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Objective: To determine the clinical and biochemical pattern of parathyroid disorders in a tertiary care setting.., Methods: The cross-sectional study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from September 2017 to February 2018, and comprised patients with suspected parathyroid disorders. A panel of biochemical tests were used for diagnosis of parathyroid disorders, which included parathyroid hormone levels, total calcium, ionized calcium, inorganic phosphorus, alkaline phosphatase, magnesium, total vitamin D and urinary calcium-to-creatinine ratio. SPSS 24 was used for data analysis., Results: Of the 384 subjects, 248(65%) were male and 136(35%) were female. Overall mean age was 48±19years. Of the total, 302(786%) had parathyroid issues, with 244(81%) having secondary hyperparathyroidism. Mean serum total calcium, phosphorus, ionized calcium, magnesium and total vitamin D were 8.98±1.52 mg/dl, 4.0±1.30 mg/dl, 4.65±0.52 mg/dl, 2.11±0.27 mg/dl and 20.5±8.52 ngml respectively. Of the patients diagnosed with secondary hyperparathyroidism, 72.2% patients had chronic kidney disease and 20.2% had isolated vitamin D deficiency., Conclusions: Parathyroid disorders had significant impact on bone health. Moreover, secondary hyperparathyroidism was seen to be emerging as a major endocrine problem, especially in chronic kidney disease patients and vitamin D-deficient individuals.

Introduction: There is a great scarcity of literature in Pakistan investigating the proportion of end stage renal disease (ESRD) patients undergoing hemodialysis (HD) who meet the recommended kidney diseases outcome quality initiative (K/DOQI) guidelines for serum calcium (Ca), phosphorus (P), calcium phosphorus product (Ca x P) and parathyroid hormone (PTH) levels. Our study aimed to determine frequencies of patients who met the K/DOQI targets for these minerals at a tertiary care hospital's dialysis unit., Methods: 111 ESRD patients on maintenance HD were selected from a tertiary care hospital. Serum Ca and P were assayed on chemistry analyser. PTH was measured through electrochemiluminescence sandwich method. Data were compared with K/DOQI targets and analysed using SPSS-21., Results: The mean age of patients was 55.85 years (SD ± 13.95). Gender distribution was almost equal with 49.5% males and 50.5% females. The patients had mean corrected serum Calcium 9.12 ± 0.64 mg/dL, Phosphorus 4.57 ± 1.54 mg/dL and Parathyroid hormone 333.8 ± 278.4 pg/mL. The patients had achieved K/DOQI target ranges of Ca, P, PTH, Ca x P product and all 4 criteria in 63.1%, 47.6%, 38.7%, 84.7% and 10.8% respectively., Conclusion: Majority of patients on maintenance HD at our institution did not achieve the recommended K/DOQI target ranges. Further studies pertaining to the Asian subcontinent will prove resourceful for comparison of mineral metabolism and dialysis outcome of ESRD patients., Competing Interests: The authors declare no competing interests., (© Taimoor Khalid Janjua et al.)

Objective: To compare vitamin D levels with bone mineral density, serum calcium, phosphorous and alkaline phosphatase., Methods: The cross-sectional multicentre study was conducted at Pakistan Health Research Council centres in Islamabad, Lahore, and Karachi,and comprised subjects coming for either vitamin D testing or bone mineral density examination. Information related to demography, height/weight, skin colour, smoking, use of sun screen, daily milk intake, sun exposure and exercise was taken along with biochemical tests like serum calcium and phosphorous, alkaline phosphatase, and 25 hydroxy vitamin D.Bone mineral density was done using dual-energy X-ray absorptiometry scan. SPSS 15.0 was used for data analysis., Results: Of the 291 subjects, 100(34.3%) each were enrolled from Islamabad and Lahore, while 91 (31.2%) were from Karachi. Overall, 245(84%) had insufficient vitamin D which was significantly associated with age and dark skin colour (p<0.05 each). Besides, 137(48%) cases had a reduced bone density, and there was a significant difference between age groups, gender and skin colour (p<0.05 each).Vitamin D deficiency did not have any effect on bone mineral density (p>0.05) Serum calcium and phosphorus levels were also similar regardless of vitamin D level (p>0.05)., Conclusions: Vitamin D deficiency did not have any direct impact on bone mineral density and serum calcium, phosphorous and alkaline phosphatase.

