Steroid Use Research Articles

Fungal Keratitis in Northwestern Spain: Epidemiology, Risk Factors and Outcomes.

To review the clinical features, risk factors, microbiological profile, and treatment regimens of fungal keratitis in Galicia, a region in Northwestern Spain with temperate humid weather. A retrospective case series was employed, including patients with fungal keratitis from nine hospitals within the region of Galicia, Spain, between 2010 and 2020. Data obtained from clinical records were analysed. Out of 654 cases of infectious keratitis, 77 cases (9.9%) were identified as fungal keratitis. The median age of affected patients was 68.0 years, with a higher incidence in rural areas (62.3%). Candida spp. infections were the most frequent type (55.8%) and were associated with a higher median age than were the non-dermatophyte mould infections. The primary risk factors included steroid eyedrop use (29.9%), recent keratoplasty (18.2%), ocular trauma (19.5%), and contact with vegetable matter (11.7%). Most ulcers displayed stromal involvement, and 37.7% presented corneal thinning. The median duration of infection was longer in fungal than in bacterial keratitis, and surgical intervention was required in 48.1% of cases. Fungal keratitis, mainly involving Candida spp., accounted for 9.9% of microbial keratitis cases in Galicia, Spain, with significant risk factors being topical steroid use, ocular trauma, and contact with vegetable matter. Delayed diagnosis often resulted in poor outcomes, highlighting the need for early detection through awareness and new technologies to improve prognosis.

First-Line Chemo-Immunotherapy in SCLC: Outcomes of a Binational Real-World Study

IntroductionSCLC is characterized by aggressiveness and limited treatment options, especially in extensive-stage SCLC (ES-SCLC). Immunotherapy added to the platinum-etoposide combination has recently become standard in this setting. This retrospective study aims to evaluate the real-world effectiveness of chemo-immunotherapy in patients with ES-SCLC, focusing on subpopulations excluded from clinical trials. MethodsA retrospective binational multicenter study was conducted, involving consecutive patients with ES-SCLC from 10 British and 10 Swiss institutions. Patients received platinum-etoposide chemotherapy in combination with immunotherapy (atezolizumab or durvalumab). Patient, tumor, and treatment details were collected. Overall survival (OS), progression-free survival, overall response rate, and safety outcomes were analyzed. ResultsA total of 436 patients were included. One hundred forty-two patients (32.6%) in our cohort would not have been eligible for the pivotal registrational trials owing to an Eastern Cooperative Oncology Group performance status of 2 or higher, autoimmune disease, active brain metastases, and/or steroid use. Most patients received carboplatin (96.8%) and atezolizumab (97.9%). The median progression-free survival was 5.5 months and the median OS was 9.3 months. The two-year OS was 14%. Patients with liver or bone metastases or an Eastern Cooperative Oncology Group performance status of 2 or higher had worse survival outcomes. Treatment-related adverse events were reported in 222 patients (51%) whereas immune-related adverse events occurred in 95 patients (22%). Three out of five grade 5 immune-related adverse events were caused by pneumonitis. ConclusionsTo our knowledge, this is the largest real-world cohort of patients treated with chemo-immunotherapy for ES-SCLC. Although one-third of patients would not have been eligible for pivotal trials, the survival outcomes in our cohort are similar to those in registrational trials. In particular, the number of long-term survivors and the safety data are comparable, supporting the use of chemo-immunotherapy as first-line treatment for ES-SCLC in daily clinical practice.

Successful use of therapeutic plasma exchange for the management of acute lung transplant rejection secondary to immune checkpoint inhibitor therapy

The use of immune checkpoint inhibitors (ICIs) in individuals with a history of solid organ transplantation is fraught with the emergence of solid organ transplantation rejection (SOTR). The current recommendations for the management of SOTRs secondary to ICI include the use of high-dose steroids along with the escalation of immunosuppressive therapy. Therapeutic Plasma Exchange (TPE) has been described to be effective in managing various immune-related toxicities, however, the data for using TPE in the setting of acute SOTRs induced by ICIs are limited. Herein, we describe the successful use of TPE in a patient with a history of bilateral lung transplantation who developed an episode of mixed acute cellular and antibody-mediated lung transplant rejection after a single dose of PD-1 inhibitor Pembrolizumab for the treatment of underlying melanoma.

