bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patients With Primary Hyperparathyroidism Have Shorter QT/QTc Intervals
Authors: Stewart Latoya A , Steinl Gabrielle K , Huang Bernice L , McManus Catherine , Lee James A , Walker Marcella D , Kuo Jennifer H 
Published: May 2021

Abstract
Background: Previous studies suggest that patients with primary hyperparathyroidism (PHPT) have subclinical cardiovascular disease, but data regarding cardiac conduction abnormalities are limited. The aim of this study was to assess cardiac conduction abnormalities in patients with PHPT compared to controls with thyroid disease (TD).
Method: We conducted a retrospective analysis of patients over 40 years of age who underwent parathyroidectomy or thyroidectomy at a single tertiary institution between 2013 and 2018. Demographics and EKG parameters from pre-operative EKG reports were compared using the Mann-Whitney U and Chi Square tests. Regression was used to compare EKG differences between the PHPT and control groups adjusted for sex, age, and other variables found to be significant on univariate analysis.
Results: A total of 1181 patients were analyzed, 51% in the PHPT group (n=602) and 49% in the TD group (n=579). The median age was 60.5 years (IQR 53.5–67.9) and there was no difference in sex between the cohorts. PHPT patients had a higher prevalence of hyperlipidemia (HLD, 49% vs 36%, p&lt;0.001) and hypertension (HTN, 50.7% vs 42.1%, p&lt;0.01), but had no differences in EKG rhythm patterns or prevalence of arrhythmia compared to TD patients. As expected, mean serum calcium levels were higher for the PHPT group, 10.74 (0.66) vs 9.53 (0.44). However, the PHPT group included both normocalcemic and hypercalcemic patients. The PHPT group had a lower median QT interval compared to the TD group, 386ms (IQR 368–406) vs 398ms (IQR 376–418), p&lt;0.001 and a higher median PR value, 158ms (IQR 144–174.5) vs 156ms (IQR 143.5–171), p&lt;0.05. More PHPT patients (n=21, 3.5%) had a short QTc interval (&lt;360ms males/&lt;370ms females), compared to TD controls (n=1, 0.2%). Among PHPT patients with a short QT interval, the proportion of patients with hypercalcemia (95%) was higher than that of the PHPT group overall (75%). On multivariable analysis, PHPT patients had a shorter QT interval than TD controls after controlling for sex, age, HLD, HTN. There was no difference between PHPT and TD when serum calcium was included in the model, suggesting that calcium mediates the relationship between QT interval and disease status.
Conclusion: PHPT patients have shorter QT/QTc intervals compared to TD controls, but no increased prevalence of arrythmia at baseline. While the QT interval was associated with degree of serum calcium elevation, these findings in a large cohort suggest that PHPT is not associated with arrythmia at baseline among those undergoing parathyroidectomy.
Dress-Style Effect on Vitamin D3 Metabolic Profile
Authors: Odhaib Samih A , Alibrahim Nassar T Y , Zaboon Ibrahim A , Mansour Abbas A 
Published: May 2021

Abstract
Background and Objectives:Conservative clothing like niqab and hijab dress-style may affect the vitamin D metabolic parameters even in the predominantly sunny areas of the world, with adequate sunlight exposure throughout the year. Our objective is to evaluate the effect of wearing the niqab or hijab style on different vitamin D3 metabolic parameters in a sample of premenopausal women from Basrah. Methods: This was a cross-sectional observational study on premenopausal women who wore a niqab (n=64), with a comparable age-matched group of women who wore the hijab dress-style (n=60). Biochemical evaluation of the vitamin D3 metabolic profile involved 25-OH-vitamin D, corrected serum calcium, parathyroid hormone, phosphorus, and alkaline phosphatase estimation. Statistical comparison of these parameters was made using the independent sample t-test and Mann-Whitney-U test.
Results: The two groups of women were age- and weight-matched, with a median age was 39 years, and median body mass index (BMI) of 31.8 kg/m2. Overall, age, marital status, and BMI of women in both groups had no significant relationship to the vitamin D3 metabolic parameters (low 25-OH-vitamin D, low corrected calcium, and high parathyroid hormone). The subgroup analysis for women with the niqab showed the same results. Conclusions: Wearing niqab or hijab dress-style by the premenopausal women was not associated with any significant statistical relationship or difference in vitamin D3 metabolic parameters.
Vitamin D and Muscle Health: A Systematic Review and Metaanalysis of Randomized Placebo-Controlled Trials
Authors: Bislev Lise Sofie , Grove-Laugesen Diana , Rejnmark Lars 
Published: May 2021

