Correction: Mobile Apps for COVID-19 Detection and Diagnosis for Future Pandemic Control: Multidimensional Systematic Review

[This corrects the article DOI: 10.2196/44406.].

Mobile Apps for COVID-19 Detection and Diagnosis for Future Pandemic Control: Multidimensional Systematic Review

BACKGROUND

In the modern world, mobile apps are essential for human advancement, and pandemic control is no exception. The use of mobile apps and technology for the detection and diagnosis of COVID-19 has been the subject of numerous investigations, although no thorough analysis of COVID-19 pandemic prevention has been conducted using mobile apps, creating a gap.

OBJECTIVE

With the intention of helping software companies and clinical researchers, this study provides comprehensive information regarding the different fields in which mobile apps were used to diagnose COVID-19 during the pandemic.

METHODS

In this systematic review, 535 studies were found after searching 5 major research databases (ScienceDirect, Scopus, PubMed, Web of Science, and IEEE). Of these, only 42 (7.9%) studies concerned with diagnosing and detecting COVID-19 were chosen after applying inclusion and exclusion criteria using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol.

RESULTS

Mobile apps were categorized into 6 areas based on the content of these 42 studies: contact tracing, data gathering, data visualization, artificial intelligence (AI)-based diagnosis, rule- and guideline-based diagnosis, and data transformation. Patients with COVID-19 were identified via mobile apps using a variety of clinical, geographic, demographic, radiological, serological, and laboratory data. Most studies concentrated on using AI methods to identify people who might have COVID-19. Additionally, symptoms, cough sounds, and radiological images were used more frequently compared to other data types. Deep learning techniques, such as convolutional neural networks, performed comparatively better in the processing of health care data than other types of AI techniques, which improved the diagnosis of COVID-19.

CONCLUSIONS

Mobile apps could soon play a significant role as a powerful tool for data collection, epidemic health data analysis, and the early identification of suspected cases. These technologies can work with the internet of things, cloud storage, 5th-generation technology, and cloud computing. Processing pipelines can be moved to mobile device processing cores using new deep learning methods, such as lightweight neural networks. In the event of future pandemics, mobile apps will play a critical role in rapid diagnosis using various image data and clinical symptoms. Consequently, the rapid diagnosis of these diseases can improve the management of their effects and obtain excellent results in treating patients.

A Review on Multi-organ Cancer Detection Using Advanced Machine Learning Techniques

Abnormal behaviors of tumors pose a risk to human survival. Thus, the detection of cancers at their initial stage is beneficial for patients and lowers the mortality rate. However, this can be difficult due to various factors related to imaging modalities, such as complex background, low contrast, brightness issues, poorly defined borders and the shape of the affected area. Recently, computer-aided diagnosis (CAD) models have been used to accurately diagnose tumors in different parts of the human body, especially breast, brain, lung, liver, skin and colon cancers. These cancers are diagnosed using various modalities, including computed tomography (CT), magnetic resonance imaging (MRI), colonoscopy, mammography, dermoscopy and histopathology. The aim of this review was to investigate existing approaches for the diagnosis of breast, brain, lung, liver, skin and colon tumors. The review focuses on decision-making systems, including handcrafted features and deep learning architectures for tumor detection.

0846 Reports of Sleep Symptoms in Young Adults of College Age

Introduction

Young adults of college age in the United States often report inadequate sleep. The objectives of this study were to identify a) how often young adults of college age report symptoms of insomnia, fatigue and mood disorder and b) identify differences in symptom reporting based on their sleep duration.

Methods

This is a cross-sectional study, using data from 2013 through 2018 of the National Health Interview Survey (NHIS). 11,028 subjects, ages 18-22 years, for whom information was available on duration of sleep were included. We analyzed reports of trouble falling sleep, trouble staying sleep, non-restorative sleep, fatigue and symptoms of mood disorder. Subjects were divided into 2 groups: ≤7 hours and > 7 hours of sleep. Data was analyzed using Complex Sample Analysis of IBM SPSS version 26.