An Update on Spinal Cord Injury and Current Management

» Spinal cord injury is associated with increased lifelong cost and decreased life expectancy.» Current treatment guidelines have been limited to studies of small effect sizes and limited availability of randomized control trials.» Recovery is best correlated with the initial American Spinal Injury Association impairment scale grade with A and B less likely to recover regarding ambulation as compared with C and D grades.» Surgical intervention within less than 24 hours, especially in the cervical spine, has been associated with some motor improvement.» The use of mean arterial pressure goals and steroids to maintain perfusion and decrease secondary injury requires further study to elucidate clearer evidence-based results.

Development an automated and high -throughput analysis methods for detecting 64 anabolic androgenic steroids in urine using gas chromatography-mass spectrometry

A gas chromatography tandem mass spectrometry (GC–MS/MS) assay was developed for the simultaneous detection of 64 anabolic androgenic steroids (AAS). Urine is extracted with tertbutyl methyl ether under alkaline conditions, purified with C18, and derived through silanization, Detection is carried out in dynamic multiple reaction monitoring (dMRM) mode, The overall recoveries ranged from 74.31 % to 119.66 %, The relative standard deviation is <10 %, with a linear range of 1–200 ng/ml, The linear range of endogenous androsterone (A) and etiocholanolone (Etio) is 1.7–10,000 ng/ml, with a correlation coefficient 0.9991– 0.9999. The limit of detection (LOD) range of this experiment was 0.2 ng/ml-1.2 ng/ml, and limit of quantification (LOQ) was 0.7 ng/ml-4 ng/ml, The results of testing 100 actual samples show that this method is simple, effective and feasible, and can be used for the detection of AAS, meeting the requirements of the World Anti Doping Agency (WADA)

Neglected Pulmonary Infection Caused by Exophiala dermatitidis Misidentified as Rhodotorula spp.

Exophiala dermatitidis is an emerging black fungus that causes pulmonary infections that may be underestimated by conventional culture methods. We encountered one case that initially appeared to be yeast and was misidentified as Rhodotorula spp. using a commercial identification kit. Thus, genetic identification and clinical background investigations were conducted on 46 strains of Rhodotorula spp. The sequences of the internal transcribed spacer and large-subunit RNA genes (D1/D2 regions) of 43 isolates, excluding two environmental isolates and one difficult-to-culture isolate, were determined and genetically identified. Notably, 22 isolates were identified as E. dermatitidis and misidentified as Rhodotorula spp. using the conventional method. Based on the exclusion criteria, the clinical information of 11 patients was retrospectively reviewed. Five cases (definite) had definite exacerbation of pulmonary infections due to E. dermatitidis, and six cases (possible) had undeniable infections. Of the 11 cases of pulmonary infection suggested to be caused by E. dermatitidis, comorbidities included two cases of chronic pulmonary aspergillosis (CPA), three cases of pulmonary non-tuberculous mycobacterial (NTM) infection and one case of pulmonary nocardiosis, suggesting a trend towards simultaneous detection of chronic pulmonary infections. Steroid and immunosuppressive drug use was observed in five cases, and β-D-glucan elevation was observed in three of five definite cases of pulmonary infections due to E. dermatitidis. The possibility of E. dermatitidis infection should be considered when Rhodotorula spp. are isolated from cultures of airway-derived specimens, and, in addition to CPA and NTM, identification of E. dermatitidis may be important in chronic pulmonary infections.

