LIFE-THREATENING HYPOCALCEMIA IN A PATIENT WITH HIGHLY SUSPECTED OSTEOMALACIA: A CASE REPORT

ABSTRACT: Objective: Osteomalacia is a metabolic bone disease characterized by impaired mineralization with increased non-mineralized osteoid tissue, increased frailty, and reduced bone mineral density. A common cause of osteomalacia in adults and the elderly is severe deficiency of vitamin D, which leads to chronic hypocalcemia, hypophosphatemia, and secondary hyperparathyroidism. The objective of this case report is to describe an unusual clinical presentation of osteomalacia, consisting of life-threatening acute hypocalcemia.Methods: Clinical, laboratory, and imaging data are presented.Results: We report the case of a 65-year-old man that showed symptoms and signs of severe and prolonged hypocalcemia due to unrecognized vitamin D deficiency. He presented at the emergency room reporting abdominal pain and vomiting since the evening before. Blood tests showed increased levels of rhabdomyolysis markers, severe hypocalcemia, hypophosphatemia, hypomagnesemia, normal renal function, elevated levels of alkaline phosphatase, extremely high levels of parathyroid hormone, and hypovitaminosis D. Radiological skeletal features of bone demineralization and bone abnormalities suggestive of osteomalacia were additionally detected. Other secondary causes of hypocalcemia were excluded. Clinical and biochemical resolution were progressively obtained only after an intramuscular loading dose of cholecalciferol was added to the standard calcium intravenous replacement therapy.Conclusion: This case report shows that osteomalacia consequent to a severe vitamin D deficiency can present with acute symptoms and signs of severe hypocalcemia requiring hospital admission. In such cases, vitamin D administration, and not intensive calcium supplementation alone, is essential to achieve clinical resolution of symptoms and normalization of mineral metabolism parameters.Abbreviations: 25-OH-D 25-hydroxyvitamin D CT computed tomography IV intravenous PTH parathyroid hormon

A 15-Year-Old Boy with Anterior Chest Pain, Progressive Dyspnea, and Subcutaneous Emphysema of the Neck

We describe the case of an adolescent who was admitted to the hospital because of sudden occurrence of chest pain, dyspnea and subcutaneous emphysema. On admission, physical examination revealed subcutaneous crepitations in the superior part of the rib cage, and auscultation of the chest showed widespread wheezing. The radiological assessment confirmed the diagnosis of pneumomediastinum and pneumothorax. A follow-up CT scan performed one week after the admission showed almost complete resolution of the radiological alterations. At the following visits, the patient was asymptomatic, but reported to have suffered from frequent episodes of rhinorrea, sneezing, nasal blockage, and sometimes, chest tightness, especially during exposure to pets and/or windy weather. Skin prick testing showed sensitivities to dermatophagoides pteronyssinus and farinae, grass pollen and dog dander. Spirometry documented significant improvement in lung function after short-acting bronchodilator, allowing for the diagnosis of asthma to be made. Although pneumomediastinum may be a complication of various respiratory diseases, including asthma, it has never been reported as the first presentation of underlying bronchial asthma. Herein, the physiopathological mechanisms, the diagnostic procedures and treatment of pneumomediastinum in asthma are discussed. We suggest that the diagnosis of asthma should be considered in the differential diagnosis of pneumomediastinum in adolescence

Klotho and vitamin D in multiple sclerosis: an Italian study

Introduction Low vitamin D levels have been recognised as an important risk factor for autoimmune diseases, including multiple sclerosis (MS). MS is a multifactorial disease, the pathogenesis of which contributes both to genetic and environmental factors. Polymorphisms in genes codifying molecules involved in vitamin D homeostasis have been associated with hypovitaminosis D. However, the influence of polymorphisms of Klotho, which codify a protein with a pivotal role in vitamin D metabolism, have never been investigated. The aim of this study was to evaluate the association among genetic variants of Klotho, namely rs1207568 and rs9536314, serum 25(OH)D3 levels, and multiple sclerosis (both risk and disease progression). Material and methods 107 patients with MS and 133 healthy controls were enrolled in this study. Serum 25(OH)D3 levels and genotyping of Klotho SNPs were evaluated in all participants by high-performance liquid chromatography and real-time polymerase chain reaction, respectively. Results Allelic and genotypic frequencies did not differ between patients and controls. Concerning rs1207568, we found a trend toward lower serum 25(OH)D3 levels in MS patients with A allele (mutant), both in heterozygosis (AG) and in homozygosis (AA), in comparison to MS patients with G allele in homozygosis (GG) (AG + AA 20.5 ±6.3 µg/l; GG 22.5 ±7.5 µg/l, p = 0.07). Conclusions Our findings did not identify a role of Klotho in the genetic susceptibility to MS

Circular economy and agritourism: a sustainable behavioral model for tourists and farmers in the post-COVID era.

Introduction: In recent years, issues related to environmental and ecosystem protection have been given greater consideration than in the past. The goal of adopting sustainable development models is vigorously pursued in the European Union and is reflected concretely in the new Common Agricultural Policy 20232027. The circular economy can certainly be an emerging economic response that can eectively replace growth models centered on a linear view. Agriculture and tourism are two crucial sectors where the “green transition” should be encouraged to help achieve sustainability goals through economic circularity. Agritourism’s activity may be relevant in contributing to a behavioral change based on ethical choices. The study aim is to find out if agritourism can be the forerunner for the green transition. The objective is to know motivations and current level of awareness and adoption of concrete behaviors of the circular economy by agritourisms and their guests. The tourists’ preferences for Sicilian agritourism oerings were also observed. Methods: Two types of surveys were conducted: a Census of the Sicilian Agritourisms active at an online travel agency and a sampling survey of the agritourism’s visitors. Results and discussion: The results showed that agritourism by its very nature carries the green transition, partly due to the enormous financial support of the new CAP. Second, it is a provider of quality food and ecosystem services, and a promoter of healthy behaviors and consumption of seasonal and local short-chain products by visitors, so it can be a vehicle for the adoption of the Mediterranean Diet as a sustainable lifestyle and food system. Tourists’ propensity to seek out environmentally friendly products and green services can help to improve ethical, responsible, and sustainable tourism. A sustainable behavioral model for farmers and tourists was provided

Integrated techniques to evaluate the features of sedimentary rocks of archaeological areas of Sicily

Sicily includes a great variety of lithologies, giving a high complexity to the geologic landscape. Their prevalent lithology is sedimentary. It is well known that rocks of sedimentary origin, compared with metamorphic and volcanic deposits, can be relatively soft and hence fairly easy to model. Nevertheless, this workability advantage is a drawback for Cultural Heritage applications. In fact, these materials show a high porosity, with pore-size distributions that lead to deterioration through absorption of water. In this paper, several sedimentary rocks used in historical Cultural Heritage items of Sicily, from "Magna Graecia" to nowadays, are classified for mineralogical features, chemical composition, and for porosity. Particularly, some samples collected in quarries relevant to the archaeological sites of 41 Agrigento, Segesta and Selinunte will be considered and characterized using integrated techniques (XRD, XRF, NMR and CT). Data on samples obtained in laboratory will be compared with the relevant values measured in situ on monuments of historical-cultural interest of the quoted archaeological places