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Salama M, Tebben PJ, Al Nofal A. An infant developing hypercalcemia and hypophosphatemia due to the use of exclusively almond milk. J Pediatr Endocrinol Metab 2024; 37:375-379. [PMID: 38414167 DOI: 10.1515/jpem-2023-0494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES Plant-based milk alternatives are increasingly utilized in children with cow milk allergy, lactose intolerance, and personal preference. However, notable differences exist in mineral content between cow milk and plant-based alternatives. Almond milk, in particular, varies in mineral and caloric content across different brands. This case report highlights a toddler who developed hypercalcemia and hypophosphatemia attributed to almond milk consumption. CASE PRESENTATION A fourteen-month-old girl with a history of biliary atresia underwent liver transplant at seven months of age. She was exclusively consuming almond milk for two months prior to presentation. She was admitted to the hospital for severe hypercalcemia (14.6 mg/dL) and hypophosphatemia (1.6 mg/dL). She had elevated random urine calcium to creatinine ratio (2.56 mg/g) and low urine phosphorus to creatinine ratio (<0.44 mg/g) were noted. Parathyroid hormone (PTH) level was appropriately suppressed (<6 pg/mL), while 1,25 dihydroxyvitamin D level was slightly elevated at 88 pg/mL. Initial management included intravenous fluids, followed by a switch to a formula with higher phosphorus and lower calcium concentrations. The patient was discharged after six days with normalized calcium and phosphorus levels, which remained within the normal range. CONCLUSIONS Although plant-derived milk serves as a viable alternative to cow milk, careful consideration of mineral content, particularly in infants and toddlers, is imperative. Sole reliance on almond milk for nutritional needs in this population is not recommended. Caregivers should be informed about the potential risks associated with almond milk consumption in infants and toddlers.
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Affiliation(s)
- Mostafa Salama
- Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, 4352 Mayo Clinic , Rochester, MN, USA
| | - Peter J Tebben
- Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, 4352 Mayo Clinic , Rochester, MN, USA
- Department of Medicine, Division of Endocrinology, Diabetes, Metabolism and Nutrition, 123305 Mayo Clinic , Rochester, MN, USA
| | - Alaa Al Nofal
- Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, 4352 Mayo Clinic , Rochester, MN, USA
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Benning TJ, Heien HC, Herges JR, Creo AL, Al Nofal A, McCoy RG. Glucagon fill rates and cost among children and adolescents with type 1 diabetes in the United States, 2011-2021. Diabetes Res Clin Pract 2023; 206:111026. [PMID: 38000667 PMCID: PMC10872944 DOI: 10.1016/j.diabres.2023.111026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 11/26/2023]
Abstract
AIMS To characterize glucagon fill rates and costs among youth with type 1 diabetes mellitus (T1DM). METHODS Claims-based analysis of commercially-insured youth with T1DM included in OptumLabs® Data Warehouse between 2011 and 2021. Glucagon fill rates and costs were calculated overall and by formulation (injectable, intranasal, autoinjector, and pre-filled syringe). Sociodemographic and clinical factors associated with glucagon fills were examined using Cox regression. RESULTS We identified 13,267 children with T1DM (76.4% non-Hispanic White). Over mean follow-up of 2.81 years (SD 2.62), 70.0% filled glucagon, with stable fill rates from 2011 to 2021. Intranasal glucagon had rapid uptake following initial approval, and it accounted for almost half (46.6%) of all glucagon fills by 2021. Family income was positively associated with glucagon fills in a stepwise fashion (HR 1.39 [95% CI 1.27-1.52] for annual household income ≥$200,000 vs. <$40,000), while Black race was negatively associated with fills (HR 0.83 [95% CI 0.76-0.91]) compared to White race). Annual mean out-of-pocket costs ranged from $21-$68 (IQR $29-$44). CONCLUSION Roughly 30% of commercially-insured youth with T1DM may lack access to unexpired glucagon, with significant disparities among Black and low-income patients. Health systems, clinicians, schools, and caregivers should work together to ensure children have reliable access to this critical medication.
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Affiliation(s)
- Tyler J Benning
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1(st) St. SW, Rochester, MN 55905, United States
| | - Herbert C Heien
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1(st) St. SW, Rochester, MN 55905, United States
| | - Joseph R Herges
- Pharmacy Services, Mayo Clinic, 200 1(st) St. SW, Rochester, MN 55905, United States
| | - Ana L Creo
- Division of Pediatric Endocrinology, Mayo Clinic, 200 1(st) St. SW, Rochester, MN 55905, United States
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Mayo Clinic, 200 1(st) St. SW, Rochester, MN 55905, United States
| | - Rozalina G McCoy
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1(st) St. SW, Rochester, MN 55905, United States; Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, 670 West Baltimore Street, Baltimore, MD 21201, United States; University of Maryland Institute for Health Computing, 6116 Executive Blvd, Bethesda, MD 20852, United States; OptumLabs, 11000 Optum Circle, Eden Prairie, MN 55344, United States.
