Brown tumour mimicking skeletal metastasis

2021 ◽  
Vol 14 (7) ◽  
pp. e243478
Author(s):  
Pankti Parikh ◽  
Sahana Shetty ◽  
Gabriel Rodrigues ◽  
Shyamasunder N Bhat
Keyword(s):  
Clinical Symptoms ◽  
Skeletal Metastasis ◽  
Vitamin D Supplementation ◽  
Active Vitamin ◽  
Osteolytic Lesions ◽  
Lower Back ◽  
Neoplastic Process ◽  
Bony Lesions ◽  
Calcium Infusion ◽  
Hungry Bone

Brown tumours of bone are highly vascular osteolytic lesions that depict a reparative cellular process instead of a neoplastic process in hyperparathyroidism (HPT) patients. These tumours have the potential to be aggressive and destructive. We report a case of a 30-year-old woman who presented with left thigh and lower back pain. The radiological evaluation showed multiple bony lesions in the pelvis and the spine, which mimicked multiple metastatic tumours. However, on biochemistry evaluation, serum calcium, alkaline phosphatase, and parathyroid hormone were all high, while serum phosphate was low, indicating primary HPT (PHPT), which was confirmed by parathyroid scintigraphy showing left parathyroid adenoma. Hence, the bony lesions were diagnosed as brown tumours secondary to PHPT. The patient underwent parathyroidectomy and developed severe hungry bone syndrome requiring parenteral calcium infusion along with oral calcium and active vitamin D supplementation. The clinical symptoms of bone pain improved after surgery.

scholarly journals Active vitamin D supplementation and COVID-19 infections: review

2021 ◽  
Author(s):  
Nakhoul Farid ◽  
Nakhoul Rola ◽  
Elias A. T. Koch ◽  
Nakhoul Nakhoul
Keyword(s):  
Vitamin D ◽  
Vitamin D Supplementation ◽  
Active Vitamin ◽  
Active Vitamin D

scholarly journals COVID-19 in age-related neurodegenerative diseases: is there a role for vitamin D3 as a possible therapeutic strategy?

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Milena de Barros Viana ◽  
Bárbara dos Anjos Rosário ◽  
Maria de Fátima Santana de Nazaré ◽  
Débora Estadella ◽  
Daniel Araki Ribeiro ◽  
...  
Keyword(s):  
Vitamin D ◽  
Therapeutic Strategy ◽  
Clinical Symptoms ◽  
Large Population ◽  
Mortality Rates ◽  
Vitamin D Supplementation ◽  
World Health ◽  
Age Related ◽  
Alzheimer’S Diseases ◽  
Alzheimer's Diseases

AbstractThe coronavirus disease (COVID-19), identified in Wuhan, China, on December 2019, was declared a pandemic by the World Health Organization, on March, 2020. Since then, efforts have been gathered to describe its clinical course and to determine preventive measures and treatment strategies. Adults older than 65 years of age are more susceptible to serious clinical symptoms and present higher mortality rates. Angiotensin-converting enzyme 2 (ACE2) is a major receptor for some coronavirus infection, including SARS-COV-2, but is also a crucial determinant in anti-inflammation processes during the renin–angiotensin system (RAS) functioning – converting angiotensin II to angiotensin 1–7. The decline in ACE2 expression that occurs with aging has been associated to the higher morbidity and mortality rates in older adults. These observations highlight the importance of investigating the association between COVID-19 and age-related neurodegenerative disorders, i.e., Parkinson’s and Alzheimer’s diseases. A possible option to reduce the risk of COVID-19 is vitamin D supplementation, due to its anti-inflammatory and immune-system-modulating effects. It has also been suggested that vitamin D supplementation plays a role in slowing progression of Parkinson and Alzheimer. The present study is a literature review of articles published on the theme COVID-19, Parkinson and Alzheimer’s diseases, and the role played by vitamin D. PUBMED, MEDLINE, and EMBASE databases were consulted. Results confirm neurodegenerative and neuroinflammatory effects of COVID-19, aggravated in Parkinson’s and Alzheimer’s patients, and the important role of vitamin D as a possible therapeutic strategy. Nevertheless, randomized controlled trials and large population studies are still warranted.

