Common Secondary Cause Research Articles

Genetic background of neonatal hypokalemia.

Neonatal hypokalemia (defined as a serum potassium level <3.5 mEq/L) is the most common electrolyte disorder encountered in clinical practice. In addition to common secondary causes, primary genetic etiologies are also closely associated with hypokalemia. Currently, a systematic characterization of these genetic disorders is lacking, making early recognition challenging and clinical management uncertain. This review will aid clinicians by summarizing the genetic background of neonatal hypokalemia from two aspects: (1) increased excretion of K+, whereby genetic factors primarily lead to increased renal Na+ influx, decreased H+ efflux, or reduced Cl- influx, ultimately resulting in increased K+ efflux; and (2) decreased extracellular distribution of K+, whereby genetic factors result in abnormalities in transmembrane ion channels, reducing outward potassium currents or generating inward cation leak currents. We describe over ten genetic diseases associated with neonatal hypokalemia, which involve pathogenic variants in dozens of genes and affect multiple target organs, including the kidneys, intestines, and skeletal muscle. For example, in the renal tubules, pathogenic variants in the SLC12A1 gene encoding the Na+-K+-2Cl- cotransporter lead to renal K+ loss, causing Bartter syndrome type I; in intestinal epithelial cells, pathogenic variants in the SLC26A3 gene result in a defective Cl⁻-HCO₃⁻ exchanger, causing congenital chloride diarrhea; and in skeletal muscle, pathogenic variants in the CACNA1S gene impact membrane calcium ion channels resulting in hypokalemic periodic paralysis. Given the wide variety of organs and genetic alterations that can contribute to neonatal hypokalemia, we believe this review will provide valuable insights for clinical diagnosis and treatment.

Clinical characteristics and outcomes of band keratopathy: a 10-year retrospective analysis

Background: Band keratopathy is a chronic, degenerative corneal disease resulting from gradual calcium deposition in the superficial cornea. Herein, we report the spectrum of causes, treatment outcomes, and recurrence rates of band keratopathy at a tertiary referral center throughout one decade. Methods: This retrospective study included patients with clinical diagnoses of band keratopathy who were treated with combined ethylenediaminetetraacetic acid (EDTA) and superficial keratectomy with or without amniotic membrane transplantation (AMT). Patient medical records were reviewed, and detailed demographic and ophthalmological data, such as baseline and last follow-up best-corrected distance visual acuity (BCDVA), ocular or medical comorbidities, type of intervention, postoperative follow-up duration, relevant complications, and recurrence were recorded. Results: A total of 32 eyes of 29 patients with 3 (10.3%) bilateral and 26 (89.7%) unilateral cases of treatment-requiring bank keratopathy were included. The mean (standard deviation [SD]) (range) age was 39.4 (22.4) (2–74) years, and most patients were female. The most common secondary cause was previous vitreoretinal surgery with silicone oil tamponade (15.6%); however, idiopathic cases were the most common (18.8%). Systemic comorbidities were present in 27.6% of patients, consisting of hypertension, diabetes mellitus, epilepsy, coronary artery disease, Behcet’s disease, and juvenile idiopathic arthritis; however, none of the patients had systemic diseases associated with hypercalcemia. Two of the 3 patients with bilateral involvement had chronic uveitis secondary to systemic rheumatological disease. The mean (SD) follow-up duration was 5.6 (4.0) years, and no serious postoperative complications occurred. The mean (SD) baseline and final BCDVA in logarithm of the minimum angle of resolution (logMAR) were 1.98 (1.0) and 1.7 (1.0), respectively (P &gt; 0.05). Combined EDTA chelation and superficial keratectomy with and without AMT were performed in 12.5% and 87.5% of eyes, respectively. Recurrence was observed in 37.5% of eyes within the mean (SD) (range) follow-up of 9.4 (9.1) (1–32) months. Seven of the 12 eyes with recurrence underwent re-EDTA chelation combined with superficial keratectomy and AMT; however, 5 patients managed conservatively. Conclusions: In this study, band keratopathy requiring intervention more commonly affected female individuals and was unilateral. Most cases were idiopathic. Systemic comorbidities were present in approximately one-third of cases. Managing band keratopathy using a combination of EDTA chelation and superficial keratectomy with or without AMT could be a potential treatment modality. Further large-scale studies are required to provide robust conclusions regarding the efficacy and safety of this management approach.