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Al Nofal A, Hanna C, Lteif AN, Pittock ST, Schwartz JD, Brumbaugh JE, Creo AL. Copeptin levels in hospitalized infants and children with suspected vasopressin-dependent disorders: a case series. J Pediatr Endocrinol Metab 2023; 36:492-499. [PMID: 37029788 DOI: 10.1515/jpem-2022-0525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/20/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES There have been recent advances assessing copeptin levels in adults with suspected disorders of vasopressin release. Very limited data exits on copeptin levels in children and infants, especially in a critically-ill hospitalized population where hyper- and hypo-natremia are very common. Our objective is to describe the institutional experience assessing copeptin levels in hospitalized infants and children with hyper- or hypo-natremia. METHODS We performed a single-center retrospective case series of all infants, children, and adolescents who had an ultrasensitive plasma copeptin level obtained between 2019-2021. RESULTS A total of 29 critically ill patients (6 infants) were identified with 38 % of patients having copeptin levels after neurosurgical procedures for tumors or trauma. Approximately 13/17 children with hypernatremia had CDI to diagnose CDI, A copeptin level ≤ 4.9 pmol/L resulted in an 88 % sensitivity (95 % CI 47-99 %), and 66 % specificity (95 % CI 30-93 %). Amongst those with hyponatremia levels were more variable, 8/12 children had SIAD with copeptin levels ranging 4.7-72.6 pmol/L. CONCLUSIONS While difficult to conclude due to multiple limitations, this case series highlights that typical copeptin cutoffs used to diagnose DI in adults in an ambulatory setting may also translate to a critically-ill pediatric population. Large prospective studies are needed to confirm this observation. In addition, postoperative copeptin levels could potentially be utilized as an additional marker to predict permanent from transient DI, but much larger studies are needed. Further work is needed to establish normative copeptin levels in infants and patients with SIAD.
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Affiliation(s)
- Alaa Al Nofal
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Christian Hanna
- Division of Pediatric Nephrology and Hypertension, Mayo Clinic, Rochester, USA
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Aida N Lteif
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Siobhan T Pittock
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ana L Creo
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
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Stys J, Bernis K, Al Nofal A, Ryckman J. Fluoroscopy-assisted laparoscopic retrieval of retained abdominal wall and intraabdominal continuous glucose monitoring sensor wires. Journal of Pediatric Surgery Case Reports 2023. [DOI: 10.1016/j.epsc.2023.102599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
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Salama M, Biggs BK, Creo A, Prissel R, Al Nofal A, Kumar S. Adolescents with Type 2 Diabetes: Overcoming Barriers to Effective Weight Management. Diabetes Metab Syndr Obes 2023; 16:693-711. [PMID: 36923685 PMCID: PMC10010139 DOI: 10.2147/dmso.s365829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/09/2023] [Indexed: 03/12/2023] Open
Abstract
The prevalence of type 2 diabetes (T2DM) among children and adolescents has remarkably increased in the last two decades, particularly among ethnic minorities. Management of T2DM is challenging in the adolescent population due to a constellation of factors, including biological, socioeconomic, cultural, and psychological barriers. Weight reduction is an essential component in management of T2DM as weight loss is associated with improvement in insulin sensitivity and glycemic status. A family centered and culturally appropriate approach offered by a multidisciplinary team is crucial to address the biological, psychosocial, cultural, and financial barriers to weight management in youth with T2DM. Lifestyle interventions and pharmacotherapy have shown modest efficacy in achieving weight reduction in adolescents with T2DM. Bariatric surgery is associated with excellent weight reduction and remission of T2DM in youth. Emerging therapies for weight reduction in youth include digital technologies, newer GLP-1 agonists and endoscopic procedures.
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Affiliation(s)
- Mostafa Salama
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bridget K Biggs
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Ana Creo
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rose Prissel
- Division of Endocrinology and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Correspondence: Seema Kumar, Email
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Jackson S, Creo A, Al Nofal A. Management of Type 1 Diabetes in Children in the Outpatient Setting. Pediatr Rev 2022; 43:160-170. [PMID: 35229106 DOI: 10.1542/pir.2020-001388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Sarah Jackson
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine
| | - Ana Creo
- Division of Pediatric Endocrinology and Metabolism and Division of Endocrinology, Mayo Clinic, Rochester, MN
| | - Alaa Al Nofal
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Vermillion, SD
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Jackson S, Al Nofal A. Bilateral Femoral Fracture in an Adolescent Male Due to Severe Vitamin D Deficiency. S D Med 2021; 74:256-259. [PMID: 34449164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE/BACKGROUND Mild to moderate vitamin D deficiency is common in pediatric patients in the U.S. Severe hypovitaminosis D has been linked to specific risk factors, such as female gender, obesity, winter season, darker skin, lack of exposure to the sun, and low vitamin D intake. It has been reported that adolescents usually experience less severe clinical symptoms than young children with vitamin D deficiency. We present a previously healthy 15-year-old Caucasian male with bilateral spontaneous femoral fracture due to severe hypovitaminosis rickets. He had unusual eating habits such as avoiding dairy, vegetables, and fruits. In addition to always preferring to eat alone due to anxiety. Patient is underweight with a BMI z score of -4.05 at time of presentation. Due to lack of interest in physical activities, the patient spent most of his time indoors. DESIGN/METHODS This is a case report of a patient who presented to the children's hospital for further workup for bilateral spontaneous femoral fractures. FINDINGS/RESULTS Laboratory work up revealed that his 25 hydoxy-vitamin D level was less than 4 ng/ml, calcium level was 5.7 mg/dl (8.4-10.5mg/dL), and phosphorus was 3.5 mg/dl (3.7-4.7 mg/dl). His intact parathyroid hormone was elevated at 555 pg/ml (14-95 pg/ml) and alkaline phosphatase was elevated at 777 U/L (91-339 U/L). A wrist x-ray showed widening of the distal radial and ulnar metaphyses with metaphyseal cupping. Further labs showed macrocytic anemia and severe vitamin B12 deficiency. Workup for malabsorption was negative. Patient underwent bilateral open hip reduction internal fixation. Hypovitaminosis D and hypocalcemia were treated with calcium carbonate and oral vitamin D3 supplements. His follow up laboratory evaluation showed normalization of his calcium, phosphorus, PTH, alkaline phosphatase, and vitamin D levels. Repeat wrist X-ray two months later revealed marked improvement in the appearance of the distal radial and ulnar growth plates and metaphyseal regions. CONCLUSIONS This patient's vitamin D deficiency/rickets was found to be secondary to malnutrition due to limited intake, along with limited sunlight exposure. We recommend that a detailed dietary history is obtained in every adolescent patient to evaluate for proper vitamin D intake, especially in patients who are significantly underweight. If vitamin D deficiency is expected, vitamin D level should be checked and appropriate treatment should be initiated once vitamin D insufficiency is confirmed.
