Introduction Despite the high prevalence of hypocalcemia in patients with COVID-19, very limited studies have been designed to evaluate etiologies of this disorder. This study was designed to evaluate the status of serum parameters involved in calcium metabolism in patients with COVID-19 and hypocalcemia. Materials and methods This cross-sectional study was conducted on 123 hospitalized patients with COVID-19. Serum concentrations of PTH, 25 (OH) D, magnesium, phosphate, and albumin were assessed and compared across three groups of moderate/severe hypocalcemia (serum total calcium < 8 mg/dl), mild hypocalcemia (8 mg/dl ≤ serum total calcium < 8.5 mg/dl) and normocalcemia (serum total calcium ≥ 8.5 mg/dl). Multivariate analyses were performed to evaluate the independent roles of serum parameters in hypocalcemia. Results In total, 65.9% of the patients had hypocalcemia. Vitamin D deficiency was found in 44.4% and 37.7% of moderate/severe and mild hypocalcemia cases, respectively, compared to 7.1% in the normal serum total calcium group ( P = 0.003). In multivariate analysis, vitamin D deficiency was independently associated with 6.2 times higher risk of hypocalcemia ( P = 0.001). Only a minority of patients with hypocalcemia had appropriately high PTH (15.1% and 14.3% in mild and moderate/severe hypocalcemia, respectively). Serum PTH was low/low-normal in 40.0% of patients with moderate/severe low-corrected calcium group. Magnesium deficiency was not associated with hypocalcemia in univariate and multivariate analysis. Conclusion Vitamin D deficiency plays a major role in hypocalcemia among hospitalized patients with COVID-19. Inappropriately low/low-normal serum PTH may be a contributing factor in this disorder.

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10.30699/jambs.28.129.218 Tuberculous empyema (TE) is an uncommon form of pleural tuberculous (TB). Although the incidence of TE has significantly decreased, it still threatens public health. Patients with TE experience a protracted illness and significant morbidity and mortality risk. Male sex is a significant risk factor for TE. Herein, we report an adult case of TE admitted to a tertiary care hospital of Iran with clinical characteristics, treatment modalities, and outcomes of this disease. The duration of illness and duration of chest tube drainage equaled 7 months and 48 days, respectively. Our patient required surgery despite the administration of antituberculosis drugs and chest tube drainage. Due to the presence of parenchymal lesions, bronchopleural fistula, and failure of lung re-expansion after chest tube insertion, the patient required decortication with the closure of the bronchopleural fistula and additional thoracoplasty. In the case presentation, we emphasize difficulties encountered in the treatment of such patients.

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