimmunoassay, and the cutoff value for vitamin D deficiency was set at 20 ng/mL. Statistical analyses were performed using the Mann–Whitney U test, the Fisher’s exact, and the Spearman’s rho, where appropriate, with a significance threshold set at 0.05. We recruited 68 SSc patients (85% female). The mean 25(OH)D3 level was 21.6 ± 10 ng/mL, and 50% of subjects (n = 34) presented vitamin D deficiency (mean 13.7 ± 3.9 ng/mL). Vitamin D-deficient SSc patients exhibited higher prevalence of arterial hypertension (p = 0.002), proteinuria (p = 0.002), and lung fibrosis (p = 0.032), as well as higher CRP (p = 0.035). The modified Rodnan skin score correlated negatively with 25(OH)D3 in diffuse cutaneous SSc (dcSSc). We found no correlation with the disease duration, age, joints, and the heart. Vitamin D deficiency was common in the studied population of Polish SSc patients and was associated with arterial hypertension, proteinuria, lung involvement, and increased CRP.

SARS-CoV-2 Seroprevalence in Western Romania, March to June 2021

Background and Objectives: The extent of SARS-CoV-2 infection among a population may be assessed by the presence of serum SARS-CoV-2 antibodies, which indicates previous exposure. The aim of this study was to determine the seroprevalence of SARS-CoV-2 infection in the adult population from Western Romania. Materials and Methods: Samples of 2443 consecutive individuals, referred for routine laboratory investigations, were tested for SARS-CoV-2 antibodies using the Elecsys immunoassay that targets the nucleocapsid protein, for identifying the presence of the total antibodies against SARS-CoV-2. Results: The overall SARS-CoV-2 seroprevalence was 45.60%. SARS-CoV-2 seroprevalence was significantly higher in age group 30–49 years (53.94%) compared to age groups 50–69 years (43.53%) and 70–91 years (30.79%) (p < 0.001, p < 0.001, respectively). No significant difference in seroprevalence was observed between females (44.83%) and males (47.05%). Conclusions: Our data revealed a high seroprevalence of SARS-CoV-2 infection in the adult population from Western Romania and indicate the rapid and significant spread of the virus. The estimated prevalence of 45.60% was 6 times higher than the rate of confirmed COVID-19 cases reported in the study area. This indicates the magnitude of virus transmission in the community.

A case of Vaccine-Induced Thrombotic Thrombocytopenia (VITT) with thrombosis of the superior mesenteric artery after ChAdOx1 nCov-19 COVID-19 Vaccine

We describe the case of a 64 years-old woman admitted to the Emergency Department of the ASST-Spedali Civili of Brescia with fever and gastrointestinal symptoms 10 days after the first dose of ChAdOx1 nCov-19 vaccine. Laboratory investigations showed severe thrombocytopenia and high D-dimer, while an abdominal CT scan reported a partially occluding thrombosis of the superior mesenteric artery. Following treatment with fondaparinux, immunoglobulins and high dosage steroid therapy, we observed a rapid improvement of patient’s conditions. An ELISA assay showed the presence of antibodies against heparin PF4-complex. Subsequent abdominal CT-scan showed the superior mesenteric artery thrombosis resolution, and the patient was finally discharged after 12 days of hospitalization. Several reports pointed to the venous system as the main district affected by Vaccine-Induced Thrombotic Thrombocytopenia (VITT), while a peculiar feature of this report is the involvement of the mesenteric arterial system. Further investigation of VITT’s pathophysiological mechanisms is mandatory to develop preventive strategies and effective treatments.

Multisystem inflammatory syndrome in neonates due to severe acute respiratory syndrome coronavirus 2: An emerging entity

Severe acute respiratory syndrome coronavirus 2 was declared as a pandemic in March 2020. The virus has affected more adults than children, with disease severity being lesser in children. We present a case of a neonate who tested positive for coronavirus disease 2019 infection on day of life 3, 6, and 15. The baby had fever, respiratory distress, and shock. Laboratory investigations showed raised inflammatory markers, raised D dimer suggesting coagulopathy, coronary dilatation on 2D echocardiogram, and raised N terminal pro-brain natriuretic peptide. The neonate was successfully treated with good supportive care, lung-protective ventilatory strategies, early intravenous immunoglobulin administration, corticosteroids, and remdesivir.

Zebrafish Embryos and Larvae as Alternative Animal Models for Toxicity Testing

Prerequisite to any biological laboratory assay employing living animals is consideration about its necessity, feasibility, ethics and the potential harm caused during an experiment. The imperative of these thoughts has led to the formulation of the 3R-principle, which today is a pivotal scientific standard of animal experimentation worldwide. The rising amount of laboratory investigations utilizing living animals throughout the last decades, either for regulatory concerns or for basic science, demands the development of alternative methods in accordance with 3R to help reduce experiments in mammals. This demand has resulted in investigation of additional vertebrate species displaying favourable biological properties. One prominent species among these is the zebrafish (Danio rerio), as these small laboratory ray-finned fish are well established in science today and feature outstanding biological characteristics. In this review, we highlight the advantages and general prerequisites of zebrafish embryos and larvae before free-feeding stages for toxicological testing, with a particular focus on cardio-, neuro, hepato- and nephrotoxicity. Furthermore, we discuss toxicokinetics, current advances in utilizing zebrafish for organ toxicity testing and highlight how advanced laboratory methods (such as automation, advanced imaging and genetic techniques) can refine future toxicological studies in this species.