Results

Out of the 11,028 subjects 50.7% were male and 49.3% were female. Mean sleep duration for all subjects was 7.44 ± 0.02 hours (mean± SE). 13.5% subjects reported trouble falling asleep while 10.6% reported trouble staying asleep for ≥4 nights per week. Non-restorative sleep and frequent fatigue were reported by 33.8% and 12.4% respectively. Daily/weekly symptoms of anxiety and depression were reported by 23.9% and 8.6% respectively. There were 48.4% subjects with ≤7 hours and 51.6 % with >7 hours of sleep. When compared to subjects with ≤7 hours to >7 hours of sleep, trouble falling asleep, trouble staying asleep and non-restorative sleep were reported by 19.9% vs. 7.5%, 14.8% vs. 6.6% and 45.9% vs. 22.4% respectively. Symptoms of fatigue, anxiety and depression reported by subjects with ≤7 hours vs. >7 hours of sleep were: 18.6% vs. 6.6%, 26.9% vs. 21% and 10.2% vs.7% respectively.

Conclusion

Young adults with ≤ 7 hours of sleep are more likely to report trouble falling sleep, trouble staying sleep, non-restorative sleep, fatigue and symptoms of mood disorder.

Support

None

Genetic heterogeneity of synpolydactyly: a novel locus SPD3 maps to chromosome 14q11.2-q12

Syndactyly type II or synpolydactyly (SPD) is the second most frequent syndactyly type and is inherited in an autosomal dominant fashion. The cardinal features of this malformation are the cutaneous or bony fusion of third and fourth fingers, and fourth and fifth toes associated with additional digital elements within the web. It shows incomplete penetrance and high inter- and intrafamilial phenotypic variability. Two loci are known for SPD (MIM 186000, MIM 608180) associated with mutations in HOXD13 and FBLN1, respectively. Here, we report further genetic heterogeneity for SDP. Employing a whole genomic screen, we demonstrate, in a large Pakistani kindred, that the classical phenotype of SPD maps on a new locus at chromosome 14q11.2-q12. The highest LOD score (Z(max) = 4.06) was obtained with microsatellite marker D14S264, and the multipoint LOD score reached a maximum of 5.01. Haplotype analysis revealed that the disease interval is flanked by microsatellite markers D14S283 and D14S1060, encompassing a physical distance of 10.72 Mb. We propose to allocate to this locus the symbol SPD3 (synpolydactyly 3), and to name the loci associated with HOXD13 or FBLN1 mutations SPD1 and SPD2, respectively.

An unusual swelling in the neck

Venous thrombosis is a fundamental pathological entity. Our patient provides an opportunity to consider etiology in terms of Virchow's classic triad. We also draw attention to the effort syndrome, in which recurrent, vigorous exertion of an upper extremity is thought to produce venous thrombosis by virtue of local endothelial trauma.

Metformin-induced lacticacidemia in patients with type 2 diabetes mellitus

OBJECTIVE

To determine whether metformin therapy can predispose patients with type 2 diabetes and normal renal function to lactic acidosis when certain conditions are present.

METHODS

We undertook this prospective cohort study in 110 consecutive patients (age range, 27 to 85 years) with normal serum creatinine levels (<1.5 mg/dL in men; <1.4 mg/dL in women), receiving metformin as monotherapy or in combination with sulfonylurea or insulin, who were undergoing assessment on a regular basis for diabetes care. Clinical evaluations were performed at 4- to 12-week intervals for up to 2 years. Serum electrolytes and creatinine as well as plasma lactic acid determinations were done in all patients, regardless of symptoms. The anion gap was calculated.

RESULTS

Plasma lactic acid concentrations were normal in 47 patients (mean, 9.4 +/- 18.0 mg/dL or 1.053 +/- 0.194 mmol/L) and high in 63 patients (19.63 +/- 5.11 mg/dL or 2.208 +/- 0.569 mmol/L; P<0.001). The anion gap was increased in the high lactic acid group in comparison with the normal group (P<0.001). Comorbid conditions (for example, cardiovascular or respiratory disease) that may predispose to hypoxemia or compromise tissue perfusion were significantly more prevalent in patients in the high lactic acid group than in those with normal lactic acid values.

CONCLUSION

Lacticacidemia may occur in metformin-treated patients with type 2 diabetes mellitus who have normal renal function. An increased anion gap and certain clinical symptoms may serve as clues for the presence of lacticacidemia. Progression from lacticacidemia to clinical lactic acidosis, under certain hemodynamic or respiratory adverse conditions, remains conjectural and needs further evaluation.

