Actualizaciones en Osteología

Dengue and multiple osteonecrosis of the maxilla and mandible: a case report

2024-10-04T21:12:02+00:00

Dengue is a viral disease transmitted by Aedes aegypti mosquitoes that has recently experienced a significant increase in incidence. This report presents an unusual case of osteonecrosis affecting both the upper and lower jaw in a young patient without a history of pathological or medication exposure before contracting dengue virus infection.

Similar to other viral diseases associated with maxillary osteonecrosis, Dengue induces endothelial inflammation that triggers a series of events leading to thrombosis and necrosis of bone tissue.

Considering that the increase in dengue cases is linked to climate change, it is plausible to speculate that dengue will become more frequent in the future, as well as its association with osteonecrosis.

Renal lithiasis and non-parathyroid hormone-dependent hypercalcemia associated with alterations in vitamin d metabolism: a clinical case report

2024-11-27T17:01:28+00:00

In recent years, it has been discovered that mutations in CYP24A1 (24 alpha-hydroxylase) promote an excess of calcidiol and calcitriol due to a failure in catabolic activity, which manifests as hypercalcemia, renal lithiasis, and nephrocalcinosis. This condition is known as Idiopathic Infantile Hypercalcemia (IIH). Biallelic alterations are severe expressions of the disease and are diagnosed in childhood. Little is known about heterozygous forms. This report presents andult patient illustrating this alteration.

A 27-year-old male was referred for evaluation due to repeated low and inhibited PTH levels. The patient has had bilateral renal lithiasis associated with hypercalciuria since the age of 10, without response to conventional treatment. Persistent lithiasis, chronic kidney disease, and intermittent hypercalcemia were observed. His mother presents with hypercalciuria. The physical examination is normal. Highlights of the studies include hypercalcemia, inhibited PTH, high-normal levels of 25OH vitamin D and 1,25(OH)2 D3, increased creatinine, normal phosphatemia and alkaline phosphatase. The 1,25(OH)₂D₃/PTH ratio is elevated (> 40 pmolL/pmol/L).

Granulomatous and oncological diseases were ruled out by specific studies. The possible mutation of the CYP24A1 gene was considered.

Molecular study of CYP24A1 showed mutations described in IIH: exon 2 variant c.428-430delAAG / alteration p. Glu143del, heterozygous, pathogenic, and exon 8 variant c.999_1006delCAGTCTAA / p. Ser334Valfs*9, heterozygous, possibly pathogenic. It is assumed that the patient presents a monoallelic form of IIH.

It is important to consider the mutations of the enzyme CYP24A1, which catabolizes the metabolites of vitamin D, calcidiol and calcitriol, in the differential diagnosis of non-PTH-dependent hypercalcemia and hypercalciuria.

Dr. Fernando Saraví: our chief of service, teacher, mentor and friend

2025-05-30T20:50:24+00:00

Approaches to Treat Hypocalcemia Pre and Post Thyroidectomy

2024-09-26T18:20:43+00:00

Patients who underwent thyroidectomy are at high risk of developing hypocalcemia secondary to the surgical procedure, and the incidence of this complication is not insignificant. This literature review focuses aims to update guidelines to support physicians in the evaluation and management of patients at risk of post-thyroidectomy hypocalcemia, with a holistic approach from the preoperative period to the evaluation after surgery.

Prevalence of vitamin d deficiency in hospitalized COVID-19 patients

2024-08-17T18:50:58+00:00

Introduction: The emergence of the SARS-CoV-2 pandemic presented numerous challenges, including identifying disease predictors and developing effective therapeutic options. Numerous studies have reported the potential protective effect of vitamin D (VD) against respiratory infections. However, the literature remains inconclusive regarding the benefits of taking VD on COVID-19 progression.

Objectives: This study aimed to assess the prevalence of VD deficiency (VDD) and its association with COVID-19 severity in hospitalized patients.

Methods: We enrolled 250 adults (≥50 years) of both sexes with COVID-19 admitted between 2020-09-01 and 2021-06-31. VD levels, comorbidities, inflammatory markers, oxygen or mechanical ventilation needs, ICU admission, and mortality were analyzed. VDD was defined as <20 ng/mL. The association between VD value and death was evaluated with a logistic regression model.

Results: Mean age was 73.4± 11 years, and 49.2% males. Median VD level was 20.2 ng/mL. The prevalence of VDD was 49.2% (n 123; CI95 43-55.4%). Hypovitaminosis D (<30 ng/mL) was observed in 77.2%. Patients with VDD had a higher Charlson index (p=0.02). VD levels did not correlate with oxygen saturation, inflammatory markers, or severity events (mechanical ventilation, ICU admission and death). In a mortality analysis, VD level was not a prognostic factor (OR 0.98 CI 0.95-1; p 0.1).

Conclusion: The prevalence of VDD in our cohort was 49.2%. We found no association between VD levels and COVID-19 severity, similar to several published studies.

¿Influyen la posición, la hora del día y el estímulo verbal en la medición De la fuerza de prensión de la mano?

2025-04-03T02:08:26+00:00

Introducción

La utilización de la medición de fuerza de puño en la práctica clínica y en el ámbito de la investigación ha ganado relevancia por su íntima relación con eventos en salud. El Grupo de Trabajo Europeo sobre Sarcopenia (EWGSOP2) introdujo la medición de la función muscular (fuerza y rendimiento físico) como un criterio fundamental para el diagnóstico de sarcopenia. El objetivo principal de nuestro estudio fue realizar tres diferentes métodos para evaluar la fuerza de puño.

Materiales y métodos

Un estudio cuasiexperimental fue conducido en tres centros de referencia en Argentina. Hombres y mujeres voluntarias entre 18 y 40 años fueron incluidos en el estudio. Se evaluó el impacto de la dominancia, postura (parado vs sentado), tiempo de día (mañana y tarde) y estímulo verbal sobre las mediciones de fuerza de puño.

Resultados:

Un total de 117 participantes fueron analizados, de los cuales el 41% fueron masculinos. La media de edad fue de 27.7 años en hombres y 28.7 años en mujeres. Los hombres presentaron mayor fuerza de puño en comparación con mujeres (46.5 ± 11.7 kg vs. 27.0 ± 6.8, p<0.001). Además, la fuerza en el miembro dominante fue mayor en todas las pruebas realizadas (p<0.05). No se observaron variaciones con respecto a la postura y el tiempo del día. Sin embargo, se observaron incrementos significativos posterior al estímulo verbal (29.81 ± 12.14 kg vs. 33.50 ± 11.40 p<0.001).

Conclusion

De acuerdo a nuestras observaciones, la medición de la fuerza de puño debería ser medida usando el miembro dominante y con estímulos verbales para obtener la máxima prensión.

Información sobre la aprobación ética: Universidad Nacional de Rosario (resolución N°5596/2023)

Dr. Fernando Saraví

2025-05-30T20:45:31+00:00