Abstract
Background: Data regarding effects of vitamin D on muscle function are inconsistent. Discrepancies between observational and placebo-controlled studies are an indisputable fact. Objective: To investigate effects of vitamin D supplementation vs placebo on muscle health. Data Sources: A systematic research of published randomized controlled trials published until October 2020 has been conducted on Medline, Cochrane Database of Systematics Reviews, Embase and Google Scholar. Study Selection: Participants treated with vitamin D2 or vitamin D3 supplementation vs placebo, with or without calcium co-supplementation. All studies despite administration form (daily, bolus and duration) and populations, except athletes, were included. The pre-defined end-points were maximum muscle strength (Newton) measured as handgrip, elbow flexion, elbow extension, knee flexion, and knee extension. Physical performance reported as Timed Up and Go test (s), Chair Rising Test (s), 6 minutes walking distance (m) and Standard Physical Performance Battery (points). Finally, muscle mass in term of total lean mass (kg) was included. As the end-point measures were standardized, we apriori used random model effects and mean difference. Data Synthesis: In total, 51 randomized controlled trials involving 7798 individuals were included. Of included studies, 14 studies included participants with vitamin D insufficiency (25(OH)D&lt;50 nmol/l) as inclusion criteria (19% of individuals). Outlier studies (N=1) were excluded. Analyses revealed a significant negative effect of vitamin D supplementation on knee flexion strength, mean difference -3.3 N, 95% CI (-6.63 to -0.03), I2=0%, n=765. The majority (8/12) of the studies used dosages &gt; 2800 IU/day. Time spend performing the TUG test was also significant longer in individuals treated with vitamin D as compared with placebo, mean difference at 0.15 s (95% CI 0.04 to 0.26), I2=0%, n=5175. Excluding studies using bolus therapy or daily dosages &gt; 2800 IU, the negative findings were no longer significant. No significant effect was found on the other measures of muscle strength, physical performance or muscle mass. In the minority of studies using vitamin D insufficiency as inclusion criteria, subgroup analysis revealed comparable effects of vitamin D and placebo. Conclusions: Overall, vitamin D do not have a beneficial effect on muscle health in non-athletes and may in some cases even have a negative effect. Subgroup analysis suggest that this finding may be dose-dependent. Our data do not support a beneficial effect on muscle health in vitamin D insufficient individuals, albeit only a minority of included studies investigated individuals suffering from vitamin D insufficiency. As an increasing number of studies report negative musculoskeletal effects including an increased fall risk, this study support the theory, that vitamin D should be dosed with care.
Black Women Have a Worse Cardio-Metabolic Risk Profile Compared to White Women with Polycystic Ovary Syndrome in the United States: A Systematic Review and Meta-Analysis
Authors: Kazemi Maryam , Kim Joy Y , Parry Stephen A , Azziz Ricardo , Lujan Marla E 
Published: May 2021