Predictors of lean body mass and total adipose mass in community-dwelling elderly men and women

As part of an ongoing longitudinal study, we analyzed cross-sectional data to identify the predictors of lean body mass (LBM) and total adipose mass (TAM) in community-dwelling elderly men and women. Body composition analysis was done using dual energy x-ray absorptiometry. A total 262 subjects (118 women and 144 men), 60 to 80 years of age, from the urban and suburban communities of southeastern Wisconsin were studied. In women, the age (r = -.18), body mass index (BMI) (r = .43), and waist-to-hip ratio (WHR) (r = .30), and in men, BMI (r = .45) and insulin-like growth factor-1 (IGF-1) (r = .32) were identified as predictors (P < .05) of LBM. In women, the BMI (r = .87), WHR (r = .21), and functional work capacity (VO2 max) (r = -.47), and in men, the BMI (r = .83), WHR (r = .52), dehydroepiandrosterone sulfate (DHEAS) (r = -.27), total testosterone (TT) (r = -.35), free testosterone (FT) (r = -.23), physical activity (LTE) (r = -.32), and VO2 peak (r = -.59) were identified as predictors of TAM. After partialling out age in addition to the predictors identified earlier, the VO2 peak was identified as a predictor (P < .05) of LBM in both women and men, and TT, FT, and LTE as predictors (P < .05) of LBM in men. We conclude that the BMI, WHR, and VO2 peak influences LBM and TAM in both women and men. Additionally, in men LBM and TAM is influenced by hormone profile.

Serum insulin-like growth factor-I and serum testosterone status of elderly men in an inpatient rehabilitation unit

This study was designed to estimate the prevalence of hyposomatomedinemia and hypogonadism in an inpatient rehabilitation unit. The authors studied healthy young men (HOM) ages 20-29 years (n=33); healthy old men (HOM) ages 59-98 years (n=27), and elderly men in an inpatient rehabilitation unit (ERM) ages 58-95 years (n=42). Serum concentrations of insulin-like growth factor (IGF-I), total testosterone (TT), and free testosterone (FT) were measured. A low IGF-I level (below the lower 2.5 percentile of HYM) occurred in 85% of the HOM and in 62.5% of the ERM. When a low IGF-I was defined as a value below the 2.5 percentile of the HOM, the prevalence in ERM was 6.2%. A low TT level (below the lower 2.5 percentile of the HOM) occurred in 78% of the HOM and in 90% of the ERM. Low TT, defined as a value below the lower 2.5 percentile of the HOM, occurred in 22% of the ERM. The results with FT were similar. In neither HOM nor ERM was IGF-I significantly correlated to TT and FT. A large percentage of HOM and ERM have severe hypogonadism (TT<193 ng/mL) as compared with HOM. The ERM had a higher prevalence of severe hypogonadism as compared with the HOM.

Observations on nursing home residents with a history of hip fracture

The authors evaluated nursing home residents with a prior history of hip fracture for osteopenia and its risk factors, and attempted to learn to what extent the residents' bone status had been considered by their primary care physicians. Thirty-one hip fracture residents in the Milwaukee VA nursing home were studied to determine their status with regard to bone mineral density of the proximal femur, and the following risk factors or predictors of osteopenia: history of smoking; history of fractures; calcium and vitamin D intake; underweight; immobility; hypogonadism; and administration of drugs that may accelerate bone demineralization. Data were also collected on the evaluation and management of the post hip fracture residents in three other nursing homes. In the Milwaukee nursing home, out of 31 hip fracture survivors, 74% had sustained a hip fracture before admission to the nursing home; 29% had a history of second fracture. In 84% of patients, there was no mention of osteopenia in the active medical problem list and, therefore, there was no intervention plan in place to improve or prevent further bone loss. Thirty-two percent were underweight, 36% were currently smoking, 55% were immobile, 64% were consuming at least one medication that might increase bone loss, calcium intake was less than 1,000 mg daily in 52%, and 66% were hypogonadal (serum testosterone level less than 300 ng/dL). Chart reviews of the hip fracture survivors at three other nursing homes revealed similar findings. Approximately 5-15% of nursing home residents are hip fracture survivors. They usually have severe osteopenia and multiple risk factors for further bone loss and future fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Observations on the nutrient intakes of eating-dependent nursing home residents: underutilization of micronutrient supplements

OBJECTIVE

To estimate the intakes of essential nutrients by eating-dependent nursing home residents (EDR).

