RAJIVGANDHIUNIVERSITY OF HEALYH SCIENCES,
BANGALORE, KARNATAKA
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FORDISSERTATION
1. / NAME OF THE STUDENT / DR.MAHESH HOLEYANNAVARS/O N.K.HOLEYANNAVAR
H.NO.164, RAVINAGAR
GOKUL ROAD, HUBLI-580030
2. / NAME OF THE INSTITUTION / J.S.SMEDICALCOLLEGE, MYSORE
3. / COURSE OF THE STUDY AND SUBJECT / M.D. IN PEDIATRICS
4. / DATE OF ADMISSION TOCOURSE / 31ST MAY 2007
5. / TITLE OF THE TOPIC / STUDY OF PARATHYROID HORMONE STATUS IN HYPOCALAEMIC CHILDREN IN THE AGE GROUP 3 MONTHS TO 12 YEARS.
6. / BRIEF RESUME OF THE WORK
6.1 NEED FOR THE STUDY
Hypocalcaemia is one of the common metabolic abnormalities presenting as a paediatric emergency. It can be devastating if unrecognised and it may also pose as a chronic diagnostic dilemma. Its manifestations are varied emphasizing the need of estimation of serum calcium in varied clinical settings. Data concerning clinical, laboratory features and management of hypocalcaemia in indian children is scarce.
Serum calcium is normally maintained within normal rangeby an exquisitely sensitive homeostatic system. Parathyroid hormone one of the key factor in calcium homeostasis which is necessary to achieve metabolic and neuroregulatory functions of this essential mineral. In the absence of the calcium maintaining effects of parathyroid hormone, the hypoparathyroid disorders cause hypocalcaemia in subset of patients with this biochemical abnormality. Parathyroid hormone levels may be raised hypocalcaemic children with prolonged vitamin D deficiency. It will be normal in hypocalcaemia secondary to hypoalbuminemia.
This emphasizes that parathyroid hormone will act as an entry point investigation for the further biochemical workup for any case of hypocalcaemia. And data regarding parathyroid status in hypocalcaemic children is not known in our setup. Hence this study aims at documenting parathyroid status in children presenting with hypocalcaemia.
6.2 REVIEW OF LITERATURE
Hypocalcaemia is defined as total serum concentration less than 7mg/dl (equivalent to a calcium activity of 3.5mEq/L).1
Hypocalcaemia can be devastating if unrecognised. Neuromuscular dysfunction may occur in severe cases. Hypocalcaemia occurs in various conditions and their biochemical profile are different. Most important causes of hypocalcaemia in childhood are parathyroid hormone related( hypothyroidism, pseudohypothyroidism type 1 and type 2) vitamin D related, calcium/phosphorus related( malabsorption, hyperphosphataemia) and organ related.2
PTH plays an important role in calcium homeostasis by mechanisms like calcium mobilisation, increase dietary absorption of calcium and decreases renal clearance. Hence serum PTH assays are important in assessment of calcium metabolism disorders.3
Awareness of hypocalaemia as a cause of seizures is important because children are still treated with anticonvulsants without serum calcium being checked.4 Hypoparathyroidism should be kept in mind whenever a patient present with persistent hypocalcaemia.5 hypomagnesemia causes secondary hypoparathyroidism hence is also associated with secondary hypocalcaemia.6
A prospective study conducted by jyothi sharma et al, of 29 children with diagnosed hypocalcaemia, 25 cases were presented with seizures. Etiological diagnosis included Hypoparathyroidism(9 cases),pseudohypothyroidism(15 cases),vitamin D dependent rickets(4 cases), hypomagnesaemia(1 case).7
The study done by P D Robinson et al of 126 diagnosed vitamin D deficient children, 33% of cases presented with seizures,22% with bowed legs. PTH was raised in 80% of cases.This study also noted highest number i.e. 37% cases were of Indian subcontinent.8
6.3OBJECTIVES OF STUDY
Primary objective: To study the changes in parathyroid hormone levels in hypocalcaemic children in age group 3 months to 12 years.
Secondary objective: To study the biochemical profileof investigations donefor etiological evaluation. Vitamin D3, serum albumin, serum magnesium, alkaline phosphatase and serum phosphorus in same children.