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Affiliation(s)
- Sarah Jackson
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Alaa Al Nofal
- Sanford Children's Hospital, Sioux Falls, South Dakota
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Barrionuevo P, Kapoor E, Asi N, Alahdab F, Mohammed K, Benkhadra K, Almasri J, Farah W, Sarigianni M, Muthusamy K, Al Nofal A, Haydour Q, Wang Z, Murad MH. Efficacy of Pharmacological Therapies for the Prevention of Fractures in Postmenopausal Women: A Network Meta-Analysis. J Clin Endocrinol Metab 2019; 104:1623-1630. [PMID: 30907957 DOI: 10.1210/jc.2019-00192] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Osteoporosis and osteopenia are associated with increased fracture incidence in postmenopausal women. We aimed to determine the comparative effectiveness of various available pharmacological therapies. METHODS We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science, and Scopus for randomized controlled trials that enrolled postmenopausal women with primary osteoporosis and evaluated the risk of hip, vertebral, or nonvertebral fractures. A network meta-analysis was conducted using the multivariate random effects method. RESULTS We included 107 trials (193,987 postmenopausal women; mean age, 66 years; 55% white; median follow-up, 28 months). A significant reduction in hip fractures was observed with romosozumab, alendronate, zoledronate, risedronate, denosumab, estrogen with progesterone, and calcium in combination with vitamin D. A significant reduction in nonvertebral fractures was observed with abaloparatide, romosozumab, denosumab, teriparatide, alendronate, risedronate, zoledronate, lasofoxifene, tibolone, estrogen with progesterone, and vitamin D. A significant reduction in vertebral fractures was observed with abaloparatide, teriparatide, parathyroid hormone 1-84, romosozumab, strontium ranelate, denosumab, zoledronate, risedronate, alendronate, ibandronate, raloxifene, bazedoxifene, lasofoxifene, estrogen with progesterone, tibolone, and calcitonin. Teriparatide, abaloparatide, denosumab, and romosozumab were associated with the highest relative risk reductions, whereas ibandronate and selective estrogen receptor modulators had lower efficacy. The evidence for the treatment of fractures with vitamin D and calcium remains limited despite numerous large trials. CONCLUSIONS This network meta-analysis provides comparative effective estimates for the various available treatments to reduce the risk of fragility fractures in postmenopausal women.
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Affiliation(s)
- Patricia Barrionuevo
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
- Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ekta Kapoor
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Noor Asi
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
| | - Fares Alahdab
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
| | - Khaled Mohammed
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
| | - Khalid Benkhadra
- Department of Internal Medicine, School of Medicine, Wayne State University, Detroit, Michigan
| | - Jehad Almasri
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
| | - Wigdan Farah
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
| | - Maria Sarigianni
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
| | - Kalpana Muthusamy
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Sanford Children's Specialty Clinic, Sioux Falls, South Dakota
| | - Qusay Haydour
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
| | - Zhen Wang
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
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Creo A, Alahdab F, Al Nofal A, Thomas K, Kolbe A, Pittock S. The Authors' Reply: Diagnostic accuracy of the McGill thyroid nodule score in pediatric patients: methodological issues. Clin Endocrinol (Oxf) 2019; 90:385. [PMID: 30374996 DOI: 10.1111/cen.13893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ana Creo
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Fares Alahdab
- Division of Preventative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Sanford Health, Sioux Falls, South Dakota
| | - Kristen Thomas
- Division of Pediatric Radiology, Mayo Clinic, Rochester, Minnesota
| | - Amy Kolbe
- Division of Pediatric Radiology, Mayo Clinic, Rochester, Minnesota
| | - Siobhan Pittock
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
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Creo A, Alahdab F, Al Nofal A, Thomas K, Kolbe A, Pittock ST. Ultrasonography and the American Thyroid Association Ultrasound-Based Risk Stratification Tool: Utility in Pediatric and Adolescent Thyroid Nodules. Horm Res Paediatr 2019; 90:93-101. [PMID: 30021204 DOI: 10.1159/000490468] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/28/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Pediatric thyroid nodules are more likely to be malignant compared to those in adults and may have different concerning ultrasound (US) features. Recent adult guidelines stratify malignancy risk by US features. Our aim is to (1) describe and confirm US features that predict pediatric malignancy, and (2) apply the Adult American Thyroid Association (ATA) Risk Stratification Guidelines to a large pediatric cohort. METHODS We identified 112 children with 145 thyroid nodules from 1996 to 2015. Two blinded pediatric radiologists independently read all US images, described multiple features, and reported their overall impression: benign, indeterminate, or malignant. Each nodule was assigned an ATA risk stratification category. Radiologists' impressions and ATA risk stratification were compared to histology and cytology results. RESULTS Multiple US features including a solid composition, presence of microcalcifications, irregular margins, increased blood flow, and hypoechogenicity were associated with increased odds of malignancy. ATA risk stratification correlated with the radiologists' overall impression (p < 0.001). The sensitivity for detecting malignancy was comparable between both ATA stratification (91%) and the radiologists' overall impression (90%). The specificity of the radiologists' malignant overall impression (80%) was better compared to the ATA high risk stratification (54%). CONCLUSIONS At our institution, pediatric radiologists' overall impressions had similar sensitivity but better specificity for detecting malignancy than the ATA risk stratification tool by our convention. However, neither US-based methods perfectly discriminated benign from malignant nodules, supporting the continued need for fine needle aspiration for suspicious nodules. Further work is needed to develop an US-based scoring system specific to pediatric patients.