Genetic testing for familial hyperaldosteronism type 1 in Aotearoa/New Zealand.

Primary aldosteronism (PA) is the most common secondary endocrine cause of hypertension with familial hyperaldosteronism type 1 (FH-1), a rare heritable subtype. Timely identification of FH-1 is important because of an increased risk of vascular events in affected individuals and because it provides the opportunity to guide appropriate treatment. Genetic testing is recommended if onset is at a young age (<20 years), there is a family history of PA or early cerebrovascular events occur. To assess national rates of testing for FH-1, whether this varied over time and by region. De-identified data were obtained on genetic testing performed for FH-1 from 1 April 2010 to 30 October 2023 (163 months) from the Canterbury Health Laboratories database, the sole national testing laboratory for FH-1. A total of 147 tests were performed, of which 19 (12.9%) were positive. Eleven of the positive tests were requested by one region. Testing rates varied from 0.00 to 0.63 per 100 000 people per annum. Most tests were requested by endocrinology services. Testing increased over time from an average of 4.6 tests per annum in the first 5 years of the period studied to 17.7 tests in the most recent 5 years. Limitations include lack of ethnicity data, information on testing indications and testing rates for other familial PA subtypes. Testing for FH-1 has increased over time but remains low. Testing for familial forms of PA should be considered in those in whom PA was diagnosed at a young age or with a suggestive family history.

Red cell serological characterization of autoimmune hemolytic anemia in systemic lupus erythematosus patients

Abstract: INTRODUCTION: Autoimmune hemolytic anemia (AIHA) is a clinical condition with increased red cell destruction or decreased red cell survival due to autoantibodies against self-antigens on red blood cells. AIHA may be primary or secondary to other underlying illness. Systemic lupus erythematosus (SLE) is the most common secondary cause of AIHA. Although the incidence of AIHA in SLE patients is low (5%–10%), sometimes, it causes severe anemia which requires blood transfusion. Characterization of these autoantibodies in AIHA is very important, because the clinical condition and treatment of the patient depend on the optimal temperature reactivity, class, and subclass of immunoglobulin responsible. AIM AND OBJECTIVES: The aim and objective of this study are to perform detailed characterization of red cell autoantibodies for accurate diagnosis of AIHA in SLE patients, to find out specific class (immunoglobulin G [IgG]/IgM/IgA) of immunoglobulin and/or complement (C3c/C3d) responsible for AIHA, and their association with severity of hemolysis. MATERIALS AND METHODS: This was a prospective analytical study, done at a tertiary care hospital in Hyderabad, conducted between February 2021 and May 2022. SLE patients with AIHA were included in the study. Monospecific direct antiglobulin test (DAT) was performed to identify the specificity of autoantibody or complement. Based on hematological laboratory values, the study population was divided into three groups, i.e., mild, moderate, and severe hemolysis. DAT strength, hemolytic parameters, and severity of hemolysis were compared between different types of AIHA in SLE patients. Correlation statistics were used to know the association of severe hemolysis with DAT strength and different combinations of autoantibodies. RESULTS: Among 150 patients enrolled, 16 (10.6%) patients had severe hemolysis, 51 (34%) patients had moderate hemolysis, and 83 (55.3%) patients had mild hemolysis. Only IgG was positive in 109 (72.6%) patients, both IgG and C3d were positive in 37 (24.6%) patients, C3d was positive in 4 patients, and IgM was positive in 19 patients. High DAT reaction strength (3+–4+) and presence of C3d or IgM along with IgG were moderately correlated with severe hemolysis. CONCLUSION: Warm AIHA is the most common type of AIHA in SLE patients mediated by IgG. Mild and moderate hemolysis was seen in most cases. Severe hemolysis was moderately correlated with the presence of C3d or IgM. Further studies are warranted to find the predisposing factors leading to severe hemolysis.

