Prevalence Of Hypo Research Articles

Gender-specific risk factors and outcomes of hyperkalemia in CKD patients: smoking as a driver of hyperkalemia in men.

Hyperkalemia is common among patients with chronic kidney disease (CKD) but there is scarce information on differential risk factors and outcomes for men and women. For instance, smoking has been suggested to be a risk factor for hyperkalemia, but specific analysis of the sex-specific impact of smoking on hyperkalemia in CKD is lacking. We studied serum potassium levels in 2891 participants from the NEFRONA cohort: 483 controls (47% women) and 2408 CKD patients (38% women) without prior cardiovascular disease (CVD), assessing whether smoking is a risk factor for hyperkalemia, and if hyperkalemia is associated with outcomes separately for men and women. Median potassium levels and prevalence of hypo and hyperkalemia were higher in CKD participants than in controls. Serum potassium levels were higher and hyperkalemia and severe hyperkalemia more prevalent in men than in women with non-dialysis CKD (G3-G5). The highest prevalence of hyperkalemia for each gender was found in CKD G4-G5 and hemodialysis patients for men (46%) and in hemodialysis (54%) for women. Gender-specific etiological multivariate analysis identified current smoking as a risk factor for hyperkalemia only in men. Hyperkalemia was independently associated with stopping RAASi, an outcome which was more common in women. Hyperkalemia was also associated to higher risk of cardiovascular events within 4 years in men. In conclusion, hyperkalemia is common among men and women with CKD, but the prevalence, risk factors and outcomes may differ by gender. Specifically, current smoking is a driver of hyperkalemia in men.

Mechanism of development of residual goitre and associated thyroid disorders

In post salt iodination period, endemic goiter that generally develops for iodine deficiency is found prevalent in many regions, including India, despite adequate iodine intake. Such goiters are termed as residual goiters. Consumption of dietary goitrogens could be the possible regulator in the persistence of residual goitre and associated disorders. Residual goitres exist in Manipur, India for the consumption of bamboo shoots (BS). Therefore, to study the actions of BS on major thyroid hormone synthesizing regulatory factors at cellular and molecular levels on isolated thyrocytes conducted perusing expression of NIS, TPO, Tg and PDS proteins as well as mRNA and protein expression of NIS, TPO, Tg, PDS, MCT8 and PAX8 with and without extra iodine in in-vitro studies. Simultaneously, ROS generation in terms of H2O2 and antioxidant status, NO, LPO were assayed. Cellular and DNA damage and oxidation, including cell cycle alterations after BS exposure, were also investigated. Precursors and metabolic end products of cyanogenic glycosides on phytochemical analysis found in BS. It has pleiotropic effects on thyrocytes. It repressed the activities of Na+-K+-ATPase, TPO and D2, as well as reduced the expression of NIS, TPO, Tg, PDS proteins and MCT8 and PAX8, at mRNA level. All these effects of BS are mediated through increased ROS levels as H2O2 upsurge leading to a perturbed pro-oxidant antioxidant balance in thyrocytes associated with cellular and DNA damage and oxidation. Increased LPO and NO levels upon exposure of BS extract triggered plasma membrane and organelle damage of thyrocytes, which are major sites of NIS, TPO, PDS and MCT8, leading to thyroid disfunction. Cellular and DNA damage/oxidation was observed that leads to disruption of normal cell cycle pattern of thyrocytes which in turn causes changes in apoptotic proteins Bax, Bcl-2 and p53. These changes imply imbalance of cell death and proliferation equilibrium leading to disease conditions as found in goitre upon exposure to BS extract. Extra iodine prevents goitrogenic/anti-thyroid influences of BS on such actions to an extent. Thyroid diseases among residual goitrous population following consumption of BS evaluated by their iodine nutritional and salt iodization status, serumT3, T4 and TSH profiles, TPO- and Tg-Ab antibodies, thyroid ultrasonography, the prevalence of hypo- and hyperthyroidism and cytomorphological features. Goitrous populations are affected by subclinical and overt hypo- and hyperthyroidism with elevated thyroid autoantibodies, hypoechoic thyroid and thyroiditis. This study concludes that residual goitrous individuals are affected by different autoimmune thyroid disorders. Excess thiocyanate from dietary goitrogens of cyanogenic origin (BS) is responsible for the development of residual goitre followed by its progression towards different thyroid autoimmune disorders.