7. / MATERIALS AND METHODS
7.1 SOURCE OF DATA
Children of age between 3months to 12 years diagnosed of having hypocalcaemia. (serum calcium level less than 7mg/dl corrected for normal albumin levels)
7.2 METHOD OF COLLECTION
Study design- Analytical study.
Samples size- Sample size is proposed to include 30 cases of hypocalcaemia. The sample size is proposed on the basis of hospital records of minimum number of cases seen at JSSHospital in one year.
Source of data collection-Children in the age group 3 months to 12 years admitted in paediatrics department of JSS Hospital Mysore with hypocalcaemia
1.Inclusion criteria
All children admitted with hypocalcaemia(serum calcium <7mg/dl corrected for normal serum albumin) between age group 3 months to 12 years.
2.Exclusion criteria
Nil.
3. Methods of data collection
All the children meeting inclusion criteria are admitted and selected as study group.
1. Data will be collected on a pre tested proforma.
2. Collecting blood samples for biochemical investigations, before starting any treatment for hypocalcaemia.
PTH will be measured by fully automated chemi luminescent assay. Further relevant investigations are done for aetiological diagnosis of cases.
Statistical analysis of outcome measures(primary hypoparathyroidism, secondary hypoparathyroidism and hyperparathyroidism secondary to vitamin D3 deficiency) on data collected on hypocalcaemicchildren.
The hypocalcaemia cases will be classified into three groups with low, normal and high PTH levels as per standard reference values for age. The association of biochemical parameters with PTH status, will be carried out by estimating mean and standard deviation. Analysis of variance will be done to test the significant difference between the three groups.
7.3 Does the study require any investigations to be conducted on patients or other humans or animals, if so describe briefly.
Yes, the investigations such as,
Serum calcium
Serum PTH
Serum phosphorus
Serum alkaline phosphatase
Serum vitamin D3 levels
Serum urea and creatinine
Serum magnesium
Serum albumin
7.4 Has the ethical clearance been obtained from your institution?
Yes. Obtained.
.
8 / LIST OF REFERENCES
- Hay W et al.disorders of calcium homeostasis:In:Current Diagnosis and Treatment in paediatrics, 18th edn. Eds. Hay Wet al. New York, Lange Medical books/Mcgraw-Hill, 2007;63-64.
- Umpaichitra V,Bastian W,Castells W, Hypocalcemia in children: pathogenesis and management. Clin pediatr.2001;40:305-312
- Cioffi M et al,Serum Concentrations of Intact Parathyroid Hormone in
- Singh et al. The investigation of hypocalcaemia and rickets.ArchDis child.2003; 88: 403-407
- Tauk S J et al. familial hypoparathroidism. Ind pediatr. 1999;36:714
hypocalcaemia in an infant.Ind pediatr,2002 ;39:297
7. Sharma J, Bajpai A, Kabra M, Menon PSN Madhulika.
Hypocalcaemia-clinical , biochemical, radiological follow up in a
tertiary hospital in India. Ind Pediatr. 2002 Mar; 39(3): 276-82.
8. Robinson P D The re-emerging burden of rickets: a decade of
experiencefrom Sydney. Arch Dis Child. 91(7):564-568, July 2006.
9. / SIGNATURE OF THE CANDIDATE
10. / REMARRKS OF THE GUIDE / Hypocalcaemia is a paediatric emergency. Every case should be evaluated properly for diagnosis of etiology. Hypoparathyroidism is one of the most important cause of hypocalcaemia which present with acute emergency or chronic persistant.Since the data regarding PTH status in hypocalcaemic children in Indian children is scarce in Indian children, this study will aimed at assessment of PTH status in hypocalcaemic children.
11 / NAME AND DESIGNATON OF
11.1 GUIDE / DR.V.G. MANJUNATH,
MBBS,DCH,DNB
ASSOCIATE PROFFESSOR,
DEPARTMENT OF PEDIATRICS
JSSMEDICALCOLLEGE, MYSORE
11.2 SIGNATURE OF GUIDE
11.3 CO-GUIDE
11.4 SIGNATURE OF CO GUIDE
11.5 HEAD OF THE DEPARTMENT / DR. D NARAYANAPPA M.D
PROFESSOR AND HOD,
DEPARTMENT OF PAEDIATRICS,
JSSMEDICALCOLLEGE, MYSORE
11.6 SIGNATURE OF HEAD OF DEPARTMENT
12 / 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL
12.2 SIGNATURE