Objective: To determine the frequency of nutritional rickets in children hospitalized with severe pneumonia., Method: This study was carried out at the department of paediatric medicine at National Institute of Child Health Karachi. It is a case series done over a period of six months from 15th November 2008 to 15th may 2009. Patients admitted (n=137) with severe pneumonia were included in the study and were investigated for presence of rickets with serum calcium, phosphorus and alkaline phosphatase. Those having low to normal calcium low phosphorus and raised alkaline phosphatase were labeled as having rickets. All data collected were entered on Performa. Children with familial, vitamin D dependent/resistant rickets, secondary rickets, and cerebral palsy or on anti convulsant therapy were excluded from this study., Results: Out of 137 patients, with severe pneumonia, 83 were male and 54 female. Frequency of nutritional rickets in children with severe pneumonia was observed in 101(74%) cases. Rickets was more common in 2 to 12 months of age, i.e., 79.8% (67/84) and in those children who were breast fed (85.3% vs. 40%). Frequency was higher in those children who were not exposed to sunlight., Conclusion: Pneumonia is a very common presentation of rickets. This study suggests that rickets may be more common in children who are breast fed and those who have less exposure to sunlight.

Background: Osteomalacia is a common diagnosis in the Kohistani women presenting with aches and pains. This study was conducted to assess calcium and Phosphate levels in Kohistani women with osteomalacia., Methods: 50 diagnosed cases of Osteomalacia selected from amongst the women presenting with body aches were included in the study. History regarding age, marital status, parity, dietary habits, socioeconomic status etc was taken., Results: The median age was 23 years. 74% were married. Most of the women had 5 children (mode). Nine (18%) patients had hypocalcaemia, 10 (20%) had hypophosphatemia. Alkaline phosphatase was elevated in 13 patients (26%). Six (12%) patients were pregnant at the time. 74% of patients belonged to the poor class. 70% of the patients drank less than 1 cup of milk per day. Body aches (100%), waddling gait (14%), proximal myopathy (12%), bone tenderness (6%) and carpopedal spasm (8%)., Conclusions: We therefore conclude that in comparison with other parts of the world where individual risk factors cause osteomalacia. Kohistani population has a higher frequency of osteomalacia due to aggregation of three major factors namely lack of sunlight due to geographical location, excessive clothing blocking available sunlight and nutritional deficiency.

Background: This study aims at evaluating serum calcium, magnesium and phosphorus levels in women taking oral and injectable contraceptives., Methods: Serum calcium, magnesium and phosphorus were measured in 50 women taking oral contraceptives (Lofeminal) and 50 women taking injectable contraceptive (Depo-medroxy progesterone acetate and Norigest). These women were used as controls before starting these contraceptives., Results: There was significant decrease in serum levels of calcium, magnesium and phosphorus in women taking oral contraceptives but there was significant increase in these minerals in women taking injectable contraceptives., Conclusions: It is suggested that these contraceptives should be used with due care and with proper investigations of the women before and during the therapy.

This study was conducted to evaluate the vitamin D status of healthy breastfed Pakistani infants and their nursing mothers. Sixty-two breastfed healthy infants and their nursing mothers belonging to the upper and lower socioeconomic classes were examined. Serum 25-hydroxy vitamin D [25(OH)D], serum calcium, phosphorus and alkaline phosphatase were measured. The mean serum 25(OH)D in infants was 34.59 +/- 26.56 nmol/l. Fifty-five percent of infants and 45% of mothers had very low serum 25(OH)D levels (<25 nmol/l). Significantly higher levels were found in infants of lower socioeconomic class (p < 0.001) and in those living in mud houses (p = 0.002) and infants >6 months (p < 0.001). A high prevalence of vitamin D deficiency was found in breastfed infants and nursing mothers, predominantly among those belonging to the upper socioeconomic class. Infants of the lower socioeconomic class had comparatively higher serum 25(OH)D levels, but even these levels were below the normal range for infants (90 +/- 27.5 nmol/l).