Clinicopathological characteristics, prognostic factors, and outcomes of elderly patients with lymphoma-associated hemophagocytic lymphohistiocytosis: A multicenter analysis.

Lymphoma is the most common secondary cause of hemophagocytic lymphohistiocytosis (HLH) in adults. Lymphoma-associated HLH (LA-HLH) in the elderly population is not rare, however, little has been reported regarding clinicopathological characteristics, prognostic factors, and outcomes of LA-HLH in the elderly population. We retrospectively analyzed a multicenter cohort of elderly patients with LA-HLH. Clinicopathological features and treatment information were collected. The impacts of baseline characteristics and treatments on survival outcomes were analyzed. A total of 173 elderly patients with LA-HLH were included. Compared with young patients, elderly patients showed different clinical and laboratory features. Regarding lymphoma subtypes, B-cell lymphoma was more common in elderly patients (elderly 61.3% vs. young 32.3%, p < 0.001) while T/NK-cell lymphoma was more common in young patients (65.3% vs. 35.3%, p < 0.001). The median survival of elderly patients with LA-HLH was only 92 days. The prior use of HLH therapy or etoposide-containing HLH therapy was not associated with improved overall survival. T/NK-cell subtype, a lower platelet count (≤53 × 109/L), a lower albumin level (≤32.1 g/L), a higher LDH level (>1407 U/L), and a higher creatinine level (>96.8 μmol/L) were independent predictors of decreased overall survival and 60-day survival. A prognostic index was established and demonstrated to be robust in predicting the overall survival and 60-day survival of elderly patients with LA-HLH. LA-HLH in elderly patients displayed heterogeneous clinicopathological features and survival outcomes. Treatments need to be optimized to improve the outcomes of elderly patients with LA-HLH.

A Rare Case of Sclerosing Encapsulating Peritonitis Secondary To Tuberculosis

Sclerosing encapsulating peritonitis is a relatively rare, potentially life-threatening condition that causes intestinal loops to become encapsulated as a fibro-collagen cocoon. Despite advances in treatment, mortality is high. It shows vague clinical signs and is therefore difficult to diagnose clinically. Abdominal Contrast Enhanced CT (CECT) is an excellent modality for diagnosing the condition, assessing its complications such as perforation, and guiding the treatment approach to the condition. This case report highlights a rare case of sclerosing encapsulating peritonitis in a young adult secondary to tuberculosis. Although the most common secondary cause of SPE is peritoneal dialysis, consideration of tuberculosis as a cause of such a condition is very important, especially in the Indian context.

Synergistic interaction between hyperlipidemia and obesity as a risk factor for stress urinary incontinence in Americans

Urinary incontinence is a common disease among middle-aged and elderly women, which not only affects the physical and mental health of patients, but also brings a great medical burden to society. Obesity is a known risk factor for urinary incontinence and is the most common secondary cause of hyperlipidemia. Most obese patients also suffer from hyperlipidemia in the clinic. However, few studies have explored the role of hyperlipidemia in women with urinary incontinence. Using data from the 2005–2018 National Health and Nutrition Examination Survey (NHANES), we aimed to evaluated the independent associations of high body mass index and hyperlipidemia with urinary incontinence in Americans by conducting a weighted multivariate logistic regression model. Additive interactions were also assessed using the relative excess risk due to interaction (RERI), attributed proportion of interaction (AP) and synergy index (S). This study demonstrated that hyperlipidemia was associated with a higher risk of stress urinary incontinence among women with obesity (OR = 1.52, 95% CI = 1.03–2.25), and there was a significant synergistic effect of hyperlipidemia and obesity on stress urinary incontinence(adjusted RERI: 3.75, 95% CI 0.30–7.20; adjusted AP: 0.67, 95% CI 0.54–0.80; adjusted S: 5.49, 95% CI 4.15–7.27). Moreover, fasting serum triglyceride lipids were the most relevant blood lipid indicator for the risk of stress urinary incontinence, especially among obese women younger than 50 years old, which contributes to the development of more refined lipid control protocols for patients with urinary incontinence in different age groups.