Prevalence and impact on outcome of sodium and potassium disorders in patients with community-acquired pneumonia: A retrospective analysis

Introduction: Disorders of sodium and potassium are common and predictors of adverse outcome. Prevalence and impact on outcome of hypokalemia, hyperkalemia, hyponatremia and hypernatremia were investigated in emergency patients with community-acquired pneumonia (CAP). Methods: Patients ≥18 years presenting to our emergency department between January 1st 2017 and December 31st 2018 with on-admission electrolyte measurements were included. Chart reviews were performed to identify patients with CAP. Results: 19.948 cases had measurements of sodium and potassium of which 469 had CAP (2.4%). Prevalence of hypo- and hypernatremia was significantly increased in patients with compared to those without CAP (hyponatremia: 28.8% vs. 10.5% respectively, p<0.0001; hypernatremia: 1.9% vs. 0.6% respectively, p=0.002). The prevalence of hypo- and hyperkalemia was significantly higher in patients with than without CAP (hypokalemia 15.6% vs. 11.4% respectively, p=0.004; hyperkalemia: 4.5% vs. 2.0% respectively, p=0.001). Hyponatremia was significantly associated with longer hospital stay in patients with CAP (regression coefficient 0.194, standard error 0.079, p=0.015). None of the investigated electrolyte disorders were predictive of 30-day re-admission and 180-day pneumonia recurrence rates. Use of loop diuretics was an independent predictor for 30-day re-admission (OR 2.351 (1.099-5.03). p=0.028). Pneumonia Severity Index (PSI) risk class was an independent predictor of 180-day pneumonia recurrence (OR 1.494 (1.022-2.184), p=0.038). Conclusion: Dysnatremias and dyskalemias are common findings complicating CAP in emergency patients. Prevalence of hyponatremia was highest followed by hypokalemia. Hyponatremia was an independent predictor of prolonged length of hospital stay. Loop diuretic use was associated with 30-day readmission and PSI risk class with 180-day pneumonia recurrence.

Is It Time to Remove Total Calcium from the Basic and Comprehensive Metabolic Panels? Assessing the Effects of American Medical Association–Approved Chemical Test Panels on Laboratory Utilization

The necessity of individual tests within the most commonly used disease-oriented test panels has not been well established. We evaluated test-ordering practices for total calcium, both before and after implementation of American Medical Association (AMA)-approved panels (basic metabolic panel [BMP] and comprehensive metabolic panel [CMP]) in our electronic ordering system. We performed a retrospective review of all total calcium orders placed during April and June 2018, before and after implementation of the panels. Orders from inpatient, outpatient, and emergency department (ED) care units were totaled, and the percentage of abnormal test results was calculated. We then queried institutional databases to determine the number of unique patients with calcium-related diagnoses and compared the rates from a 5-month period both before and after implementation of the panels. Total test volumes and tests per unique patient increased by more than 3-fold after implementation of calcium-containing AMA-approved panels, with the majority of those orders coming from BMPs and CMPs. The rate of low calcium values increased because of the shift toward more inpatient testing; however, the percentage of abnormal results within each patient population (inpatient, outpatient, ED) decreased. The prevalence of hypo- and hypercalcemia-related diagnoses among patients in the 5 months after implementation did not change significantly (1.29% before implementation vs 1.27% after implementation). Implementation of BMPs and CMPs dramatically increased total calcium testing volumes without changing the rate of calcium-related diagnoses. The results suggest that the increase in total calcium orders associated with panel-based testing largely constitutes excess or unnecessary testing.