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Affiliation(s)
- Ana Creo
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota, USA
| | - Fares Alahdab
- Division of Preventative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Sanford Health, Sioux Falls, South Dakota, USA
| | - Kristen Thomas
- Division of Pediatric Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy Kolbe
- Division of Pediatric Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Siobhan T Pittock
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota, USA
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Creo A, Alahdab F, Al Nofal A, Thomas K, Kolbe A, Pittock S. Diagnostic accuracy of the McGill thyroid nodule score in paediatric patients. Clin Endocrinol (Oxf) 2019; 90:200-207. [PMID: 30326152 DOI: 10.1111/cen.13878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/11/2018] [Accepted: 10/11/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Thyroid cancer is the most common paediatric endocrine cancer; accurate diagnosis and prompt management of paediatric thyroid nodules is critical. The McGill Thyroid Nodule Score (MTNS), based upon clinical, ultrasound (US) and cytology criteria, has recently been modified and studied in a pilot paediatric group with good results. We aim to describe the diagnostic accuracy of the paediatric modified MTNS (PMTNS) in a large paediatric cohort. METHODS We utilized an established retrospective cohort between 1996 and 2015 of 99 patients ≤21 years old with 131 thyroid nodules. Two experienced paediatric radiologists, blinded to pathology and radiology reports, reviewed US features. We abstracted cytology, histology and laboratory results, assigning each nodule a PMTNS. PMTNS performance was compared to FNA and histology. RESULTS Approximately 33% of nodules were malignant. The cohort was predominantly adolescent (mean age 15.4 ± 3.8 years). The average PMTNS for malignant and benign nodules, based on final histology, was 12.7 ± 4.3 and 1.7 ± 2.9, respectively. A PMTNS ≥8 resulted in a 93.2% sensitivity and 93.1% specificity for detecting malignancy, while a PMTNS ≥9 resulted in a 90.9% sensitivity and 96.6% specificity. However, Bethesda cytology category ≥4 independently had a 97.7% sensitivity and 94.0% specificity for detecting malignancy. The PMTNS had diminishing diagnostic accuracy in younger children compared with older children. CONCLUSION Paediatric modified McGill Thyroid Nodule Score predicts malignancy, perhaps due to the score's emphasis on cytology results; however, the score is less accurate in younger patients. While cytology results remain reliable, further work is needed to develop a non-invasive scoring system to predict malignancy in children.
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Affiliation(s)
- Ana Creo
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Fares Alahdab
- Division of Preventative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Sioux Falls, South Dakota
| | - Kristen Thomas
- Division of Pediatric Radiology, Mayo Clinic, Rochester, Minnesota
| | - Amy Kolbe
- Division of Pediatric Radiology, Mayo Clinic, Rochester, Minnesota
| | - Siobhan Pittock
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
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Dahl AR, Dhamija R, Nofal AA, Pittock ST, Schwenk WF, Kumar S. Transient Neonatal Diabetes due to a Mutation in KCNJ11 in a Child with Klinefelter Syndrome. J Clin Res Pediatr Endocrinol 2018; 10:79-82. [PMID: 28766502 PMCID: PMC5838377 DOI: 10.4274/jcrpe.4807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Klinefelter syndrome is the most frequent chromosomal aneuploidy in males occurring in about 1 in 660 males. Epidemiological studies have demonstrated increased risk of type 1 diabetes and type 2 diabetes in adults with Klinefelter syndrome. There is only one previous report of neonatal diabetes in a patient with Klinefelter syndrome. We report transient neonatal diabetes due to a pathogenic heterozygous variant in KCNJ11 in a male infant with Klinefelter syndrome. A 78-day old male infant was noted to have sustained hyperglycemia with serum glucose ranging between 148 mg/dL (8.2 mmol/L) and 381 mg/dL (21.2 mmol/L) three days after undergoing a complete repair of an atrioventricular defect. Hemoglobin A1c was 6.6%. The patient was born at term with a birth weight of 2.16 kg following a pregnancy complicated by gestational diabetes that was controlled with diet. The patient was initially started on a continuous intravenous insulin drip and subsequently placed on subcutaneous insulin (glargine, human isophane and regular insulin). Insulin was gradually decreased and eventually discontinued at seven months of age. Chromosomal microarray at 11 weeks of age showed XXY and a panel-based, molecular test for neonatal diabetes revealed a pathogenic heterozygous variant c.685G>A (p.Glu229Lys) in KCNJ11. The patient is now 34 months old and continues to have normal fasting and post-prandial glucose and HbA1C levels. The patient will need prospective follow up for assessment of his glycemic status. To our knowledge this is the second reported case of neonatal diabetes in an infant with Klinefelter syndrome and the first due to a mutation in the KCNJ11 in a patient with Klinefelter syndrome.