Hypertension in the emergency department: A missed opportunity to screen for primary aldosteronism?

Primary aldosteronism (PA) is a common but underdiagnosed secondary cause of hypertension. Emergency departments (EDs) often assess patients with severe hypertension or its sequelae, some of whom have underlying PA. We aimed to determine the proportion of patients presenting to the ED with hypertension who meet the Endocrine Society criteria for PA testing and the proportion who were screened. We performed a structured retrospective chart review of adults who presented to three EDs in an Australian tertiary health network between August 2019 and February 2020, with a coded presenting complaint of hypertension. Clinical parameters to determine whether the patients met the criteria for PA testing were extracted from electronic medical records. Of the 418 patients who presented to the EDs with documented elevated blood pressure (BP), 181 patients (43.3%) fulfilled PA screening criteria and nine patients (2.2%) underwent PA testing. Individuals who fulfilled screening criteria were older; had higher prevalence of Type 2 diabetes, coronary artery disease, and congestive heart failure; took more antihypertensive medications; and had lower estimated glomerular filtration rate. Individuals who were tested for PA were younger and had higher BP on presentation. Screening for PA was more frequent in patients who were referred to medical teams. As far as we are aware, our study is the first to evaluate PA testing in hypertensive patients who present to ED. More than 40% of adults presenting to the EDs with hypertension met the current criteria for testing for PA but only few were tested. These results emphasize that increased awareness of PA in the ED is needed to encourage opportunistic testing, referral, and treatment, especially in patients who present with hypertensive emergencies. Prospective studies are required to determine the feasibility and effectiveness of this.

Catheter-associated urinary tract infections in critical care: Understanding incidence, risk factors, and pathogenic causes in Palestine.

Catheter-associated urinary tract infections (CAUTI) are the most common secondary cause of bloodstream infection. CAUTI is particularly prevalent in critical care departments and developing countries, where the duration of catheterization remains the most significant risk factor. This study focused on the characteristics, risk factors, and outcomes of CAUTI patients in a tertiary care hospital setting. It also provides the incidence rate of CAUTI in an ICU setting in Palestine. The study adopted a retrospective observational design at a tertiary care hospital in Palestine. The data were collected from patient records as well as from nursing flow charts. Variables are reported as frequencies, percentages and means + standard deviations. Independent t-tests was used for numerical variables, while Pearson's chi-square or Fisher's exact test were used for categorical variables. Multivariate analysis was performed to adjust for confounders using binary logistic regression. Mortality risk factors were assessed using the proportional Cox regression model. Of the 377 patients included in the study, 33 (9%) developed CAUTI. Among CAUTI patients, 75% had Candida species isolated, with non-albicans Candida predominating (72%) fungal isolates. On the other hand, 25% of the patients had bacterial isolates in their urine, with a predominance of Escherichia coli growing in 36% of bacterial cultures. Multivariate regression analysis revealed that female gender, longer catheterization days, and corticosteroid use were associated with an increased risk of CAUTI. On the other hand, developing CAUTI, having a malignant disease, developing kidney injury, and developing shock were associated with increased mortality. This study highlighted the emerging presence of fungal and resistant bacterial CAUTI. It also emphasized that the risk of CAUTI was associated with a longer duration of urinary catheterization. The findings of this study may help formulate antimicrobial management and stewardship plans as well as emphasize the risk of urinary catheterizations.

Retrospective Evaluation of Patients Admitted to the Pediatric Neurology Outpatient Clinic with Headache: Experience of a Tertiary Hospital.