F68. Sensory abnormalities and ultrasound-verified neuromas in lower extremity amputees: An ongoing study

Introduction The role of neuromas in stump and phantom limb pain remains unclear. This ongoing study examines whether neuromas are more frequent in amputees experiencing spontaneous and evoked pain after lower extremity amputation than in amputees without pain. Methods In this observational cohort study, amputees with lower and upper extremity amputation are recruited. They answer pain questionnaires and undergo a clinical examination with sensory testing performed within the area of spontaneous pain. Testing includes mapping and registration of sensation elicited by brush, cold and heat (thermorolls 20 °C and 40 °C) and pinprick stimuli (60 g von Frey filament). Neuromas are identified using high resolution (6–18 MHz) ultrasound by an investigator blinded to the patients’ history of pain. Cross sectional areas of the neuromas are measured by the direct tracing method and shear wave elastography is performed. Pressure pain thresholds are measured by an hand held pressure algometer. Results So far, 45 lower and upper extremity amputees have participated in the study (29 men and 16 women; age 25–83 years). Seventy-three percent had at least one neuroma verified by ultrasound. All amputees experienced stump or phantom pain, and the pain was present at least once a month in 16 patients. Only four patients had pain on a daily basis. All amputees experienced abnormal sensations with either hypo- and/or hyperesthesia, and pinprick hyperalgesia was present in seven patients. No significant difference in prevalences of stump pain, intermittent phantom pain and spontaneous phantom pain in patients with and without ultrasound-verified neuromas.No significant difference in prevalence of hypo- or hyperesthesia, hyperalgesia, allodynia and occurrence of Tinel’s sign in patients with and without ultrasound-verified neuromas. Conclusion The recruitment is ongoing. Preliminary data show no association between the occurrence and severity of neither stump nor phantom pain and the presence of neuromas at the amputation site. Sensory abnormalities, pinprick hyperalgesia and brush- and/or cold-evoked allodynia are common findings at the site of the stump, regardless of the occurrence of neuromas.

Effect of serum calcium status at calving on survival, health, and performance of postpartum Holstein cows and calves under certified organic management

The study objective was to assess the effect of hypocalcemia (HYPO; ≤2.0 mmol/L) of the dam at calving on survival, health, and performance of lactating dairy cows and their calves under certified organic management. Prepartum dairy cows (primiparous, n = 445; multiparous, n = 328) from 1 dairy herd were monitored (prepartum pen) for imminent signs of parturition (appearance of amniotic sac outside the vulva) until birth. All calves were subject to the same newborn care, colostrum management, and failure of passive transfer assessment (serum total protein ≤5.5 mg/dL). Serum total calcium of cows was determined in samples taken within 2 h after calving. To define HYPO cows after calving, a cut-point of total serum Ca concentration with optimal sensitivity and specificity to predict metritis or calf diarrhea was established by using the receiver operator characteristic. The effect of HYPO on survival (died or culled within 60 DIM), health status, and pregnancy per artificial insemination (PAI) for first services of lactating cows were analyzed using the GLIMMIX procedure of SAS. Additionally, the effect of HYPO at calving on days in milk (DIM) at first service (DIMFS), milk yield (kg), milk components (percent fat and protein), and somatic cell count were analyzed for the first 3 Dairy Herd Improvement Association (DHIA) tests using the MIXED procedure of SAS (SAS Institute Inc., Cary, NC). The effect of parity (primiparous and multiparous), body condition score at calving, and manure hygiene score at calving were also included in the statistical models. The effect of HYPO at calving on calf survival, serum total protein, and diarrhea within 10 d of age were assessed using GLIMMIX procedure of SAS. The overall prevalence of HYPO was 14.6% (2.7% for primiparous and 30.8% for multiparous cows). Cows experiencing HYPO at calving had greater proportion of metritis (25.1 vs. 14.7%) and culling within 60 DIM (15.9 vs. 6.8%) compared with non-HYPO cows, respectively. For the first 3 DHIA tests, milk yield and components did not differ between HYPO and non-HYPO cows. The DIMFS as well as proportion of cows with dystocia, births of twins, mastitis, and PAI at first service were not different between HYPO and non-HYPO cows. The proportion of stillbirth, weaned calves, and serum total protein did not differ between calves born from HYPO or non-HYPO cows. However, calves born from HYPO cows had greater incidence of diarrhea (49%) than calves born (33.3%) from non-HYPO cows. Findings from the present study showed that HYPO at calving had significant health implications for both dams and calves under certified organic management.