scholarly journals Vitamin D prescribing in children in UK primary care practices: a population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e031870 ◽  
Author(s):  
Mandy Wan ◽  
Laura J Horsfall ◽  
Emre Basatemur ◽  
Jignesh Prakash Patel ◽  
Rukshana Shroff ◽  
...  
Keyword(s):  
Primary Care ◽  
Vitamin D ◽  
Cohort Study ◽  
Clinical Symptoms ◽  
Population Based ◽  
Vitamin D Supplementation ◽  
Annual Incidence ◽  
Health Improvement ◽  
Laboratory Test Results ◽  
General Practices

ObjectiveTo examine temporal changes in the incidence and patterns of vitamin D supplementation prescribing by general practitioners (GPs) between 2008 and 2016.DesignPopulation-based cohort study.SettingUK general practice health records from The Health Improvement Network.ParticipantsChildren aged 0 to 17 years who were registered with their general practices for at least 3 months.Outcome measuresAnnual incidence rates of vitamin D prescriptions were calculated, and rate ratios were estimated using multivariable Poisson regression to explore differences by sociodemographic factors. Data on the type of supplementation, dose, dosing schedule, linked 25-hydroxyvitamin D (25(OH)D) laboratory test results and clinical symptoms suggestive of vitamin D deficiency were analysed.ResultsAmong 2 million children, the crude annual incidence of vitamin D prescribing increased by 26-fold between 2008 and 2016 rising from 10.8 (95% CI: 8.9 to 13.1) to 276.8 (95% CI: 264.3 to 289.9) per 100 000 person-years. Older children, non-white ethnicity and general practices in England (compared with Wales/Scotland/Northern Ireland) were independently associated with higher rates of prescribing. Analyses of incident prescriptions showed inconsistent supplementation regimens with an absence of pre-supplementation 25(OH)D concentrations in 28.7% to 56.4% of prescriptions annually. There was an increasing trend in prescribing at pharmacological doses irrespective of 25(OH)D concentrations, deviating in part from UK recommendations. Prescribing at pharmacological doses for children with deficient status increased from 3.8% to 79.4%, but the rise was also observed in children for whom guidelines recommended prevention doses (0% to 53%). Vitamin D supplementation at pharmacological doses was also prescribed in at least 40% of children with no pre-supplementation 25(OH)D concentrations annually.ConclusionsThere has been a marked and sustained increase in vitamin D supplementation prescribing in children in UK primary care. Our data suggests that national guidelines on vitamin D supplementation for children are not consistently followed by GPs.

scholarly journals Oxygen-ozone therapy: our experience in the treatment of hard-root conflicts

Ozone Therapy ◽  
2016 ◽  
Vol 1 (2) ◽  
pp. 34
Author(s):  
Maria Laura Rosato ◽  
Marco Mainini ◽  
Margherita Luongo ◽  
Luigi Mascolo ◽  
Silvana Mattera ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Back Pain ◽  
Lower Back Pain ◽  
Positive Response ◽  
Clinical Symptoms ◽  
Significant Extent ◽  
Ozone Therapy ◽  
Lower Back ◽  
Herniated Discs

Lower back pain and sciatica are clinical symptoms with debilitating effects on the quality of life; they are extremely common in the population. The treatment of patients affected by sciatica, and in particular of those incurred by herniated discs, may be medical, physiatric, percutaneous minimally invasive surgery. In recent years, for the treatment of disc-radicular conflicts the Oxygen-Ozone (O<sub>2</sub>-O<sub>3</sub>) therapy is spreading to a more and more significant extent. We report our experience with O<sub>2</sub>-O<sub>3</sub> therapy in the treatment of herniated lumbar discs, evaluating the efficacy of the therapy in lower back pain and sciatica. We treated 32 patients with paravertebral intramuscular infiltrations of about 15 cc of the mixture of O<sub>2</sub>-O<sub>3</sub> at a concentration of 30 µg/cc: 66.6 % of the patients had a positive response to the treatment.

Are tactile acuity and clinical symptoms related to differences in perceived body image in patients with chronic nonspecific lower back pain?