It was aimed to determine the etiological and clinical features of pediatric patients with headache complaints. The files of patients who were admitted to the pediatric neurology outpatient clinic with headache were reviewed retrospectively. Patients' age, gender, features of headache, symptoms accompanying headache, available blood tests, brain magnetic resonance (MR) and electroencephalography (EEG) results were recorded. Of the total 470 patients, aged between 3 and 17 years, 291 (61.9%) were female and 179 (39.1%) were male. The mean age of the patients was 12.38±3.45 years. According to age groups, there were 16 (3.4%) patients under the age of 5, 159 (33.8%) between the ages of 6-11, and 295 (62.8%) patients aged 12-17 years. While 289 (61.5%) patients were diagnosed with primary headache, 122 (26.0%) patients were diagnosed with secondary headache, and headaches of 59 (12.5%) patients could not be classified. The most common primary headaches were tension-type headache (TTN) (n=177, 37.7%) and migraine (n=111, 23.6%). The 86 (70.5%) of the patients with secondary headache were diagnosed with sinusitis. Abnormal neurological examination finding was determined in 8 (1.7%) patients. Brain MR was performed in 439 (93.4%) of all patients and abnormal brain MR findings were detected in 52 (11.8%) patients. EEG was performed in 205 (43.6%) of all patients and abnormal EEG findings were detected in 24 (11.7%) patients. According to age groups, headache was most common in the 12-17 age group. The most common causes of headache were TTN and migraine, respectively. The most common secondary headache cause was sinusitis. We think that physical and neurological examination still maintains its priority in determining the causes of headache.

Evaluation and Treatment of a Severe Case of Pediatric Idiopathic Hypereosinophilic Syndrome

BackgroundHypereosinophilic syndromes (HES) are a group of rare disorders characterized by marked peripheral eosinophilia resulting in end organ damage. When evaluating a patient with persistent hypereosinophilia, it is important to screen for the more common secondary causes of eosinophilia and assess for primary, myeloid HES. When no clear etiology is determined, a diagnosis of idiopathic HES is made. While this evaluation can be clinically challenging, making an accurate diagnosis can help guide effective treatment. CaseA 3-year-old Caucasian female with profound peripheral eosinophilia (70,100 cells/mL) and lymphocytosis (24,900 cells/mL) presented for immunologic evaluation following a two year history of persistent eosinophilia (1,450–27,700 cells/mL), presumably secondary to recurrent toxocariasis. The patient had been treated with albendazole three times for Toxocara after having positive serology and imaging consistent with visceral larva migrans in the context of an otherwise negative extensive infectious evaluation. Intermittent oral steroids and daily medium-dose inhaled steroids had also been started for wheezing. A bone marrow biopsy (BMbx) demonstrated increased numbers of eosinophils with cytoplasmic vacuoles, areas of hypogranulation, and subtle segmentation abnormalities, but genetic rearrangements for PDGFRA, PDGFRB, FIP1L1, and JAK2 were negative. An abnormal population of lymphocytes (CD3-CD4+) making up 1.7% of total lymphocytes was noted; however, this was not reproducible on repeat BMbx. Positron emission tomography redemonstrated bilateral pulmonary nodules and mild hilar lymphadenopathy, and bronchoalveolar lavage was normal other than an eosinophilia. The remainder of her immunologic evaluation was normal other than a pan-hypergammaglobulinemia without evidence ofT or B cell clonality. A 429 gene primary immunodeficiency panel was not felt to be clinically significant.Given the patient's persistent eosinophilia, oral steroids at 2 mg/kg were started with only a partial response (2,600 eosinophils/mL). Ultimately, mepolizumab 100 mg injected subcutaneously every 4 weeks was started as steroid sparing therapy with an excellent clinical response (780 eosinophils/mL) even after weaning off of oral steroids. ConclusionThis unique case illustrates the importance of a thorough evaluation of patients with persistent eosinophilia and the efficacy of mepolizumab in a child with marked idiopathic HES.

Senescence of bone marrow fat cells: A new clue for glucocorticoid-induced bone deterioration

Glucocorticoid (GC)-induced osteoporosis is the most common secondary cause of osteoporosis, resulting in fractures and significant morbidity. In this issue of Cell Metabolism, Liu etal. reveal that in response to GCs, bone marrow adipocytes (BMAds) undergo rapid cellular senescence, triggering secondary senescence in bone marrow and causing bone deterioration.