Feature of amenorrhea in postoperative tamoxifen users with breast cancer

ObjectiveTamoxifen has been used to prevent the recurrence of breast cancer. However, tamoxifen-users frequently experience amenorrhea and it can be confused from that caused by other hormonal abnormalities. In amenorrheic patients without breast cancer, clinicians usually measure the sex hormone levels that are known to be associated with ovarian or menstrual function. This study aimed to investigate the feature of female sex hormones in premenopausal breast cancer patients undergoing tamoxifen treatment.MethodsThe medical records of fifty-nine premenopausal breast cancer patients who underwent tamoxifen treatment were reviewed retrospectively. The study population consisted of amenorrheic patients (n=36) and patients with menstruation (n=23). Serum hormone levels were measured either specifically between cycle days 2 and 5 in menstruating patients or at any time in amenorrheic participants.ResultsSerum levels of lutenizing hormone and estradiol were not statistically different according to the presence of menstruation. Serum follicle stimulating hormone level was significantly higher in amenorrheic patients (8.1±5.7 mIU/mL) than those in menstruating subjects (5.1±2.2 mIU/mL) (p=0.01). Serum concentration of thyroid stimulating hormone was lower in patients with amenorrhea (1.5±0.9 vs. 2.3±2.2 μIU/mL, p=0.04), although the prevalence of hypo- or hyperthyroidism was not different according to the pattern of menstruation.ConclusionMenstruation status and hormone levels can be influenced by tamoxifen use in reproductive age breast cancer patients. Physicians should be attentive to the alteration of pituitary hormone levels in addition to sex steroid hormones in this population.

Magnesium and Dialysis: The Neglected Cation

Disorders of magnesium homeostasis are very common in dialysis patients but have received scant attention. In this review, we address measurement of plasma magnesium, magnesium balance and the factors that affect magnesium flux during dialysis, the prevalence of hypo- and hypermagnesemia in dialysis patients, and the potential clinical significance of hypo- and hypermagnesemia in dialysis patients. Many factors can affect plasma magnesium concentration, including diet, nutritional status (including plasma albumin level), medications (such as proton pump inhibitors), and dialysis prescription. Further interventional studies to determine the effect of normalization of plasma magnesium concentration on clinical outcomes are needed. Atthe present time, we recommend that predialysis plasma magnesium be measured on a regular basis, with the dialysate magnesium concentration adjusted to maintain plasma magnesium concentration within the normal range.

Prevalence of Hypogonadotropic Hypogonadism in Type 2 Diabetes Male Patients

Background: Erectile dysfunction is common in patients with diabetes mellitus. In addition, reduced testosterone itself is considered as a risk factor for diabetes; therefore hypogonadism was studied in diabetes. Objective: This study was done to determine the prevalence of hypo- and hypergonadotropic hypogonadism in the type 2 diabetes male patients in Mashhad in north-east of Iran. Methods: This study was done on type 2 diabetic men aged 40 - 60 years in the endocrine clinic, Endocrinology Research Center, Mashhad University of Medical Sciences, Iran. Fasting blood samples were collected at 8 am for measurement of fasting blood sugar (FBS), HbA1C, total serum testosterone, FSH, Sex Hormone Binding Globulin (SHBG), LH, prolactin, thyroxin-stimulating hormone (TSH), and immediately was sent to laboratory. Results: Out of total 96 type 2 diabetic males (mean age of 51.4 ± 11.26 years, range of 40 - 60 years), 11 (12.94%) patients were excluded because of inadequate samples, insufficient information and fulfillment of the exclusion criteria of the study. Hypogonadism based on Testosterone, Calculated free testosterone (CFT), and boiavailable testosterone (BT) were observed in 10 (11.8%), 31 (36.6%), and 30 (35.3%) of the patients, respectively. Libido was decreased in 55 (64.7%) of the patients. Based on the obtained SHBG values there were 7 (8.2%), 52 (61.2%), and 26 (30.6%) cases of low, normal and high values, respectively. According to TSH observed values there were 6 (7.1%) patients and 1 case of sub-clinical hypothyroidism and hyperthyroidism, respectively, and the rest 78 (91.8%) cases were euthyroid. Prolactin level was normal in all cases. Conclusion: Hypogonadotropic hypogonadism is common in type 2 diabetic men, and whether its treatment is useful for erectile dysfunction or not, needed additional investigation.

Using the glucometrics website to benchmark ICU glucose control before and after the NICE-SUGAR study.