Illicit Anabolic-Androgenic Steroid Induced Vascular Occlusions In Weightlifters: A Tale Of Two Cases

Illicit Anabolic-Androgenic Steroid Induced Vascular Occlusions In Weightlifters: A Tale Of Two Cases

Adrenocorticotropic hormone: Therapeutic use and effects in nephrotic syndrome

Background: NS is defined by the presence of significant proteinuria, which leads to low levels of albumin in the blood and the development of edema. This occurs as a result of damage to the glomerular filtration barrier. Corticosteroids are the main therapeutic approach for NS. Prolonged usage of steroids can result in numerous side effects, including steroid resistant NS, which poses a difficult challenge for treatment and can cause substantial morbidity and mortality. Although efforts have been made to decrease the use of steroids by employing non-steroidal immunosuppressive drugs for rapid recovery, these treatments have also exhibited adverse consequences. These difficulties have prompted the notion of utilizing ACTH in these situations. Objective: This study seeks to analyze the efficacy of ACTH by thoroughly examining its mechanism and comparing it to conventional treatment for NS. Summary and important messages: The study demonstrates that ACTH has the potential to not only decrease protein loss but also reduce the occurrence of relapses and the amount of glucosteroids required. This suggests that ACTH could be a viable treatment alternative. The exact mechanism is currently unidentified, while the MCR1 agonism linked to ACTH suggest a renoprotective mechanism that is beneficial in NS. A comprehensive analysis using a large-scale randomized controlled trial is necessary to fully comprehend the effectiveness and safety profile of ACTH in improving the quality of care for patients.

Oral and radiological features of mucormycosis in post-Covid patients – a clinical study

Introduction. Mucormycosis, commonly referred to as “black fungus,” has emerged as a life-threatening opportunistic infection, particularly in post-COVID patients. This study aims to evaluate the clinical, radiological, and treatment-related features of mucormycosis in post-COVID patients and assess their outcomes. Materials and methods. This observational clinical study was conducted from April 2021 to October 2021, involving 50 consecutive post-COVID patients who presented with clinical and radiological features of mucormycosis. Demographic data, clinical symptoms, comorbidities, laboratory investigations, radiological findings, and treatment details were collected. Patients underwent computed tomography (CT) to assess bone involvement, sinus, and orbital involvement. Treatment regimens, including antifungal therapy and surgical interventions, were recorded. Patients were followed up for recurrence and long-term outcomes. Results. The majority of the patients were males (58%) and in the 31-45 age group (34%). Diabetes mellitus (60%) and steroid use (80%) were the most common comorbidities. Clinically, 70% of patients presented with soft tissue swelling or necrosis, and 44% had black eschar on the palate. CT findings revealed maxillary bone involvement in 56% of cases and sinus involvement in 50%. Orbital involvement was noted in 20%. Amphotericin B was the most commonly used antifungal therapy (70%), and 60% of patients underwent debridement. The overall recovery rate was 70%, with a recurrence rate of 16%. Facial deformities or ongoing oral issues were noted in 24% of patients during follow-up. Conclusion. Mucormycosis in post-COVID patients is associated with high morbidity, particularly in those with diabetes and those treated with corticosteroids. Antifungal therapy combined with surgical intervention yielded a 70% recovery rate, although recurrence and long-term complications were observed. Early diagnosis, appropriate antifungal therapy, and aggressive surgical management are critical to improving outcomes. Preventive strategies, including better management of comorbidities and judicious use of steroids, are essential in reducing the burden of mucormycosis in post-COVID patients.

Naproxen-induced liver injury in a case of adult-onset Still's disease.

We present the case of a young female with fever, rash, and joint pain without any other history of connective tissue disorder, who was found on evaluation to have neutrophilic leucocytosis, elevated inflammatory markers and lymphadenopathy with hepatosplenomegaly. After extensive workup, the possibility of adult onset Still's disease was suggested by Yamaguchi criteria. She was started on naproxen, but later on developed drug-induced liver injury. She already had central serous retinopathy due to steroid use, and it was difficult to treat the adult-onset Stills disease due to the liver injury in view of contraindication to use of anti-inflammatory drugs but her illness was monocyclic and did not require further immunosuppression.

Developing an automated algorithm for identification of children and adolescents with diabetes using electronic health records from the OneFlorida+ clinical research network.