The Effect of Aldosterone on Cardiorenal and Metabolic Systems

Aldosterone, a vital hormone of the human body, has various pathophysiological roles. The excess of aldosterone, also known as primary aldosteronism, is the most common secondary cause of hypertension. Primary aldosteronism is associated with an increased risk of cardiovascular disease and kidney dysfunction compared to essential hypertension. Excess aldosterone can lead to harmful metabolic and other pathophysiological alterations, as well as cause inflammatory, oxidative, and fibrotic effects in the heart, kidney, and blood vessels. These alterations can result in coronary artery disease, including ischemia and myocardial infarction, left ventricular hypertrophy, heart failure, arterial fibrillation, intracarotid intima thickening, cerebrovascular disease, and chronic kidney disease. Thus, aldosterone affects several tissues, especially in the cardiovascular system, and the metabolic and pathophysiological alterations are related to severe diseases. Therefore, understanding the effects of aldosterone on the body is important for health maintenance in hypertensive patients. In this review, we focus on currently available evidence regarding the role of aldosterone in alterations of the cardiovascular and renal systems. We also describe the risk of cardiovascular events and renal dysfunction in hyperaldosteronism.

Long non-coding RNA telomerase RNA elements improve glucocorticoid-induced osteoporosis by EZH2 to regulate DKK1.

Glucocorticoid-induced osteoporosis is the most common secondary cause of osteoporosis, which increases the risk of fracture. Long non-coding RNA telomerase RNA elements (TERC) has been proven to be closely related to osteoporosis. However, the role of TERC in glucocorticoid-induced osteoporosis and its underlying molecular mechanism remains unclear. The in vitro model of osteoporosis was established after bone marrow mesenchymal stem cells (BMSCs) were exposed to dexamethasone (DEX). The cell viability, alkaline phosphatase (ALP) activity and mineralized nodules of BMSCs were evaluated. The messenger RNA and protein levels were detected by quantitative real-time polymerase chain reaction and Western blot. The interaction between TERC, enhancer of zeste homolog 2 (EZH2) and dickkopf-1 (DKK1) was confirmed by chromatin immunoprecipitation and RNA immunoprecipitation assays. Bone marrow mesenchymal stem cells were isolated, identified and induced osteogenic differentiation. The findings showed that the levels of osteogenic marker genes, including ALP, Runt-related transcription factor 2 (RUNX2) and osteocalcin (OCN) in BMSCs were increased dependent on the osteogenic induction time. Similarly, TERC was significantly increased, but DKK1 was significantly decreased during BMSC osteogenic differentiation. Functional research showed that TERC overexpression promoted cell viability, ALP activity and mineralized nodules of BMSCs and increased the levels of osteogenic differentiation-related genes (ALP, RUNX2 and OCN), and TERC overexpression increased EZH2 protein level. Moreover, the decrease of cell viability, ALP activity and mineralized nodules induced by DEX was reversed by TERC overexpression. Furthermore, TERC inhibited DKK1 expression by promoting the histone modification of DKK1, and TERC overexpression alleviated DEX suppressed osteogenic differentiation of BMSCs by interaction with EZH2 to regulate DKK1. Our findings illustrated that TERC overexpression alleviated DEX-induced osteoporosis by recruiting EZH2 to regulate DKK1. Our research provided a novel direction for the treatment of glucocorticoid-induced osteoporosis.

Diagnostic spectrum of hypereosinophilia based on bone marrow pathology: 10 years' experience at a tertiary care hospital.

