Different PTH response to oral peptone load and oral calcium load in patients with normocalcemic primary hyperparathyroidism, primary hyperparathyroidism, and healthy subjects.

BACKGROUND: Normocalcemic primary hyperparathyroidism (PHPT-N) is a condition that may have similar long-term implications to primary hyperparathyroidism (PHPT); however, differential diagnosis and treatment for parathyroid disorders are not clearly defined. We investigated the effect of an oral peptone and an oral calcium load on calcium-regulating hormones in PHPT-N compared with PHPT and healthy controls to provide a new potential diagnostic tool. DESIGN: Case-control study. METHODS: We evaluated serum gastrin, PTH, ionized calcium, and phosphate responses to oral calcium (1 g) and peptone (10 g) load in 22 PHPT and 20 PHPT-N patients matched for PTH serum values. Moreover, 30 healthy subjects were enrolled as controls. In 12 patients for each group, we also performed the oral peptone test adding aluminum hydroxide (AH) to suppress phosphate absorption. RESULTS: In PHPT patients, PTH increased significantly 30 min after the oral peptone load, while no significant increase was found in PHPT-N and controls. After oral calcium load, PTH remained stable in PHPT while it decreased dramatically in PHPT-N patients, and ionized calcium increased significantly in each of the three groups. Peptones plus AH induced a blunted PTH increase in the three groups. CONCLUSIONS: Considering the marked difference in PTH response elicited by peptones in PHPT compared with PHPT-N, we suggest that the oral peptone test could be added to the diagnostic evaluation of PHPT patients. In case of absent response to peptones, patients should have their serum calcium levels assessed twice a year in accordance with recent guidelines.

Oral pregabalin as an add-on treatment for status epilepticus.

Oral antiepileptic drugs (AEDs) represent possible add-on options in refractory status epilepticus (SE). In this setting, pregabalin (PGB) has not been reported before. Over the last 42 months, we identified 11 SE episodes (10 patients) treated with PGB in our hospital. Its use was prompted by the favorable pharmacokinetic profile, devoid of drug-drug interactions. The patients mostly had refractory, partial SE. Only two patients were managed in the intensive care unit (ICU). We found a definite electroclinical response in 5 of 11, already evident 24 h after PGB introduction, and a possible response (concomitantly with other AEDs) in 3 of 11 of the episodes; 3/11 did not respond. The treatment was well tolerated. Partial SE appeared to better respond than generalized convulsive SE. PGB appears to be an interesting option as add-on treatment in refractory partial SE.

Índice S para avaliação da qualidade física de solos

O conceito da qualidade física do solo atualmente é bem estabelecido, principalmente pelos índices que avaliam a qualidade do solo. O índice S é um recente indicador da qualidade física do solo relacionado com características importantes do solo. O objetivo deste trabalho foi fazer uma avaliação do método de obtenção do índice S quanto à derivada da função de curva de retenção de água da curva usando ou não a transformação ln(h), bem como avaliar o problema de unidades e da restrição m = 1 - 1/n no cálculo do índice. Concluiu-se que o valor do índice S é superior quando a umidade do solo usada no ajuste da curva de retenção de água proposta por van Genuchten (1980) é expressa na forma volumétrica, quando comparada com a gravimétrica. Para a mesma unidade da umidade do solo, não se observa diferença nos valores do índice S para qualquer unidade de tensão. O valor do índice S difere de acordo com o uso ou não da restrição m = 1 -1/n para estimativa dos parâmetros m e n da curva de retenção proposta por van Genuchten (1980).

Can one or two high doses of oral vitamin D3 correct insufficiency in a non-supplemented rheumatologic population?

We evaluated the effectiveness of supplementation with high dose of oral vitamin D3 to correct vitamin D insufficiency. We have shown that one or two oral bolus of 300,000 IU of vitamin D3 can correct vitamin D insufficiency in 50% of patients and that the patients who benefited more from supplementation were those with the lowest baseline levels. INTRODUCTION: Adherence with daily oral supplements of vitamin D3 is suboptimal. We evaluated the effectiveness of a single high dose of oral vitamin D3 (300,000 IU) to correct vitamin D insufficiency in a rheumatologic population. METHODS: Over 1 month, 292 patients had levels of 25-OH vitamin D determined. Results were classified as: deficiency <10 ng/ml, insufficiency ≥10 to 30 ng/ml, and normal ≥30 ng/ml. We added a category using the IOM recommended cut-off of 20 ng/ml. Patients with deficient or normal levels were excluded, as well as patients already supplemented with vitamin D3. Selected patients (141) with vitamin D insufficiency (18.5 ng/ml (10.2-29.1) received a prescription for 300,000 IU of oral vitamin D3 and were asked to return after 3 (M3) and 6 months (M6). Patients still insufficient at M3 received a second prescription for 300,000 IU of oral vitamin D3. Relation between changes in 25-OH vitamin D between M3 and M0 and baseline values were assessed. RESULTS: Patients (124) had a blood test at M3. Two (2%) had deficiency (8.1 ng/ml (7.5-8.7)) and 50 (40%) normal results (36.7 ng/ml (30.5-5.5)). Seventy-two (58%) were insufficient (23.6 ng/ml (13.8-29.8)) and received a second prescription for 300,000 IU of oral vitamin D3. Of the 50/124 patients who had normal results at M3 and did not receive a second prescription, 36 (72%) had a test at M6. Seventeen (47%) had normal results (34.8 ng/ml (30.3-42.8)) and 19 (53%) were insufficient (25.6 ng/ml (15.2-29.9)). Of the 72/124 patients who receive a second prescription, 54 (75%) had a test at M6. Twenty-eight (52%) had insufficiency (23.2 ng/ml (12.8-28.7)) and 26 (48%) had normal results (33.8 ng/ml (30.0-43.7)). At M3, 84% patients achieved a 25-OH vitamin D level >20 ng/ml. The lowest the baseline value, the highest the change after 3 months (negative relation with a correlation coefficient r = -0.3, p = 0.0007). CONCLUSIONS: We have shown that one or two oral bolus of 300,000 IU of vitamin D3 can correct vitamin D insufficiency in 50% of patients.

Índice de qualidade do solo associado à recarga de água subterrânea (IQS RA) na Bacia Hidrográfica do Alto Rio Grande, MG

A proposição de índices de qualidade do solo tem crescido de forma considerável nos últimos anos para análises de sustentabilidade ambiental e da produção agrícola. No entanto, não há, nas condições brasileiras, o desenvolvimento de qualquer indicador de qualidade do solo vinculado à recarga de água subterrânea. O objetivo deste estudo foi gerar um índice de qualidade do solo, relacionado à recarga de água subterrânea (IQS RA), válido para as condições da Bacia Hidrográfica do Alto Rio Grande e proceder a seu mapeamento por meio de técnicas geoestatísticas. O IQS RA proposto é uma combinação linear de três indicadores relacionados à infiltração de água no solo: densidade do solo, condutividade hidráulica saturada e macroporosidade. Para sua validação, foi considerada a participação do deflúvio base (ou subterrâneo) no deflúvio total para quatro sub-bacias da Bacia Hidrográfica do Alto Rio Grande, analisando o comportamento desses indicadores hidrológicos tendo-se como referência a distribuição espacial do IQS RA. O índice gerado mostrou-se uma ferramenta importante para avaliação do potencial do solo para recarga de água subterrânea, uma vez que ele reflete a influência dos usos da terra no comportamento do deflúvio base e, consequentemente, na dinâmica da produção de água pelas sub-bacias.