Abstract
Health disparities may influence cardio-metabolic risk in women with polycystic ovary syndrome (PCOS). The magnitude and direction of differences in cardio-metabolic risk between Black and White women with PCOS remain uncertain due to inconsistent reports. We conducted a systematic review and meta-analysis to evaluate evidence on cardio-metabolic health disparities between Black and White women with PCOS in the US in response to the call for further delineation of these disparities by the International Evidence-based Guideline for the Assessment and Management of PCOS. Databases of MEDLINE, Web of Science, and Scopus were searched (January 1990 to September 2020) to identify observational studies documenting cardio-metabolic risk profile (glucoregulatory, lipid profile, anthropometric, blood pressure status) in Black and White women with PCOS. The primary outcome was fasting glucose. Further, cardiovascular events (stroke, coronary heart disease, heart failure) and mortality rate (cardiovascular death, total mortality) data were evaluated between groups. Studies on children (&lt; 17 yrs.), pregnant or menopausal-aged (&gt; 50 yrs.) women were excluded. Data were pooled by random-effects models and expressed as weighted mean differences and 95% confidence intervals. Eleven studies (n = 2,821; [626 Black; 2,195 White women]) evaluated cardio-metabolic risk profile, yet none reported on cardiovascular events/mortality rate. Black women had comparable fasting glucose (-0.61 [-1.69, 2.92] mg/dL; I2 = 62.5%), yet exhibited increased fasting insulin (6.76 [4.97, 8.56] µIU/mL; I2 = 59.0%); homeostatic model assessment of insulin resistance (HOMA-IR; 1.47 [0.86, 2.08]; I2 = 83.2%); systolic blood pressure (SBP, 3.32 [0.34, 6.30] mmHg; I2 = 52.0%) and decreased triglyceride (-32.56 [-54.69, -10.42] mg/dL; I2 = 68.0%) when compared to White women with PCOS (All: P ≤ 0.03). Groups were comparable in total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and diastolic blood pressure (All: P ≥ 0.06). Paucity in the number of studies that evaluated cardiovascular events or mortality limits any conclusions about potential disparities. Overall, Black women with PCOS have a greater tendency for an adverse cardio-metabolic risk profile (increased insulin, HOMA-IR, SBP), despite lower triglyceride levels than White women. Our observations support consideration of these disparities for diagnostic, monitoring, management, and public health practices, and for future guideline recommendations. Heterogeneity among studies warrants future research to address the relative contributions of biological, environmental, socioeconomic, and healthcare factors to the observed disparities. Longitudinal research should address cardiovascular events and mortality rate in Black women with PCOS (www.crd.york.ac.uk/PROSPERO ID, CRD42020183485).
Impact of Hypertriglyceridemia on Outcome of Adult Patient Admitted With Hyperthyroidism: Analysis of the National Inpatient Sample 2016–2017
Authors: Asemota Iriagbonse , Akuna Emmanuel , Shaka Hafeez , Edigin Ehizogie , Velazquez Genaro , Ojemolon Pius , Asotibe Jennifer Chiagoziem 
Published: May 2021

Abstract
Introduction: Thyroid dysfunction has a great impact on lipids as well as a number of other cardiovascular risk factors. Though the effect of thyroid hormones on plasma cholesterol concentrations are well-recognized, however, there are conflicting reports about the effect of thyroid hormone on the metabolism of plasma triglycerides. We sought to determine the effect of hypertriglyceridemia on patient admitted with hyperthyroidism. Methods: We queried the National Inpatient Sample (NIS) databases from 2016 to 2017 for adults aged 18 and above with hypertriglyceridemia as a principle diagnosis with and without hyperthyroidism using ICD-10 codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results: There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 17,705 hyperthyroidism hospitalizations, 15% had hypertriglyceridemia. Hypertriglyceridemia with hyperthyroidism had a similar odds of inpatient mortality (AOR 0.37, CI 0.06–1.99, P=0.246), acute kidney injury (AOR 1.03, CI 0.706–1.510, P=0.868) and cardiogenic shock (AOR 0.96, CI 0.134–6.72, P=0.963). There was a statistically significant increase in odds of acute respiratory failure (AOR 0.46, CI- 0.21- 0.99, P=0.048) in those hospitalized with hyperthyroidism and hypertriglyceridemia compared to those with hyperthyroidism alone. Conclusion: Hypertriglyceridemia is associated with similar outcomes in patient admitted for hyperthyroidism in terms of mortality, acute kidney injury and acute cardiogenic shock with an increased odd of acute respiratory failure. More research is needed to explain the pathophysiologic mechanism underlying the effect of hypertriglyceridemia on hyperthyroidism.
The Relationship Between the Aldosterone-to-Renin Ratio and Blood Pressure in Young Adults: A Longitudinal Study
Authors: Yang Jun , Gwini StellaMay , Beilin Lawrence J , Schlaich Markus , Stowasser Michael , Young Morag J , Fuller Peter J , Mori Trevor 
Published: May 2021