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Affiliation(s)
- Amanda R. Dahl
- Mayo Clinic, Department of Pediatric and Adolescent Medicine, Rochester, Minnesota, USA
| | - Radhika Dhamija
- Mayo Clinic, Department of Clinical Genomics, Phoenix, Arizona, USA
| | - Alaa Al Nofal
- University of South Dakota, Sanford Children Specialty Clinic, Division of Pediatric Endocrinology, Sioux Falls, South Dakota, USA
| | - Siobhan T. Pittock
- Mayo Clinic, Department of Pediatric and Adolescent Medicine, Division of Pediatric Endocrinology, Rochester, Minnesota, USA
| | - W. Frederick Schwenk
- Mayo Clinic, Department of Pediatric and Adolescent Medicine, Division of Pediatric Endocrinology, Rochester, Minnesota, USA
| | - Seema Kumar
- Mayo Clinic, Department of Pediatric and Adolescent Medicine, Division of Pediatric Endocrinology, Rochester, Minnesota, USA,* Address for Correspondence: Department of Pediatric and Adolescent Medicine, Division of Pediatric Endocrinology, Rochester, Minnesota, USA GSM: +507-284-3300 E-mail:
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Abstract
In this study, we demonstrated an association between adrenal hyperandrogenism, as determined by dehydroepiandrostenedione-to-free testosterone (DHEA-S/FT) ratio, and metabolic phenotype in obese and lean adolescents with polycystic ovary syndrome (PCOS). We compared 64 overweight/obese adolescents with PCOS (PCOS-O) with 18 lean (PCOS-L) adolescents. We analyzed the association between DHEA-S/FT ratios and metabolic parameters. Patients in the PCOS-O group were younger (median [interquartile range]) than those in the PCOS-L group (15 [15-17] vs. 16 [16-17] years; p = .04). The median DHEA-S/FT ratio and total testosterone concentrations did not differ. However, androstenedione concentrations were higher in the PCOS-L group (p = .02) and free testosterone levels lower in the PCOS-L group compared with the PCOS-O group (p = .02). Insulin resistance was present in 30 of 64 (46.9%) adolescents with PCOS-O compared with 1 of 18 (5.6%) with PCOS-L (p = .001). A significant negative correlation between DHEA-S/FT ratios and insulin concentrations in PCOS-O (p = .03) and PCOS-L (p = .04) groups was noted. In the PCOS-O group, the DHEA-S/FT ratio was negatively associated with serum triglyceride (p = .03) and total cholesterol concentrations (p = .02). We conclude that in adolescents with PCOS, a higher ratio of adrenal to ovarian androgens, signified by DHEA-S/FT, may be associated with a more favorable metabolic phenotype.
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Affiliation(s)
| | - Lyndsay D Viers
- b Department of Radiology , Mayo Clinic , Rochester , MN , USA
| | - Asma Javed
- c Division of Pediatric and Adolescent Gynecology , Mayo Clinic , Rochester , MN , USA
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14
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Singh Ospina NM, Rodriguez-Gutierrez R, Maraka S, Espinosa de Ycaza AE, Jasim S, Castaneda-Guarderas A, Gionfriddo MR, Al Nofal A, Brito JP, Erwin P, Richards M, Wermers R, Montori VM. Outcomes of Parathyroidectomy in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta-analysis. World J Surg 2017; 40:2359-77. [PMID: 27094563 DOI: 10.1007/s00268-016-3514-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Parathyroidectomy is a definitive treatment for primary hyperparathyroidism. Patients contemplating this intervention will benefit from knowledge regarding the expected outcomes and potential risks of the currently available surgical options. PURPOSE To appraise and summarize the available evidence regarding benefits and harms of minimally invasive parathyroidectomy (MIP) and bilateral neck exploration (BNE). DATA SOURCES A comprehensive search of multiple databases (MEDLINE, EMBASE, and Scopus) from each database's inception to September 2014 was performed. STUDY SELECTION Eligible studies evaluated patients with primary hyperparathyroidism undergoing MIP or BNE. DATA EXTRACTION Reviewers working independently and in duplicate extracted data and assessed the risk of bias. DATA SYNTHESIS We identified 82 observational studies and 6 randomized trials at moderate risk of bias. Most of them reported outcomes after MIP (n = 71). Using random-effects models to pool results across studies, the cure rate was 98 % (95 % CI 97-98 %, I (2) = 10 %) with BNE and 97 % (95 % CI 96-98 %, I (2) = 86 %) with MIP. Hypocalcemia occurred in 14 % (95 % CI 10-17 % I (2) = 93 %) of the BNE cases and in 2.3 % (95 % CI 1.6-3.1 %, I (2) = 87 %) with MIP (P < 0.001). There was a statistically significant lower risk of laryngeal nerve injury with MIP (0.3 %) than with BNE (0.9 %), but similar risk of infection (0.5 vs. 0.5 %) and mortality (0.1 vs. 0.5 %). LIMITATIONS The available evidence, mostly observational, is at moderate risk of bias, and limited by indirect comparisons and inconsistency for some outcomes (cure rate, hypocalcemia). CONCLUSION MIP and BNE are both effective surgical techniques for the treatment of primary hyperparathyroidism. The safety profile of MIP appears superior to BNE (lower rate of hypocalcemia and recurrent laryngeal nerve injury).
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Affiliation(s)
- Naykky M Singh Ospina
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Rene Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Department of Internal Medicine, University Hospital "Dr. Jose E. Gonzalez", Monterrey, Mexico
| | - Spyridoula Maraka
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Ana E Espinosa de Ycaza
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sina Jasim
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ana Castaneda-Guarderas
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael R Gionfriddo
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA
- Mayo Graduate School, Mayo Clinic, Rochester, MN, USA
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Juan P Brito
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA
| | | | - Melanie Richards
- Division of Endocrine Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Robert Wermers
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Victor M Montori
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA.