2015 ◽  
Vol 20 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Tomohiko Nishigami ◽  
Akira Mibu ◽  
Michihiro Osumi ◽  
Kouki Son ◽  
Shyogo Yamamoto ◽  
...  
Keyword(s):  
Body Image ◽  
Back Pain ◽  
Lower Back Pain ◽  
Clinical Symptoms ◽  
Tactile Acuity ◽  
Lower Back

scholarly journals Disease Burden of Patients Living With Hypoparathyroidism: Results From the Voices of Hypopara Survey

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A260-A261
Author(s):  
Deborah Murphy ◽  
Bob Sanders ◽  
Loretta Gulley ◽  
Ami Knoefler ◽  
Alden Smith ◽  
...  
Keyword(s):  
Vitamin D ◽  
Serum Calcium ◽  
Disease Burden ◽  
Vitamin D Supplementation ◽  
Urgent Care ◽  
Monitoring Device ◽  
Active Vitamin ◽  
The Past ◽  
Active Vitamin D ◽  
At Home

Abstract Background: Hypoparathyroidism (HP) is a rare disease that is characterized by insufficient levels of parathyroid hormone, resulting in hypocalcemia, hyperphosphatemia and hypercalciuria. Standard of care (SoC) consists of calcium and active vitamin D supplementation. Some patients may suffer from “calcium crashes”, sudden hypocalcemia symptoms that can be severe enough to require a visit to the emergency room (ER) or urgent care. Conversely, chronic use of SoC supplements can also increase risk of hypercalciuria and renal failure. The HypoPARAthyroidism Association (HPA), a nonprofit organization dedicated to improving the lives of hypoparathyroid patients, developed the “Voices of Hypopara” survey to capture the journey of patients with HP in the US. Methods: The online survey was distributed to all HPA members (approximately 1,000) in May 2020. Questions focused on evaluating patients’ experiences including diagnosis, treatment, quality of care, and impact on daily living. Results: The survey was completed by 146 HPA members (89% female; mean age 51). Most participants reported they are currently taking SoC (calcium 91%; active vitamin D 77%). However, over half felt that this did not optimally address their disease and 29% were extremely concerned about hypocalcemia despite supplementation. Many (69%) felt that taking SoC was moderately to extremely burdensome. More than two-thirds (69%) of respondents reported a “calcium crash” in the past year; of these, 43% reported calcium crashes monthly or weekly. Almost half (42%) of all participants required a visit to an ER/urgent care in the last year as a result of HP symptoms; of these, 56% believed that the staff was inexperienced with management of a calcium crash. More than 60% of participants checked serum calcium levels at least every couple of months at a physician’s office or lab in the past year, with 36% checking monthly or more frequently; the majority of respondents (70%) said the reason was due to symptoms of hypocalcemia. Participants viewed an at-home device for measuring serum calcium, phosphate, and magnesium levels as one key approach to manage their HP symptoms (47% ranked as “most preferred”), followed by more effective medications as the second most preferred option (23%). Almost all (99%) responded that they would use an at-home monitoring device and would test frequently. Conclusions: Results from this survey underscore the high disease burden of patients with HP, highlighting sudden hypocalcemic episodes as a key morbidity despite treatment with calcium and active vitamin D supplementation, and sub-optimal management by clinicians as an impediment to optimal treatment. These findings reinforce the need for more frequent, easily accessible, and real-time serum calcium level monitoring device, more efficacious therapies, and greater disease understanding among health care workers to best manage patients with HP.

scholarly journals Effect of Vitamin-D supplementation in adults presenting with chronic lower back pain

2020 ◽  
Vol 24 (2) ◽  
pp. 161-165
Author(s):  
Rahman Rasool Akhtar ◽  
Riaz Ahmed ◽  
Sabeen Ashraf ◽  
Omair Ashraf ◽  
Umer Shafique ◽  
...  
Keyword(s):  
Vitamin D ◽  
Back Pain ◽  
Pain Score ◽  
Lower Back Pain ◽  
Vitamin D3 ◽  
Vitamin D Supplementation ◽  
Chronic Lower Back Pain ◽  
Oral Vitamin ◽  
Lower Back ◽  
Vitamin D Levels