METHODS

This study was done in a 190 bed VA nursing home. Thirty-four EDR were selected for the study. Clinical data base which included age, sex, primary diagnosis, body mass index, albumin, hematocrit, activities of daily living status, decubitus ulcer medications and use of multivitamin/trace mineral supplement were recorded from the medical records. Caloric and essential nutrient intakes were determined over a 3-day period by a registered dietitian.

RESULTS

Seventy percent (24/34) residents in the study group were underweight (body mass index < 23 kg/m2), 26% were hypoalbuminemic (serum level < 3.5 g/dl), 50% were anemic (hematocrit < 37%); and 38% had pressure ulcers. In 88% EDR, the dietary intakes of three or more essential nutrients were below 50% of the RDA. Most frequent and severely deficient were zinc, copper, and vitamin B6. Despite the inadequate essential micronutrient intakes in the majority of EDR, only 35% received a multivitamin supplement and only 3% received a trace mineral supplement. A survey of 30 other VA nursing homes indicated generally similar findings to those in the Milwaukee facility with regard to the high frequency for eating-dependence, and the low frequency for administration of multivitamin and trace mineral supplements.

CONCLUSIONS

Despite eating supervision and assistance, the majority of EDR have inadequate intakes of numerous essential macro- and micronutrients. The deficient micronutrient intakes could be normalized by administration of a multivitamin/trace mineral supplement daily. Nevertheless, only a minority of EDR in VA nursing homes currently receive such a supplement.

Undernutrition in the nursing home: prevalence, consequences, causes and prevention

Approximately 5% of Americans over age 65, or 1.5 million individuals, currently reside in the nation's 20,000 nursing homes. The authors present material that lead to three conclusions about this population. First, nutritional deficiencies are common underlying causes of adverse clinical outcomes. Second, nutritional deficiencies are frequently not recognized. Third, opportunities for preventing or correcting undernutrition exist, provided that the significant and reversible nature of the nutrient deficiencies are identified.

Low circulating levels of insulin-like growth factors and testosterone in chronically institutionalized elderly men

OBJECTIVE

To determine the prevalences of and the associations between hyposomatomedinemia and hypogonadism in healthy young men, healthy old men, and chronically institutionalized old men.

DESIGN

Survey with serial blood tests.

SETTING

Veterans Affairs nursing home and young and old men living in the community.

SUBJECTS

Three groups were studied: healthy young men (20-29 years old, n = 32), healthy old men (59-98 years old, n = 30), and chronically institutionalized old men (59-95 years old, n = 112).

MEASUREMENTS

Plasma insulin-like growth factor-I (IGF-I), total testosterone (TT), free testosterone (FT), and plasma insulin-like growth factor-II (IGF-II) were measured. In subjects with low testosterone level, serum luteinizing hormone (LH) was also determined. In a subset of chronically institutionalized old men with low IGF-I, the serum growth hormone (GH) level was analyzed during the first 4 hours of sleep.

RESULTS

A low IGF-I level (defined as a value below the lower 2.5 percentile of the comparison group) occurred in 85% of the healthy old men when compared with healthy young men (P < 0.001), in 90% of the chronically institutionalized old men when compared with healthy young men (P < 0.001), and in 26% of the chronically institutionalized old men when compared with healthy old men (P < 0.001). In chronically institutionalized old men with low IGF-I compared with healthy young men, nocturnal peaks of serum GH were < 2 ng/mL in most cases. Low TT (defined as a value below the lower 2.5 percentile of the comparison group) occurred in 86% of the healthy old men when compared with healthy young men (P < 0.001), in 88% of the chronically institutionalized old men when compared with healthy young men (P < 0.001), and in 28% of the chronically institutionalized old men when compared with healthy old men (P < 0.001). The results of FT were similar. In 80% of the institutionalized old men with low TT and FT, the serum LH level was low (< 20 mU/mL). In 53% of the institutionalized old men, the IGF-II level was below the lower 2.5 percentile of the healthy old men (P < 0.001). In both healthy and institutionalized old men, IGF-I and IGF-II levels were significantly correlated to each other (r = 0.6), but neither was significantly correlated to TT or FT. In the institutionalized old men, IGF-I was inversely correlated with age and with a diagnosis of dementia; TT and FT were inversely correlated with age and with the degree of dependency in ADL's.