Data from an animal health service in the Punjab of Pakistan showed that 39 adult female buffaloes with haemoglobinuria were 21 times more likely to have serum inorganic phosphorus (serum P) levels < 0.97 mmol/l than 24 controls sampled during the period of case occurrence (December 1984-March 1985). Age > 7 years or early lactation (1-60 days post partum) were unrelated to the disease. Similarly, symptoms of osteomalacia in 19 multiparous buffaloes were associated with low P (OR = 14.3) but not with age. Subsequently, a serum survey was carried out from February 1985 to July 1987 to investigate serum P variations with season and host factors. Data from 139 farms (426 adult female buffaloes, 468 lactations) indicated strong farm and seasonal effects on serum P. Serum P declined during the study period and was lowest during December-March 1985/1986 and again 1986/1987. Calving season, parity > 1, high pregnancy > 6 months, or daily milk production were not related to serum P in the final model. Seasonal effects were interpreted as soil borne and related to feed changes from maize to berseem in December.

To evaluate the vitamin D status in pregnant Pakistani women living in Oslo, we measured levels of serum calcidiol, calcitriol, vitamin D binding protein (DBP), osteocalcin, free calcium (Ca2+), phosphorous, alkaline phosphatase and intact parathyroid hormone (PTH). Thirty Pakistani and 23 Norwegian women who delivered vaginally after uncomplicated pregnancies were included. The serum levels of calcidiol were significantly lower in the Pakistani group (p < 0.0001) as compared with the Norwegians, the mean values being 15.1 nmol/l and 43.1 nmol/l, respectively. PTH levels were above 5.5 pmol/l in 13 of the Pakistanis, none of the Norwegians. There were no differences in calculated free calcitriol, free calcium and inorganic phosphorus between the groups. Alkaline phosphatase was high, while osteocalcin was low in both groups, but there were no significant differences between the groups. This study shows that there is a widespread vitamin D deficiency amongst pregnant Pakistani women living in Oslo, indicating the need for vitamin D supplementation to these women and their children.

Milk recording was initiated in 1980 in the Sahiwal district of the Punjab province in Pakistan with the aim of identifying superior cattle and buffalo cows. The paper describes how the recording scheme with some modification was utilised to obtain accurate information about production parameters, reproductive traits, blood mineral contents and the prevalence of certain diseases. The main findings indicate that the calving interval in cattle is even higher than previously estimated (22.3 months), that phosphorus and copper deficiency is widespread in the area and that reproductive diseases are not a major factor in infertility. It is concluded that the low reproductive efficiency among cattle and buffaloes in the Sahiwal district is due mainly to phosphorus and copper deficiency accompanied by a low level of feeding and management.

The prevalence of vitamin D deficiency was reassessed in April and May 1971, 10 years after the discovery of widespread late rickets and osteomalacia in the Glasgow Pakistani community. Evidence of vitamin D deficiency was found in 28 out of 115 adults and children examined (24%). Children at the age of puberty were most severely affected by rickets, whereas most infants and younger children in the survey were protected by vitamin D supplements. Mild biochemical osteomalacia was common in Pakistani women.A total of 21 Pakistani and Indian children with rickets were admitted to Glasgow hospitals during 1968-70. These comprised 10 children with infantile rickets and 11 with late rickets. Four of the latter group required osteotomy for severe rachitic deformity.Late rickets and osteomalacia in Pakistani and Indian immigrants are not primarily due to nutritional deficiency of vitamin D, though the high phytate content of their diet may be of aetiological importance. A combination of environmental, social, and endogenous factors, the relative importance of which is not at present clear, may also be involved. Advice on the prophylaxis of vitamin D deficiency should be given to all Pakistani and Indian communities in the United Kingdom.