To develop an automated computable phenotype (CP) algorithm for identifying diabetes cases in children and adolescents usingelectronic health records (EHRs) from the UF Health System. The CP algorithm was iteratively derived based on structured data from EHRs (UF Health System 2012-2020). We randomly selected 536 presumed cases among individuals aged <18 years who had (1) glycated haemoglobin levels ≥ 6.5%; or (2) fasting glucose levels ≥126 mg/dL; or (3) random plasma glucose levels ≥200 mg/dL; or (4) a diabetes-related diagnosis code from an inpatient or outpatient encounter; or (5) prescribed, administered, or dispensed diabetes-related medication. Four reviewers independently reviewed the patient charts to determine diabetes status and type. Presumed cases without type 1 (T1D) or type 2 diabetes (T2D) diagnosis codes were categorized as non-diabetes/other types of diabetes. The rest were categorized as T1D if the most recent diagnosis was T1D, or otherwise categorized as T2D if the most recent diagnosis was T2D. Next, we applied a list of diagnoses and procedures that can determine diabetes type (e.g., steroid use suggests induced diabetes) to correct misclassifications from Step 1. Among the 536 reviewed cases, 159 and 64 had T1D and T2D, respectively. The sensitivity, specificity, and positive predictive values of the CP algorithm were 94%, 98% and 96%, respectively, for T1D and 95%, 95% and 73% for T2D. We developed a highly accurate EHR-based CP for diabetes in youth based on EHR data from UF Health. Consistent with prior studies, T2D was more difficult to identify using these methods.

The Value of VFA (Vertebral Fracture Assessment) in Routine DXA Scanning

Abstract Background Low-trauma vertebral fractures are strongly predictive of future fracture risk so are generally given osteoporosis treatment regardless of bone density readings, and for every vertebral fracture presenting clinically, it is estimated that there are another two which are ‘silent’ or may have been ascribed to mechanical back pain. VFA (vertebral fracture assessment) during DXA scanning is a means of assessing the lateral spine for evidence of fractures which may have been undiagnosed prior. The International Society of Clinical Densitometry (ISCD) recommends a VFA in those with a T score &amp;lt;-1.0 plus one of: women ≥70 years, men ≥80 years, historical height loss &amp;gt;4cm, self-reported but undocumented prior vertebral fracture, regular use of steroids. Methods We developed a nurse-led DXA service in late 2021, conducting all scans in according with ISCD and HIQA guidelines however we do VFA on all patients aged over 50 years as it adds minimal time and negligible radiation exposure. In 2023 we commenced recording whether VFA fractures were previously diagnosed, in order to evaluate the benefits of VFA and so determine ongoing practice. To this end, we reviewed all DXA results since service launch for VFA evidence of fractures, and for patients from the calendar year 2023, we noted questionnaire responses and referral information as to whether any vertebral fracture was known of prior. Results There were 3,759 DXA scans conducted over the 24-month period 2022-2023 of whom n=3,299 had VFA performed. N=470/3,299 (14%) had a fracture identified on VFA. In the year 2023 only, of the n=289/1,795 (16%) who had a fracture on VFA, n=96 of these had not been diagnosed previously, representing a screening pick up rate of 5%. Conclusion VFA is a high-yield investigation for detecting undiagnosed vertebral fractures. As these fractures have definite treatment implications, wider use of VFA should be considered with routine DXA.

Vitamin D Deficiency Is Associated With An Increased Risk of Diabetes In Older Irish Adults: Results From The TUDA Study