CONCLUSIONS

Compared with healthy young men, most healthy old men have low serum IGF-I, TT, and FT levels. The geriatric hyposomatomedinemia and hypogonadism are more severe in institutionalized old men. In the latter group, both endocrine deficiencies are usually of central origin, but their occurrences are not significantly associated. Healthy old men usually have a low level of IGF-I compared with healthy young men, but a similar level of IGF-II; institutionalized old men are usually low in both values.

Observations on the prevalence of protein-calorie undernutrition in VA nursing homes

OBJECTIVE

To determine the prevalence of underweight and hypoalbuminemia in Veterans Affairs nursing home residents and the frequency with which physicians, nurses, and dietitians documented their awareness of the presence of underweight and hypoalbuminemia.

DESIGN

Retrospective survey of medical records.

SETTING

Twenty-six Department of Veterans Affairs nursing homes located in the Department's Central Region.

PATIENTS

2811 residents.

MAIN OUTCOME MEASURES

(1) Prevalence of underweight (defined as body weight less than 80% of standard) and hypoalbuminemia (defined as serum albumin less than 3.5 g/dl); (2) frequency with which physicians, nurses, and dietitians documented the prevalence of underweight and hypoalbuminemia in the records.

RESULTS

Three hundred thirty-two (11.8%) of the patients were underweight and 772 (27.5%) were hypoalbuminemic. The prevalence of the two conditions varied widely across nursing homes. The prevalence of low serum albumin ranged from 5% to 58% in the 26 institutions, and the prevalence of body weight less than 80% of standard ranged from 2% to 20%. In the Region as a whole, the dietician's notes in the medical charts mentioned underweight in an average of 95% of affected cases but mentioned the suboptimal albumin level in only 82% of the hypoalbuminemic individuals. In the nurses's notes, these figures were only 80% and 45%, respectively, and in the physician's notes, only 62% and 46%, respectively. The frequency of documented awareness of underweight and hypoalbuminemia by nurses and physicians varied tremendously across the 26 facilities (as few as 7% of the undernourished cases in one nursing home, 100% of the affected individuals in another).

CONCLUSIONS

This study showed a high prevalence of calorie and protein undernutrition in the nursing home residents of VA nursing homes, wide variation in the prevalence across nursing homes, and frequent lack of documentation of these nutritional deficiencies by physicians and nurses.

Laboratory testing: current recommendations for older adults

Efficient use of laboratory testing is essential in the care of the elderly, both for making accurate diagnoses and keeping costs in line. Further, primary care physicians treating the elderly need to have an understanding of the effect of age on laboratory values. Clinically significant change occurs with age in some values but not in others. This review focuses first on the effect of aging on different laboratory values and then discusses current recommendations for the most commonly used laboratory tests.

Protein quality of two liquid-formula diets used in nursing homes

The protein quality of the liquid diet Two Cal HN was evaluated by plasma amino acid (PAA) ratio and by chemical score. The PAA test was performed in young healthy men, elderly healthy men, and elderly institutionalized, tube-fed men. In all three groups the PAA ratio for tryptophan was negative, indicating a deficiency of this amino acid in the formula's protein. But the amino acid score for tryptophan based on the manufacturer's stated amino acid composition was adequate (0.90). To resolve the discrepancy between PAA test and amino acid score, the formula's protein was isolated and its amino acid composition analyzed. In three samples of Two Cal HN, the tryptophan content of the isolated protein averaged only 45% of the content stated in the manufacturer's product description. A similar discrepancy was then found for Isocal, another liquid diet used in nursing homes.