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15
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Al-Sayed SR, Hussein AA, Nofal AA, Hassab Elnaby SI, Elgazzar H. Characterization of a Laser Surface-Treated Martensitic Stainless Steel. Materials (Basel) 2017; 10:ma10060595. [PMID: 28772955 PMCID: PMC5553412 DOI: 10.3390/ma10060595] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 11/21/2022]
Abstract
Laser surface treatment was carried out on AISI 416 machinable martensitic stainless steel containing 0.225 wt.% sulfur. Nd:YAG laser with a 2.2-KW continuous wave was used. The aim was to compare the physical and chemical properties achieved by this type of selective surface treatment with those achieved by the conventional treatment. Laser power of different values (700 and 1000 W) with four corresponding different laser scanning speeds (0.5, 1, 2, and 3 m·min−1) was adopted to reach the optimum conditions for impact toughness, wear, and corrosion resistance for laser heat treated (LHT) samples. The 0 °C impact energy of LHT samples indicated higher values compared to the conventionally heat treated (CHT) samples. This was accompanied by the formation of a hard surface layer and a soft interior base metal. Microhardness was studied to determine the variation of hardness values with respect to the depth under the treated surface. The wear resistance at the surface was enhanced considerably. Microstructure examination was characterized using optical and scanning electron microscopes. The corrosion behavior of the LHT samples was also studied and its correlation with the microstructures was determined. The corrosion data was obtained in 3.5% NaCl solution at room temperature by means of a potentiodynamic polarization technique.
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Affiliation(s)
- S R Al-Sayed
- National Institute of Laser Enhanced Sciences (NILES), Cairo University, Giza 12611, Egypt.
| | - A A Hussein
- Faculty of Engineering, Cairo University, Giza 12611, Egypt.
| | - A A Nofal
- Central Metallurgical Research and Development Institute (CMRDI), Helwan 11731, Egypt.
| | - S I Hassab Elnaby
- National Institute of Laser Enhanced Sciences (NILES), Cairo University, Giza 12611, Egypt.
| | - H Elgazzar
- Central Metallurgical Research and Development Institute (CMRDI), Helwan 11731, Egypt.
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16
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Altayar O, Al Nofal A, Carranza Leon BG, Prokop LJ, Wang Z, Murad MH. Treatments to Prevent Bone Loss in Functional Hypothalamic Amenorrhea: A Systematic Review and Meta-Analysis. J Endocr Soc 2017; 1:500-511. [PMID: 29264505 PMCID: PMC5686767 DOI: 10.1210/js.2017-00102] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/21/2017] [Indexed: 12/02/2022] Open
Abstract
Objective: We conducted a systematic review and meta-analysis of studies that evaluated the effect of hormonal therapy [estrogen therapy including oral contraceptive pills (OCP)] and bisphosphonates in preventing bone loss in patients with functional hypothalamic amenorrhea (FHA). Methods: We searched several electronic databases for controlled and noncontrolled studies that enrolled females of any age presenting with FHA (including athletic, weight loss, and stress-associated amenorrhea/oligomenorrhea) through 9 January 2017. The outcomes of interest were fractures and bone mineral density (BMD). Random effects meta-analysis was used to pool outcomes across studies expressed as weighted mean difference and 95% confidence interval (CI). Results: Nine studies reporting on 280 patients that received different hormonal therapies were included. We did not identify studies that evaluated bisphosphonates. Meta-analysis demonstrated a statistically significant increase in BMD of the lumbar spine in patients receiving hormonal therapy after a median follow-up of 12 months (weighted mean difference, 0.032 g/cm2; 95% CI, 0.017 to 0.047; percentage change in BMD, 3.30%; 95% CI, 1.74 to 4.86). There was no substantial effect of receiving hormonal therapy on BMD of the femoral neck, trochanteric region, Ward triangle, or total body BMD. The quality of evidence was low because of the high risk of bias, imprecision (small sample size), and indirectness (as BMD is a surrogate outcome). None of the studies reported the incidence of fractures. Conclusion: The current evidence does not support using hormonal therapy for the sole purpose of improving bone health in patients with FHA. There are no data about bisphosphonates in this population.
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Affiliation(s)
- Osama Altayar
- Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota 55905.,Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri 36110
| | - Alaa Al Nofal
- Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota 55905.,Division of Pediatric Endocrinology, Sanford Children Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105
| | - B Gisella Carranza Leon
- Division of Diabetes, Endocrinology & Metabolism, Vanderbilt University Medical Center, Nashville, Tennessee 37232
| | - Larry J Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota 55905
| | - Zhen Wang
- Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota 55905
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota 55905
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17
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Rajjo T, Almasri J, Al Nofal A, Farah W, Alsawas M, Ahmed AT, Mohammed K, Kanwar A, Asi N, Wang Z, Prokop LJ, Murad MH. The Association of Weight Loss and Cardiometabolic Outcomes in Obese Children: Systematic Review and Meta-regression. J Clin Endocrinol Metab 2017; 102:758-762. [PMID: 28359092 DOI: 10.1210/jc.2016-2575] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/31/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Excess body weight in children is associated with multiple immediate and long-term medical comorbidities. We aimed to identify the degree of reduction in excess body weight associated with cardiometabolic changes (lipid panel, liver function tests, systolic blood pressure (SBP), diastolic blood pressure, glycosylated hemoglobin, and fasting blood glucose) in overweight and obese children. METHODS We conducted a comprehensive search of MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Scopus through February 12, 2015. We included randomized controlled trials and cohort studies that evaluated interventions to treat pediatric obesity (medication, surgery, lifestyle, and community-based interventions) with ≥ a 6-month follow-up. We used a random effects meta-regression approach to assess the association between body mass index (BMI)/weight and cardiometabolic changes. RESULTS We included 42 studies (37 randomized controlled trials and five cohorts) enrolling 3807 children (mean age, 12.2 years; weight, 74.7 kg; and BMI, 31.7 kg/m2). Studies had overall moderate to low risk of bias. A 1-mm Hg decrease in SBP was significantly associated with a decrease of 0.16 kg/m2 (P = .04) in BMI. A 1-mg/dL increase in HDL was significantly associated with a 0.74-kg decrease in weight (P = .02). A 1-mg/dL decrease in triglycerides was significantly associated with a 0.1-kg decrease in weight (P = .03). The remaining associations were not statistically significant. CONCLUSIONS Weight reduction in children is associated with significant changes in several cardiometabolic outcomes, particularly HDL, SBP, and triglycerides. The magnitude of improvement may help in setting expectations and may inform shared decision-making and counseling.