Abstract Background Several studies have shown that vitamin D deficiency may increase the risk of developing type II diabetes and prediabetes. However, the data are inconsistent. Vitamin D may improve insulin sensitivity and pancreatic beta cell function, which could influence diabetes risk. We aimed to examine the relationship between vitamin D deficiency and type II diabetes in older Irish adults. Methods Study participants were from a cross-sectional study of adults aged &amp;gt; 60 years; Trinity Ulster University Department of Agriculture (TUDA) study. Diabetes was defined by self-report, use of diabetic medications or HBA1c ≥ 6.5%. Vitamin D deficiency was defined as 25(OH)D &amp;lt; 30 nmol/l. The relationship between vitamin D deficiency and diabetes was explored in multivariate logistic regression adjusting for age, sex, BMI, waist hip ratio, season, vitamin D supplement use, timed up and go, alcohol intake, current or previous steroid use, smoking, use of statins and socioeconomic status. Results There were 5171 participants (67.2% female, mean age 74.0 years) of whom 19.7% were vitamin D deficient and 15.7% had diabetes. Vitamin D deficiency versus non-deficiency was associated with an increased risk of diabetes both before and after multivariate adjustment (OR 1.46, 1.98-1.79, p&amp;lt;0.0002). Conclusion Vitamin D deficiency was associated with a 46% increased risk of having type II diabetes. However, the results of longitudinal studies and randomised trials have produced inconsistent results, though many had participants with higher baseline 25(OH)D status. A recent review of 46 trials of vitamin D supplementation found that it may reduce Hba1c in diabetics with vitamin D deficiency. Well designed trials to assess the potential effect of vitamin D supplementation on diabetic risk should be conducted.

Attitudes of anabolic steroid users and non-users towards general practitioners in the United Kingdom

BackgroundResearch from past decades has suggested that anabolic-androgenic steroid (AAS) users are often sceptical of their physicians’ level of knowledge regarding AAS. We questioned whether contemporary British AAS users and non-AAS-using weightlifters would display similar distrust of their general practitioners. MethodsWe distributed anonymous questionnaires to 61 AAS-using and 106 non-AAS-using male British weightlifters at gymnasiums and via online social media sites. Respondents rated their general practitioners’ knowledge regarding health- and drug-related topics, using 10-point Likert scales from 0 (worst) to 10 (best). AAS users also rated their degree of trust in various sources of information about AAS, using similar scales, and were asked whether they had disclosed their AAS use to various categories of individuals. We then compared our findings with the results from a 2004 American study that had used virtually identical methodology. ResultsBoth AAS-using and non-using weightlifters rated their general practitioners favourably on knowledge of general health and disease, cigarette smoking, and alcohol, with mean scores ranging from 6.8 to 8.7. However, respondents scored their general practitioners significantly lower on knowledge of AAS, with mean ratings of 4.3 to 4.9 from AAS non-users and only 2.4 to 2.9 from users. Among various sources of information about AAS, users trusted their doctors significantly less than “underground” guides or Internet sites. Only 22 (36 %) of the AAS users had ever disclosed their use of these drugs to any physician. These findings closely resembled those of the earlier American study, with contemporary British men reporting even greater mistrust of their physicians on weightlifting- and AAS-related topics than their American counterparts. ConclusionDespite increasing AAS use worldwide and mounting evidence of the long-term dangers of these drugs, contemporary British weightlifters in general and AAS users in particular appear to remain distrustful of their physicians’ knowledge of fitness sports, performance-enhancing supplements, and especially AAS.

Risk analysis of postoperative nausea and vomiting in patients after gynecologic laparoscopic surgery

AimsThis study is designed to identify risk factors of postoperative nausea and vomiting (PONV) in patients after gynecologic laparoscopic surgery and establish a nomogram model.MethodsIn this retrospective and multicenter study, we collected and analyzed data from 1233 patients who underwent gynecologic laparoscopic surgery. The Lasso algorithm was used to optimize the selection of independent variables in the development group. Multivariate logistic regression analysis was used to explore the risk factors of PONV to develop the predictive nomogram model. Finally, we used an internal and external verification group and machine learning (ML) to evaluate the accuracy and clinical applicability of the model.ResultsThe dosage of sufentanil in patient-controlled intravenous analgesia (PCIA), the dosage of remifentanil, the use of neostigmine, duration of surgery and the maximum value of the PETCO2 were risk factors of PONV in patients after gynecologic laparoscopic surgery. In contrast, the dosage of propofol during the surgery and the use of steroids were protective factors. The nomogram was then established to predict the incidence of PONV in these patients based on the above eight indicators. The C-index of the development group, internal, and external verification groups are 0.802, 0.857, and 0.966, respectively.ConclusionA nomogram model was developed to predict the incidence of PONV in patients after gynecologic laparoscopic surgery. This model was found to be reliable and of high clinical value.