Delayed plasma clearance of phenylalanine and tyrosine in elderly men

The plasma levels of 17 amino acids were measured in three groups of men: healthy young men, healthy elderly men, and demented tube-fed elderly men living in a nursing home, prior to, and again 2, 4, and 6 hours after the consumption of a standard protein-containing meal. The standard meal provided per kilogram of body weight 8.3 calories, 0.33 grams of protein, 0.90 grams of carbohydrate, and 0.37 grams of fat. The concentrations of all amino acids, except tryptophan, rose significantly at 2 hours and returned to baseline by 6 hours. Plasma phenylalanine and tyrosine were significantly (P less than 0.05) higher at 2 hours in the two groups of elderly men than in the young healthy men. In other respects the pre- and post-prandial amino acid profiles were not influenced by age. The ratio, tyrosine/other large neutral amino acids (tyr/LNAA), was significantly higher in both elderly groups than in the young men at nearly all time points before and after the test meal. It was generally higher in the demented older men than in the healthy older men. The data demonstrated a delayed plasma clearance of phenylalanine and tyrosine in old age. The elevated plasma tyr/LNAA ratio in the elderly men may have tended to augment an entry of tyrosine, the precursor of norepinephrine and dopamine, into their brains.

Easily measurable adverse outcome indicators in a Veterans Affairs nursing home

Indicator data were collected from October 1986 through April 1987 for 356 residents of the nursing home at the North Chicago, Illinois, Veterans Administration Medical Center. Measures of prevalence, incidence, and rates of change were studied for 17 adverse outcome indicators of four main types: death, undernutrition, skin breakdown, and loss of activities of daily living (eating, mobility, transfer, and toileting). Indicator values can be calculated from data routinely collected for administrative and other clinical purposes and can be used to help nursing home administrators monitor trends in the physical status of residents and to establish and track compliance with quality assurance goals.

Effect of oral zinc therapy on gonadal function in hemodialysis patients. A double-blind study

Zinc deficiency may account for the persistence of gonadal dysfunction in a majority of uremic men despite adequate dialysis. Twenty stable patients having hemodialysis three times a week completed a double-blind trial using either 50 mg of elemental zinc as zinc acetate (10 patients) or placebo (10 patients), orally. At the end of the 6-month study period, a significant increase in the mean (+/- SE) plasma zinc (75 +/- 2 micrograms/dL to 100 +/- 2 micrograms/dL, p less than 0.001), serum testosterone (2.8 +/- 0.3 ng/dL to 5.2 +/- 0.5 ng/mL, p less than 0.001), and sperm count (30 +/- 3 million/mL to 63 +/- 5 million/mL, p less than 0.001) occurred in the zinc-treated group, but not in those receiving the placebo. The zinc-treated group also had a significant fall in serum luteinizing hormone (92 +2- 10 mIU/mL to 49 +/- 26 mIU/mL, p less than 0.005) and follicle stimulating hormone (45 +/- 9 mIU/mL to 25 +/- 7 mIU/mL, p less than 0.05), not seen in the placebo group. Patients receiving zinc had an improvement in potency, libido, and frequency of intercourse not found in the placebo group. These results suggest that zinc deficiency is a reversible cause of gonadal dysfunction in patients having regular hemodialysis.

Effect of zinc supplementation on serum testosterone level in adult male sickle cell anemia subjects

Previously, we have documented primary testicular failure in adult male subjects with sickle cell anemia. We have also reported the occurrence of zinc deficiency and suggested that androgen deficiency may be related to zinc deficiency in such patients. In this study, we present data with respect to the efferent of oral zinc supplementation on serum testosterone levels in adult male patients with sickle cell anemia. An increase in serum testosterone, neutrophil zinc, and neutrophil alkaline phosphatase activity ws observed in the zinc-supplemented group in comparison with the group on placebo. Additionally, body weight increased and serum lactic dehydrogenase activity decrease in response to zinc supplementation. We conclude that androgen deficiency in adult male subjects with sickle cell anemia is correctable with zinc supplementation and that the determination of neutrophil zinc and alkaline phosphatase activity in the neutrophils may be utilized as good indicators of body zinc status in such subjects.

Brief clinical report: 46,XX, del (18p) with amenorrhea, hypothyroidism, and ptosis

A 17-year-old girl was initially evaluated because of primary amenorrhea and lack of sexual development. Chromosome studies demonstrated the presence of 46,XX, del (18p). The patient is now 21 years old and still has not menstruated. This is the first reported case of 46,XX, del (18p) presenting with primary amenorrhea. The case is of additional interest in that ptosis, a common finding in this syndrome, was not present at birth but was first noted at age 9.