Background: Chronic pain in the lower back of adults is a common problem and mostly associated with Vitamin D deficiency. Along with standard treatment, vitamin D supplementation can help in early and better relief from back pain. Objective: To assess the effectiveness of vitamin D supplementation in patients with chronic lower back pain. Study Design & Methods: This Quasi-experimental trial was conducted at Department of Orthopaedics, Benazir Bhutto Hospital for 6 months. The patients aged between 15 to 55 years with chronic low back pain were included and pain score was noted by using a visual analogue scale (VAS). Patients were prescribed with oral vitamin D3 with a dose of 50,000 IU weekly for eight weeks (induction phase) and oral vitamin D3 with a dose of 50,000 IU once monthly for 6 months (maintenance phase). Outcome parameters included pain measured by VAS, functional disability by modified Oswestry disability questionnaire scores, and Vitamin-D3 levels at baseline,2, 3 and 6 months post-supplementation. Results: Mean age of patients was 44.21± 11.92 years.There were 337 (56.2%) male patients while 263 (43.8%) female patients. Baseline mean vitamin-D levels were 13.32 ± 6.10 ng/mL and increased to 37.18 ± 11.72 post supplementation (P < 0.0001). There was a significant decrease in the pain score after 2nd, 3rd& 6th months (61.7 ± 4.8, 45.2 ± 4.6 & 36.9 ± 7.9, respectively) than 81.2 ± 2.4 before supplementation (P < 0.001). The modified Oswestry disability score also showed significant improvement after 2nd, 3rd& 6thmonths (35.5 ± 11.4, 30.2 ± 9.4 & 25.8 ± 10.6, respectively) as compared to baseline 46.4 ± 13.2 (P < 0.001). About 418 (69.7%) patients attained normal levels after 6 months. Conclusion: Prescription of Vitamin D in addition to standard therapy for chronic lower back pain can be beneficial in getting relief from pain and improving the functional ability of the patient.

scholarly journals Comparison of sagittal spinopelvic parameters in different types of double-level degenerative lumbar spondylolisthesis: a retrospective study

2020 ◽  
Author(s):  
guangzhi zhang ◽  
Yajun Deng ◽  
Xuegang He ◽  
Enhui Ren ◽  
Zuolong Wu ◽  
...  
Keyword(s):  
Back Pain ◽  
Clinical Symptoms ◽  
Leg Pain ◽  
Neurogenic Claudication ◽  
Sacral Slope ◽  
Chronic Lower Back Pain ◽  
Spinopelvic Parameters ◽  
Lower Back ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Different Types

Abstract Background Degenerative lumber spondylolisthesis (DLS), a common orthopaedic disease causing low back pain, seriously affects daily life and work. Although sagittal spinopelvic parameters have been studied in single-level DLS patients, investigations into different types of double-level DLS are scarce. This study aims to analyse the demographic and radiological parameters of patients with different types of double-level DLS and compare their differences to provide a reference for guiding surgical treatment and restoring sagittal balance of DLS patients. Methods From January 2014 to January 2020, double-level DLS patients’ records were retrospectively reviewed and divided into three types: anterior, posterior, and combined; the anterior and combined types were studied. Two spin surgeons measured the sagittal spinopelvic parameters: C7 tilt, maximal thoracic kyphosis (TKmax), maximal lumbar lordosis (LLmax), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Following descriptive analysis, demographic and radiographic data were compared between the anterior and combined types. Results Patients in the anterior type group (n = 40) were older (67.68 ± 6.66 vs. 61.72 ± 10.06 years, P = 0.031), and the proportion of females were significantly higher (90% vs. 50%, P = 0.001) than the combined group (n = 18). Both groups had different levels of chronic lower back pain, but the incidence of radiating leg pain and neurogenic claudication was significantly higher in the anterior type. Owestry disability index and visual analogue scale lower back scores were also higher in the anterior type. In the anterior type, C7 tilt (7.14 ± 2.15 vs. 5.41 ± 2.28, P = 0.007), LLmax (50.02 ± 14.76 vs. 36.96 ± 14.56, P = 0.003), PI (68.28 ± 9.16 vs. 55.53 ± 14.19, P < 0.001), PT (28.68 ± 7.31 vs. 19.38 ± 4.70, P < 0.001), and PT/PI (42.45 ± 11.22 vs. 36.04 ± 9.87, P = 0.041) were significantly higher. In the anterior type, PI correlated significantly positively with LLmax (r = 0.59) and SS (r = 0.71). LLmax and SS (r = 0.65) had a positive correlation. PT/PI and SS (r = -0.77) had a negative correlation. In the combined type, PI correlated positively with LLmax (r = 0.61) and SS (r = 0.88), and PT/PI correlated negatively with SS (r = -0.81). Conclusions In patients with double-level DLS, the sagittal spinopelvic parameters differ between the anterior and combined types. PI and LLmax were significantly higher in the anterior type, resulting in compensation by forward flexion and pelvic retroversion. Spinal surgeons should focus on correcting sagittal deformities, relieving postoperative clinical symptoms, and improving quality of life during fusion surgery, which is proven to guarantee long-term surgical results.

Sign in / Sign up

Export Citation Format

Share Document