Abstract
Background: Hypertension tracks throughout childhood into adulthood. Aldosterone excess, or primary aldosteronism, has been reported as the most common secondary cause of hypertension in adults. Elevated aldosterone in the setting of low renin predicts incident hypertension in normotensive adults. However, the relationship between aldosterone and blood pressure in adolescents and young adults is unclear. Objectives: To evaluate the relationship between aldosterone, renin and the aldosterone:renin ratio (ARR) and blood pressure (BP) at age 17y as well as BP at age 27y in a community-based population. Methods: This is a prospective birth cohort study. Young adult offspring (Gen2) of women enrolled during pregnancy into the Raine Study, with 1239 at age 17y and 1006 at age 27y, were evaluated. Females taking hormonal contraception and participants without BP data were excluded from the current analysis. A generalised linear model was used to examine the relationship between BP and aldosterone, renin and ARR over time. The median aldosterone, renin and ARR was compared between sexes using quantile regression. Results: At 17y, females had similar aldosterone (349 vs 346 pmol/L, p=0.833) but significantly lower renin (20.6 vs 25.7 mU/L, p&lt;0.001) and thus a higher ARR (18.3 vs 13.5, p&lt;0.001) compared to males. However, they had lower systolic BP (109 vs 118 mmHg, p&lt; 0.001) versus males. A significant correlation between ARR and systolic BP was detected in 17y males when adjusted for alcohol consumption, physical activity, urinary sodium and body mass index. This was true when the ARR was expressed as a continuous variable (β-coefficient 0.1, p=0.009) or categorical variable (highest quartile, β-coefficient 3.15, p=0.003). A similar correlation was not observed in females at 17y. However, the ARR at 17y was significantly associated with both systolic (β-coefficient 0.15, p=0.009) and diastolic BP (β-coefficient 0.14, p=0.003) at 27y in females, but not males. Conclusion: A relationship between ARR and BP are observed at both 17 and 27 years but with distinct age-related sex differences. Further evaluation of the relationship between ARR and surrogate markers of cardiovascular disease such as vascular reactivity will improve our understanding of aldosterone as a cardiovascular risk factor young people.
Tolerability and Efficacy of Long-Term Medical Therapy in Primary Aldosteronism
Authors: Puar Troy , Tang Fengjie , Loh Lih-Ming , Foo Roger , Loh Wann Jia , Khoo Joan , Kek Peng Chin 
Published: May 2021

Abstract
Introduction: Patients with primary aldosteronism (PA) have increased cardiovascular risk and studies have found that medical therapy fails to ameliorate this. This may be due to side effects and limited efficacy of medications at tolerable doses. Methods: We conducted a retrospective study on 201 patients with PA treated with medical therapy (spironolactone, eplerenone or amiloride) for PA from 2000–2020 at two tertiary centres. Patients were assessed for efficacy to achieve clinical and biochemical control, and for side effects. Results: 53.7% of patients achieved blood pressure &lt;140/90mmHg, 44.6% achieved serum potassium ≥4.3mmol/L, and 63.2% achieved renin levels &gt;1ng/ml/hr. Concordance between biochemical control as assessed by potassium and renin levels was 49%. 45.3% of patients experienced side effects, with 8.5% switching to another medication, 18.9% decreasing dose, and 10.0% stopping medications altogether. Risk factors for side effects were spironolactone use, dose ≥50mg, duration of treatment ≥1 year, male gender and unilateral PA. Patients with unilateral PA, compared to bilateral PA, used higher median doses of spironolactone, 75mg vs 50mg, P&lt;0.001, but more had persistent hypokalemia, 20.5% versus 6.4%, P=0.007. 44 patients with unilateral PA underwent surgery after initial medical therapy, which further improved systolic and diastolic BP, from 142 to 134mmHg, P&lt;0.001, and from 85 to 79mmHg, P&lt;0.001, respectively. Conclusion: Dose-dependent side effects limit the efficacy of medical therapy in PA. Future prospective studies should assess the best monitoring strategy for biochemical control during long-term medical therapy. In patients with unilateral PA, surgery remains a better option compared to life-long medications.
Trends in Serum Lipid Profiles and Lifestyle Factors Among Korean Adolescents, 2007–2018
Authors: Kim Shin-Hye , Park Mi-Jung 
Published: May 2021