Hypereosinophilia (HE) is defined as peripheral blood (PB) eosinophil count exceeding 1.5 × 109 /L. As the causes of HE can be diverse, the work-up of patients was complicated. In this study, we aimed to categorize the underlying diseases associated with HE and demonstrate minimum diagnostic approach. Cases presenting with HE within 7 days of bone marrow (BM) examination conducted between 2008 and 2019 were selected. Cases were classified by the revised 2022 WHO and ICC classification. We also assessed morphologic features of unclassified persisting HE (>4 weeks) patients according to the morphologic criteria suggested a previous study by Wang et al. RESULTS: A total of 364 patients were included. The work-up confirmed primary HE in 38.7%, secondary HE in 48.9%, HE patients with insufficient evaluation in 13.7%. When conducted a slide review of HE patients with sustained HE more than 4 weeks among HE patients with insufficient evaluation, the morphological features showed abnormal eosinophils in PB/BM (69.0%/81.0%), hypercellularity (26.2%), myelofibrosis (7.1%), increased M:E ratio (5.3%), and dysmegakaryopoiesis (4.8%). Of these patients, 14 patients who met all morphologic criteria were suspected of CEL. This study demonstrates that HE is associated with variable conditions. BM morphological assessment based on a robust criterion can help to confirm a MN irrespective of the presence of clonal markers. The work-up of patients in whom ruled out the common secondary causes of HE requires a systematic but sufficient approach including at a minimum BM karyotyping, PDGFRA testing, lymphocyte immunophenotyping and TCR gene rearrangement.

STUDY OF DEMOGRAPHIC FEATURES, CLINICAL CHARACTERISTICS AND RISK FACTORS IN PATIENTS OF BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)

Introduction BPPV is the most common peripheral vertiginous disorder in the community.Due to overlapping clinical features, this condition may be misdiagnosed and erroneously treated. Clear understanding of the demographic characteristics and clinical features may help in correct diagnosis and optimal management. Method 100 diagnosed patients of BPPV were prospectively studied. Parameters studied and analysed were:- age group and gender,affected ear and Semi circular canal(SCC), clinical features, various diagnostic and therapeutic manoeuvres, , associated comorbidities, treatment efficacy and recurrence rate. Results BPPV was most commonly seen in 4th decade with a significant female preponderence(M38/F62 ). Posterior-SCC (P-SCC) is most commonly involved(82%) followed by Horizontal-SCC (H-SCC)(17%) and Superior-SCC (S-SCC) (01%). Low serum vitamin-D3 was most commonly associated comorbidity(34%). 84% were primary BPPV while head trauma was the most common secondary cause . Remission rate on repositioning manoeuvre was 73%, recurrence rate 16% and failure rate was 11%. Conclusion Undiagnosed vertigo may significantly impacts the quality of life of a person. BPPV, in spite of being one of the commonest cause of vertigo is often misdiagnosed. If accurately diagnosed, BPPV repositioning manoeuvres have a high cure rate

An effect comparison of alendronate and teriparatide in patients with glucocorticoid-induced osteoporosis: A protocol for systematic review and meta-analysis

Glucocorticoid-induced osteoporosis is the most common secondary cause of osteoporosis and the resulting fractures cause significant morbidity. Oral bisphosphonates are currently regarded as first line options on the grounds of their low cost. However, teriparatide has been shown to be superior in its effects on bone mineral density and vertebral fracture risk in glucocorticoid-treated individuals with osteoporosis. We conducted a protocol for systematic review and meta-analysis to assess the effectiveness of alendronate and teriparatide in patients with glucocorticoid-induced osteoporosis. The study protocol has been registered on international prospective register of systematic review (PROSPERO registration number: CRD42022371561). The procedure of this protocol will be conducted according to the Preferred Reporting Item for Systematic Review and Meta-analysis Protocols guidance. PubMed, EMBASE, MEDLINE, the Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang Database, ClinicalTrials.gov trials registry, and Chinese Clinical Trial Registry will be searched from January 1980 to November 2022. Two authors will assess methodological quality of included studies separately by the Cochrane collaboration's risk of bias tool. We will apply RevMan 5.4 software for statistical analysis. This study will provide a high-quality comprehensive evaluation of the efficacy and safety of alendronate and teriparatide for treating patients with glucocorticoid-induced osteoporosis. The conclusion of our systematic review will provide evidence to judge whether teriparatide is an effective intervention for patients with glucocorticoid-induced osteoporosis.

Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in Adults: Consensus Recommendations From the Belgian Bone Club.

Glucocorticoids are effective immunomodulatory drugs used for many inflammatory disorders as well as in transplant recipients. However, both iatrogenic and endogenous glucocorticoid excess are also associated with several side effects including an increased risk of osteoporosis and fractures. Glucocorticoid-induced osteoporosis (GIOP) is a common secondary cause of osteoporosis in adults. Despite availability of clear evidence and international guidelines for the prevention of GIOP, a large treatment gap remains. In this narrative review, the Belgian Bone Club (BBC) updates its 2006 consensus recommendations for the prevention and treatment of GIOP in adults. The pathophysiology of GIOP is multifactorial. The BBC strongly advises non-pharmacological measures including physical exercise, smoking cessation and avoidance of alcohol abuse in all adults at risk for osteoporosis. Glucocorticoids are associated with impaired intestinal calcium absorption; the BBC therefore strongly recommend sufficient calcium intake and avoidance of vitamin D deficiency. We recommend assessment of fracture risk, taking age, sex, menopausal status, prior fractures, glucocorticoid dose, other clinical risk factors and bone mineral density into account. Placebo-controlled randomized controlled trials have demonstrated the efficacy of alendronate, risedronate, zoledronate, denosumab and teriparatide in GIOP. We suggest monitoring by dual-energy X-ray absorptiometry (DXA) and vertebral fracture identification one year after glucocorticoid initiation. The trabecular bone score might be considered during DXA monitoring. Extended femur scans might be considered at the time of DXA imaging in glucocorticoid users on long-term (≥ 3 years) antiresorptive therapy. Bone turnover markers may be considered for monitoring treatment with anti-resorptive or osteoanabolic drugs in GIOP. Although the pathophysiology of solid organ and hematopoietic stem cell transplantation-induced osteoporosis extends beyond GIOP alone, the BBC recommends similar evaluation, prevention, treatment and follow-up principles in these patients. Efforts to close the treatment gap in GIOP and implement available effective fracture prevention strategies into clinical practice in primary, secondary and tertiary care are urgently needed.

Osteoporosis del varón

Osteoporosis in men is an underdiagnosed and undertreated disease that is highly prevalent. Up to 25% of men will present with an osteoporotic fracture throughout their life. Secondary forms of the disease are common and it is necessary to rule them out in the diagnostic evaluation process. The most common secondary causes and risk factors of osteoporosis in men include various endocrine diseases (particularly hypogonadism), lifestyle-related diseases, and some pharmacological treatments. Dual-energy X-ray absorptiometry (DXA) is an essential diagnostic test. Laboratory determinations should be aimed at ruling out secondary forms of the disease. Treatment should involve optimization of calcium and vitamin D intake and correction of the etiological abnormalities identified. Bisphosphonates, denosumab, and teriparatide have been shown to be effective in increasing bone mass in these patients

Resistant arterial hypertension: is it really so or have we missed something?

This publication discusses the relevance of the problem of blood pressure control in patients with resistance to drug therapy in real clinical practice. Data on the prevalence of true resistant arterial hypertension and clinical features of patients are presented. At the same time, taking into account the wider prevalence of patients with pseudo resistant arterial hypertension, special attention is paid to diagnostic algorithms in the publication, and the criteria for excluding pseudo resistant arterial hypertension are analyzed in detail. Presented are modern ideas about the most common secondary causes of arterial hypertension, such as obstructive sleep apnea syndrome, the possibility of correcting this condition and the choice of drug therapy. For this publication, modern recommendations were used in the strategy for choosing the optimal antihypertensive therapy, taking into account the pharmacokinetic properties and the possibility of personalized choice in various clinical situations. We analyzed data on the benefits of antihypertensive therapy using fixed combinations to increase adherence to therapy with a blood pressure control strategy and reduce the risk of cardiovascular risks. Various search engines were used to search for data and material: PubMed, Google Academy, Elsevier, information resources of the Russian Society of Cardiology and the European Society of Cardiology.