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Affiliation(s)
- Tamim Rajjo
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Jehad Almasri
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Alaa Al Nofal
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Wigdan Farah
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Mouaz Alsawas
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Ahmed T Ahmed
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Khaled Mohammed
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Amrit Kanwar
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Noor Asi
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Zhen Wang
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Larry J Prokop
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Mohammad Hassan Murad
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
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18
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Singh Ospina N, Brito JP, Maraka S, Espinosa de Ycaza AE, Rodriguez-Gutierrez R, Gionfriddo MR, Castaneda-Guarderas A, Benkhadra K, Al Nofal A, Erwin P, Morris JC, Castro MR, Montori VM. Diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy for thyroid malignancy: systematic review and meta-analysis. Endocrine 2016; 53:651-61. [PMID: 27071659 DOI: 10.1007/s12020-016-0921-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/09/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE To systematically appraise and summarize the available evidence about the diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy (USFNA) for thyroid malignancy, and to explore the integration of these estimates with the probability of thyroid malignancy before USFNA. METHODS A comprehensive search of multiple databases from each database's inception to August 2014 was performed. Eligible studies included those that evaluated patients with thyroid nodules who underwent USFNA and subsequent evaluation by histopathology or long-term follow-up. RESULTS We identified 32 studies at moderate risk of bias evaluating the USFNA diagnostic characteristics for the diagnosis of thyroid malignancy. Results were imprecise and inconsistent across trials. The pooled likelihood ratio (LR) of thyroid malignancy for a benign USFNA result was 0.09 (95 % CI 0.06, 0.14; I (2) = 33 %), whereas the pooled LR for a malignant result was 197 (95 % CI, 68, 569; I (2) = 77 %). In the case of a suspicious for follicular neoplasm result, the pooled LR for malignancy was 0.6 (95 % CI, 0.4, 1.0; I (2) = 84 %) and 8.3 (95 % CI, 3.6, 19.2; I (2) = 89) for a result of suspicious for malignancy. CONCLUSION The available evidence regarding the diagnostic accuracy of USFNA warrants only limited confidence due to risk of bias, imprecision, and inconsistency. However, some USFNA results (benign, malignant) are likely very helpful, by significantly changing the pre-test probability of thyroid cancer.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Juan P Brito
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Spyridoula Maraka
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ana E Espinosa de Ycaza
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rene Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael R Gionfriddo
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Mayo Graduate School, Mayo Clinic, Rochester, MN, USA
| | - Ana Castaneda-Guarderas
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
| | - Khalid Benkhadra
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Mayo Clinic, Rochester, MN, USA
| | | | - John C Morris
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - M Regina Castro
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Victor M Montori
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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19
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Al Nofal A, Gionfriddo MR, Javed A, Haydour Q, Brito JP, Prokop LJ, Pittock ST, Murad MH. Accuracy of thyroid nodule sonography for the detection of thyroid cancer in children: systematic review and meta-analysis. Clin Endocrinol (Oxf) 2016; 84:423-30. [PMID: 25845503 DOI: 10.1111/cen.12786] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/24/2015] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Thyroid ultrasound (US) is a widely used tool for evaluating thyroid nodules. Various US features have been suggested as predictors of thyroid cancer in children. OBJECTIVE To conduct a systematic review and meta-analysis to assess the diagnostic accuracy of different thyroid US features in detecting thyroid cancer in children. METHODS We searched multiple online databases for cohort studies that enrolled paediatric patients with thyroid nodules (age <21 years) and evaluated the accuracy of 12 relevant ultrasound features. Diagnostic measures were pooled across studies using a random effects model. RESULTS The search strategy yielded 1199 citations, of which 12 studies met the predefined inclusion criteria (750 nodules). The prevalence of thyroid cancer was 27·2% (40·8% in patients with a history of radiation exposure and 23·2% in patients without a history of exposure to radiation). The most common cancer was papillary thyroid cancer (86·7%). The presence of internal calcifications and enlarged cervical lymph nodes were the US features with the highest likelihood ratio [4·46 (95% CI: 1·87-10·64) and 4·96 (95% CI: 2·01-12·24), respectively] for thyroid cancer. A cystic nodule was the feature with highest likelihood ratio for benign nodules [1·96 (95% CI: 0·87-4·43)]. CONCLUSION Thyroid US features are not highly accurate predictors of benign or malignant aetiology of thyroid nodules in children. Internal calcification may predict malignancy, and cystic appearance may suggest benign aetiology.