Impact of catastrophic brain injury guidelines on organ donation rates: Results of an EAST multicenter trial.

One third of organ donors suffer catastrophic brain injury (CBI). There are no standard guidelines for the management of traumatic CBI prior to brain death, and not all trauma centers have institutional CBI guidelines. In addition, there is high variability in management between institutions with guidelines. Catastrophic brain injury guidelines vary and may include various combinations of hormone therapy, vasopressors, fluid resuscitation, and other practices. We hypothesized that centers with CBI guidelines have higher organ donation rates than those without. This prospective, observational EAST-sponsored multicenter trial included adult (18+ years old) traumatic-mechanism CBI patients at 33 level I and II trauma centers from January 2022 to May 2023. Catastrophic brain injury was defined as a brain injury causing loss of function above the brain stem and subsequent death. Cluster analysis with linear mixed-effects model including UNOS regions and hospital size by bed count was used to determine whether CBI guidelines are associated with organ donation. A total of 790 CBI patients were included in this analysis. In unadjusted comparison, CBI guideline centers had higher rates of organ donation and use of steroids, whole blood, and hormone therapy. In a linear mixed-effects model, CBI guidelines were not associated with organ donation. Registered organ donor status, steroid hormones, and vasopressin were associated with increased relative risk of donation. There is high variability in management of CBI, even at centers with CBI guidelines in place. While the use of institutional CBI guidelines was not associated with increased organ donation, guidelines in this study were not identical. Hormone replacement with steroids and vasopressin was associated with increased donation. Hormone resuscitation is a common feature of CBI guidelines. Further analysis of individual practices that increase organ donation after CBI may allow for more effective guidelines and an overall increase in donation to decrease the long waiting periods for organ transplant recipients. Prognostic; Level III.

Anabolic Androgenic Steroids Misuse in the Fitness Industry

Anabolic-androgenic steroids (AAS) are synthetic variations of the male sex hormone testosterone. They mimic testosterone’s effects, primarily promoting muscle growth (anabolic effects) and enhancing male traits (androgenic effects). The misuse of AAS has extended beyond high-performance athletes and is now prevalent among the general population, particularly among fitness and gym enthusiasts. Epidemiological data highlight the widespread abuse of these substances, driven by the aspiration to enhance muscle mass, strength, and overall physical performance. The misuse of AAS in the fitness industry poses significant health risks and ethical concerns. This review highlights the prevalence, consequences, and prevention strategies related to AAS misuse in the fitness industry.

The Use of Intralesional Corticosteroids in Idiopathic Granulomatous Mastitis: A Systematic Review.

Idiopathic granulomatous mastitis (IGM) is a debilitating, chronic, inflammatory condition of the breast. Several studies have emerged evaluating intralesional steroid (ILS) injection and topical steroid administration as a treatment for IGM. However, there is a dearth of international consensuses with regards to the management of IGM. Therefore, we have systematically reviewed the effectiveness of ILS in the management of IGM. A systematic search was conducted in PubMed and Cochrane Library databases, the Google Scholar website and by citation searching up to June 15th, 2023. Eight articles were selected and analyzed. A total of 397 IGM patients were included in the review. The mean patient age was 35.7 years, ranging from 23-62 years. The mean pre-treatment diameter of lesions was 27.5 mm. A total of 184 patients were treated with ILS. The mean complete clinical response time was 2.6 months. The overall complete response rate was 92.8%. Complications following ILS were minor, with hematoma, skin atrophy and hyperemia being commonly described, while avoiding the systemic side effects of oral steroid use, such as weight gain and hirsutism, which were the most commonly reported side effects with oral steroids. The recurrence rates in the ILS group (6.6%) appear to be lower than in the oral steroid group (25.8%) and surgery group (26.3%). ILS seem to show a favorable outcome in terms of complete response rate, complete clinical response time and has a lower recurrence rate and complication rate when compared to other intervention strategies. However, more comparative studies with standardized protocols are necessary to ascertain the optimum type, dosage and frequency of ILS regimens.