Abstract
Objectives: Trends in serum lipids among teenagers would be crucial predictors of potential cardiovascular disease in adults. We aimed to investigate the trends in lipid profiles and related factors, including obesity, smoking, exercise, alcohol use, and total fat intakes in Korean adolescents from 2007 to 2018. Methods: We analyzed 5,967 participants aged 12–19 yrs from the Korea NHANES 2007–2018. Fasting total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) levels were measured. Results: All kinds of lipid profiles, except TG, showed increasing trends from 2007 to 2018 (P&lt;0.01). Nevertheless, the prevalence of dyslipidemia showed a trend of decreasing in boys (from 33.3 to 26.6%; P=0.002) and maintained in girls (from 28.4 to 30.2%; P=0.465), mainly due to a substantial decrease in hypo-HDL-cholesterolemia (9% reduction in boys, 5% reduction in girls). This occurred amid an increasing trend of central obesity in boys (P&lt;0.001). In lifestyle factors, there were no significant changes in alcohol use and muscle-strengthening exercise, while a substantial decrease in smoking rate was observed. A favorable effect of muscle-strengthening exercise on both TG and HDL-C and an unfavorable impact of smoking on HDL-C were observed. Alcohol use was associated with higher HDL-C in both genders, but it showed opposite associations with TG between boys (unfavorable) and girls (favorable). Regarding dietary factors, there were increasing trends in total fat intakes and the percentage of energy supply from total dietary fat (〔total fat (%E)〕 in both genders. In boys, an increase in total fat (%E) was related to the higher HDL-C in normal-weight subjects (P&lt;0.01 in both genders); however, it was associated with higher LDL-C in overweight girls (P=0.001). Conclusions: Increases in fat intakes and a decline in smoking rates appeared to have positively impacted HDL-C in Korean adolescents over the past 12 years. We confirmed a rise in fat intakes was linked with the increase in LDL-C among overweight adolescents. Therefore, close monitoring for the dyslipidemia prevalence is essential in Korean adolescents whose obesity prevalence is on the rise.
A Case of Fishy Smell-Fish Malodor Syndrome
Authors: Wang Ally W , Greenberg Pietra D , Saul Shira R 
Published: May 2021

Abstract
Introduction: Primary trimethylaminuria (TMAU), also known as fish malodor syndrome is a rare condition that is characterized by trimethylamine excess. The hallmark of this condition is a body malodor similar to decaying fish. As this metabolic disorder is uncommon, this case highlights the management options for an endocrinologist.
Case presentation: A 56-year-old man was referred to the endocrine clinic for TMAU. Starting in puberty, the patient’s family and friends noted a malodor that he has never been able to detect. After several decades, the patient was diagnosed clinically by a dermatologist. Since then, the patient’s management had included avoiding cholines in his diet, which included egg yolks and salt-water fish. Additionally, for severe episodes occurring once to twice a year, he took a cup of charcoal daily plus Metronidazole 500 mg twice a day for ten days. The patient was the only member of his family with this condition. Physical exam was unremarkable expect for a faint malodor. Metronidazole, charcoal, and a genetics consult were ordered.
Discussion: TMAU is a rare metabolic disorder in which an individual is not able to convert trimethylamine into trimethylamine N-oxide due to a defect in the hepatic oxidase system. It results from a mutation in the flavin-containing monooxygenase 3 gene (FMO3) that is inherited via autosomal recessive pattern. An excess excretion of trimethylamine in the urine, breath, sweat, and reproductive fluids results in a body malodor similar to that of decaying fish. The odor may be exacerbated by increase in body temperature, emotional changes, puberty, and prior to and during menstruation in women and often results in distressing psychosocial difficulties. Thus, early institution of dietary and pharmacological measures will likely have a major impact on quality of life.
Treatment options are limited and include topical, dietary, and medications. Topical approaches include antiperspirants, deodorants, and pH-balanced soap. A diet low in choline-containing foods such as dairy, beans, and marine fish is beneficial as choline is metabolized to trimethylamine by the intestinal bacteria. For severe cases, antibiotics such as Metronidazole, Rifaximin, and Neomycin sulfate are helpful to reduce the intestinal bacterial load. Other therapeutic strategies consist of activated charcoal (750 mg twice a day for ten days) and copper chlorphyllin (60 mg three times a day for three weeks); both reduce urinary free trimethylamine and increase the concentration of trimethylamine N-oxide.