Prior to 2009, intensive glycemic control was the standard in main intensive care units (ICUs). Glucose targets have been recalibrated after publication of the NICE-SUGAR study in that year, followed by updated guidelines that endorsed more moderated control. We sought to determine if the prevalence of hyperglycemia in US ICUs had increased after the NICE-SUGAR study's results were reported. We used data from hospitals submitted to the Yale Glucometrics™ website to assess mean blood glucose values, percentage of blood glucose within various ranges, and the prevalence of hypo- and hyperglycemic excursions, based on the patient-day method, comparing the pre- to post-NICE-SUGAR time period. Among more than a total of 2 million blood glucose determinations, comprising 408 790 patient-days, median patient-day blood glucose decreased from 144 mg/dL to 141 mg/dL (P < .001) in the pre- versus post-NICE-SUGAR time period. The percentage of patient days with a mean blood glucose of 110-179 mg/dl increased from 58.3 to 63.6%. The percentage of patient-days with either hypoglycemia (<70 mg/dl) or severe hyperglycemia (≥300 mg/dl) decreased during this time. Our results suggest that glycemic control in US ICUs has improved when comparing time periods before versus after publication of the NICE-SUGAR study. We found no evidence that fewer hypoglycemic events were achieved at the expense of more hyperglycemia.

Prevalence of hypo- and hypermagnesemia in an Iranian urban population

Background: Magnesium (Mg) plays an important role in metabolic processes and its deficiency or excess could adversely affect metabolism. Although magnesium deficiency and excess is associated with a variety of medical conditions, the prevalence of hypo- and hypermagnesemia have not been reported in an Iranian urban population.Subjects and methods: This cross-sectional study was performed on 1558 subjects (754 males and 804 females), randomly selected from among participants of the Tehran Lipid and Glucose Study (TLGS). Serum Mg level was measured by flame atomic absorption spectrophotometry. Hypo- and hypermagnesemia were defined by serum Mg < 0.75 mmol/L and Mg>1.04 mmol/L, respectively, and sub-optimal serum Mg concentrations were defined by serum Mg < 0.8 mmol/L.Results: The prevalence of hypomagnesemia was 4.6% in the total population, being more prevalent in females (6.0%) compared to males (3.2%) (p < 0.05). The overall prevalence of hypermagnesemia was 3.0% and it was more prevalent in males (3.2%) than females (2.7%) (p < 0.05). Sub-optimal Mg levels were found in 14.6% of the total population.Conclusions: The data show a relatively high prevalence of abnormal levels of serum Mg, among a general population; levels which may contribute to the pathophysiology of several diseases.

Predisposing factors for serum sodium disturbance in patients with severe traumatic brain injury (SBI)

Disturbances in the plasma sodium level in patients with severe brain injury (SBI) is not a rare phenomenon and may cause adverse effects on prognosis and treatment outcomes. The knowledge of the prevalence of risk factors helps in early detection and good management of the serum sodium level disturbance. Materials and methods: This is a prospective clinical trial double blind study. The target population included patients with SBI who had disturbances in their plasma sodium level and were admitted at the ICU of Kashani Hospital, Isfahan, Iran, between January and October 2006. The patients with renal insufficiency, diuretic therapy, massive transfusion, brain death, and spinal cord injury were excluded. Gender, age, the prevalence of hypo- and hypernatremia, having tracheal tube or tracheostomy, requiring mechanical ventilation support, craniotomy, type of intracranial pathology, positive history of cardiopulmonary disease, the mean time after which the disturbance occurs, and the mean time needed for the recovery from the disturbance were studied. Results: The prevalence of hypo- and hypernatremia were 60% and 40%, respectively. Most of the patients were 21-50-year-old males with craniotomy. The mean time after which the disturbance occurs was 23 days after head trauma and the mean time needed for the recovery from sodium level disturbances was 11.5 days. Conclusion: Hypo- and hypernatremia are common complications of intracranial lesions. Early detection of serum sodium level disturbance is important in these patients and appropriate treatment may actually improve prognosis.

Mo-P1:69 Prevalence of hypo- and hyperalphalipoproteinemia according to different diagnostic criteria in the massa Lombarda project cohort

Mo-P1:69 Prevalence of hypo- and hyperalphalipoproteinemia according to different diagnostic criteria in the massa Lombarda project cohort