METTL23 Variants and Patients With Normal-Tension Glaucoma

This research confirms and further establishes that pathogenic variants in a fourth gene, METTL23, are associated with autosomal dominant normal-tension glaucoma (NTG). To determine the frequency of glaucoma-causing pathogenic variants in the METTL23 gene in a cohort of patients with NTG from Iowa. This case-control study took place at a single tertiary care center in Iowa from January 1997 to January 2024, with analysis occurring between January 2023 and January 2024. Two groups of participants were enrolled from the University of Iowa clinics: 331 patients with NTG and 362 control individuals without glaucoma. Patients with a history of trauma; steroid use; stigmata of pigment dispersion syndrome; exfoliation syndrome; or pathogenic variants in MYOC, TBK1, or OPTN were also excluded. Detection of an enrichment of METTL23 pathogenic variants in individuals with NTG compared with control individuals without glaucoma. The study included 331 patients with NTG (mean [SD] age, 68.0 [11.7] years; 228 [68.9%] female and 103 [31.1%] male) and 362 control individuals without glaucoma (mean [SD] age, 64.5 [12.6] years; 207 [57.2%] female and 155 [42.8%] male). There were 5 detected instances of 4 unique METTL23 pathogenic variants in patients with NTG. Three METTL23 variants-p.Ala7Val, p.Pro22Arg, and p.Arg63Trp-were judged to be likely pathogenic and were detected in 3 patients (0.91%) with NTG. However, when all detected variants were evaluated with either mutation burden analysis or logistic regression, their frequency was not statistically higher in individuals with NTG than in control individuals without glaucoma (1.5% vs 2.5%; P = .27). This investigation provides evidence that pathogenic variants in METTL23 are associated with NTG. Within an NTG cohort at a tertiary care center, pathogenic variants were associated with approximately 1% of NTG cases, a frequency similar to that of other known normal-tension glaucoma genes, including optineurin (OPTN), TANK-binding kinase 1 (TBK1), and myocilin (MYOC). The findings suggest that METTL23 pathogenic variants are likely involved in a biologic pathway that is associated with glaucoma that occurs at lower intraocular pressures.

The Impact of Vitamin D on Androgens and Anabolic Steroids among Adult Males: A Meta-Analytic Review.

Recent studies indicate that vitamin D impacts male reproductive function, with deficiency linked to infertility. This review evaluates the effect of vitamin D supplementation on male fertility, focusing on total testosterone, free testosterone, the free androgen index (FAI), follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex-hormone-binding globulin (SHBG), and estradiol. We systematically searched Medline, Web of Science, Cochrane Library, and Scopus from their inception until July 2024 for randomized controlled trials (RCTs) involving adult males. The primary focus of these studies was on reproductive hormone parameters, analyzed using a random-effects meta-analysis and weighted mean difference (WMD). Evidence quality was assessed using ROB2 and GRADE. Meta-regression and dose-response analyses were performed. Seventeen studies met the criteria for quantitative analysis. Vitamin D supplementation significantly increased total testosterone levels (WMD 0.38, 95% CI 0.06-0.70, n = 15, I2 = 67.03). However, it had no significant effect on other hormone parameters: free testosterone (WMD 0.00, 95% CI -0.02-0.03, n = 9, I2 = 48.12), FSH (WMD -0.02, 95% CI -0.57-0.53, n = 7, I2 = 48.72), LH (WMD -0.09, 95% CI -0.30-0.12, n = 8, I2 = 0.00), SHBG (WMD 0.73, 95% CI -1.14-2.61, n = 10, I2 = 69.05), FAI (WMD -0.92, 95% CI -2.12-0.27, n = 6, I2 = 0.00), and estradiol (WMD -0.02, 95% CI -2.95-2.92, n = 5, I2 = 20.63). This meta-analysis shows that vitamin D supplementation may increase total testosterone levels in men. However, further well-designed RCTs are needed to determine vitamin D's effects on other reproductive hormone parameters.