Experimental zinc deficiency in man. Effect on testicular function

Dietary zinc intake was restricted (2.7 to 5.0 mg daily) for 24 to 40 weeks in five male volunteers. Their mean age was 57 years. Oligospermia (total sperm count less than 40 million per ejaculate) was induced in four out of five subjects. A decrease in the sperm count occurred during zinc restricion and the early phase of zinc repletion before body stores of zinc were restored to normal. The duration of oligospermia in the four subjects ranged from 6 to 14 months. Oligospermia was reversed after zinc supplementation in physiologic amounts. The baseline sperm concentration and total sperm count per ejaculate in all five subjects dropped significantly (p < 0.05) after zinc restriction and returned to normal 6 to 12 months after zinc supplementation. The decrease in sperm count coincided with decline in Leydig cell function and was reversed after zinc supplementation in low doses. Our study has demonstrated that dietary restriction of zinc can affect testicular function adversely. This effect of zinc deficiency, however, is a reversible process and can be corrected by proper supplementation with zinc.

Improvement of uremic hypogeusia by zinc: a double-blind study

Diminished taste acuity may account for the persistence of protein and caloric malnutrition observed in a majority of hemodialysis patients inspite of liberalization of the prescribed amount of dietary protein. Twenty-two patients undergoing thrice weekly hemodialysis for more than 6 months were tested for taste acuity and plasma zinc concentration, after which a double-blind study was instituted using a zinc supplement (50 mg of elemental zinc as zinc acetate per day) or a placebo. The threshold of taste detection and recognition for salt (NaCl), sweet (sucrose), and bitter (urea) but not for sour (HCl) improved significantly in all patients on zinc supplementation. None of these parameters improved in those taking placebo. During the study period, the mean plasma zinc level increased from 75 +/- 8 to 97 +/- 10 microgram/dl (P less than 0.001) in patients receiving zinc acetate. There was not significant change in plasma zinc level in the placebo group (75 +/- 15 to 80 +/- 15). The results of this study show that uremic hypogeusia improved in association with zinc supplementation and elevation of plasma zinc concentration.

Hypercalcemia in active pulmonary tuberculosis

We ascertained the incidence of hypercalcemia in 79 consecutive patients with active pulmonary tuberculosis and a control group of 79 patients with chronic obstructive pulmonary disease. Twenty-two patients developed hypercalcemia (serum calcium greater than 10.5 mg/dl) within 4 to 16 weeks after initiation of chemotherapy for tuberculosis. The duration of hypercalcemia ranged from 1 to 7 months, and remission occurred spontaneously in all patients. The mean daily vitamin D supplement was greater in hypercalcemic patients than in the normocalcemic group. There was a positive correlation between daily vitamin D supplement and degree and duration of hypercalcemia. Mean serum calcium in patients with tuberculosis was higher than in patients with chronic obstructive pulmonary disease supplemented with the same dose of vitamin D. Hypercalcemia appears to be related to the activity of pulmonary tuberculosis and the intake of vitamin D; the exact mechanism, however, remains unknown.

Gonadal function abnormalities in sickle cell anemia. Studies in adult male patients

Thirty-two adult patients with sickle cell anemia were evaluated endocrinologically. Secondary sex characteristics were abnormal in 29, and eunuchoidal skeletal proportions were present in all except one. The age at which different stages of pubic hair growth were attained in these patients was delayed in comparison to normals (P less than 0.005). Hormonal assays were carried out in 14 patients. Basal serum testosterone, dihydrotestosterone, and androstenedione values were lower (P less than 0.02) in patients than controls. Serum LH and FSH levels before and after stimulation with gonadotropin-releasing hormone were consistent with primary testicular failure. Erythrocyte and hair zinc concentrations were significantly decreased, and there was positive correlation between erythrocyte zinc and serum testosterone (r = 0.61, P less than 0.01) in sickle cell anemia. Our study shows that androgen deficiency in this disease is a result of primary rather than secondary hypogondadism. Further studies are required to establish the role of zinc in the pathogenesis of testicular failure in sickle cell anemia.

Myxedema ileus. A form of intestinal pseudo-obstruction

Myxedema ileus uncommonly complicates the hypothyroid state. It is a rare cause of intestinal pseudo-obstruction that can be reversed with thyroid hormone therapy. Our two patients with myxedema ileus had concurrent infection. Intestinal ileus was completely reversed with the administration of thyroid hormone.