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Affiliation(s)
- Alaa Al Nofal
- Division of Paediatric Endocrinology, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN, USA
| | - Michael R Gionfriddo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
- Mayo Graduate School, Rochester, MN, USA
| | - Asma Javed
- Division of Paediatric Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Qusay Haydour
- Internal Medicine Program, Georgia Regents University, Augusta, GA, USA
| | - Juan P Brito
- Division of Diabetes, Endocrinology, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Larry J Prokop
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Siobhan T Pittock
- Division of Paediatric Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Mohammad Hassan Murad
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN, USA
- Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA
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Ospina NS, Al Nofal A, Bancos I, Javed A, Benkhadra K, Kapoor E, Lteif AN, Natt N, Murad MH. ACTH Stimulation Tests for the Diagnosis of Adrenal Insufficiency: Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2016; 101:427-34. [PMID: 26649617 DOI: 10.1210/jc.2015-1700] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
CONTEXT The diagnosis of adrenal insufficiency is clinically challenging and often requires ACTH stimulation tests. OBJECTIVE To determine the diagnostic accuracy of the high- (250 mcg) and low- (1 mcg) dose ACTH stimulation tests in the diagnosis of adrenal insufficiency. METHODS We searched six databases through February 2014. Pairs of independent reviewers selected studies and appraised the risk of bias. Diagnostic association measures were pooled across studies using a bivariate model. DATA SYNTHESIS For secondary adrenal insufficiency, we included 30 studies enrolling 1209 adults and 228 children. High- and low-dose ACTH stimulation tests had similar diagnostic accuracy in adults and children using different peak serum cortisol cutoffs. In general, both tests had low sensitivity and high specificity resulting in reasonable likelihood ratios for a positive test (adults: high dose, 9.1; low dose, 5.9; children: high dose, 43.5; low dose, 7.7), but a fairly suboptimal likelihood ratio for a negative test (adults: high dose, 0.39; low dose, 0.19; children: high dose, 0.65; low dose, 0.34). For primary adrenal insufficiency, we included five studies enrolling 100 patients. Data were only available to estimate the sensitivity of high dose ACTH stimulation test (92%; 95% confidence interval, 81-97%). CONCLUSION Both high- and low-dose ACTH stimulation tests had similar diagnostic accuracy. Both tests are adequate to rule in, but not rule out, secondary adrenal insufficiency. Our confidence in these estimates is low to moderate because of the likely risk of bias, heterogeneity, and imprecision.
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Affiliation(s)
- Naykky Singh Ospina
- Evidence-Based Practice Research Program (N.S.O., A.A.N., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Knowledge and Evaluation Research Unit (N.S.O., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Division of Endocrinology, Diabetes, Metabolism, and Nutrition (N.S.O., N.N., I.B.), Mayo Clinic, Rochester, Minnesota; Division of Pediatric Endocrinology and Metabolism (A.A.N., A.J., A.N.L.), Mayo Clinic, Rochester, Minnesota; Division of General Internal Medicine (E.K.), Mayo Clinic, Rochester, Minnesota 55905
| | - Alaa Al Nofal
- Evidence-Based Practice Research Program (N.S.O., A.A.N., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Knowledge and Evaluation Research Unit (N.S.O., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Division of Endocrinology, Diabetes, Metabolism, and Nutrition (N.S.O., N.N., I.B.), Mayo Clinic, Rochester, Minnesota; Division of Pediatric Endocrinology and Metabolism (A.A.N., A.J., A.N.L.), Mayo Clinic, Rochester, Minnesota; Division of General Internal Medicine (E.K.), Mayo Clinic, Rochester, Minnesota 55905
| | - Irina Bancos
- Evidence-Based Practice Research Program (N.S.O., A.A.N., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Knowledge and Evaluation Research Unit (N.S.O., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Division of Endocrinology, Diabetes, Metabolism, and Nutrition (N.S.O., N.N., I.B.), Mayo Clinic, Rochester, Minnesota; Division of Pediatric Endocrinology and Metabolism (A.A.N., A.J., A.N.L.), Mayo Clinic, Rochester, Minnesota; Division of General Internal Medicine (E.K.), Mayo Clinic, Rochester, Minnesota 55905
| | - Asma Javed
- Evidence-Based Practice Research Program (N.S.O., A.A.N., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Knowledge and Evaluation Research Unit (N.S.O., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Division of Endocrinology, Diabetes, Metabolism, and Nutrition (N.S.O., N.N., I.B.), Mayo Clinic, Rochester, Minnesota; Division of Pediatric Endocrinology and Metabolism (A.A.N., A.J., A.N.L.), Mayo Clinic, Rochester, Minnesota; Division of General Internal Medicine (E.K.), Mayo Clinic, Rochester, Minnesota 55905
| | - Khalid Benkhadra
- Evidence-Based Practice Research Program (N.S.O., A.A.N., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Knowledge and Evaluation Research Unit (N.S.O., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Division of Endocrinology, Diabetes, Metabolism, and Nutrition (N.S.O., N.N., I.B.), Mayo Clinic, Rochester, Minnesota; Division of Pediatric Endocrinology and Metabolism (A.A.N., A.J., A.N.L.), Mayo Clinic, Rochester, Minnesota; Division of General Internal Medicine (E.K.), Mayo Clinic, Rochester, Minnesota 55905
| | - Ekta Kapoor
- Evidence-Based Practice Research Program (N.S.O., A.A.N., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Knowledge and Evaluation Research Unit (N.S.O., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Division of Endocrinology, Diabetes, Metabolism, and Nutrition (N.S.O., N.N., I.B.), Mayo Clinic, Rochester, Minnesota; Division of Pediatric Endocrinology and Metabolism (A.A.N., A.J., A.N.L.), Mayo Clinic, Rochester, Minnesota; Division of General Internal Medicine (E.K.), Mayo Clinic, Rochester, Minnesota 55905
| | - Aida N Lteif
- Evidence-Based Practice Research Program (N.S.O., A.A.N., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Knowledge and Evaluation Research Unit (N.S.O., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Division of Endocrinology, Diabetes, Metabolism, and Nutrition (N.S.O., N.N., I.B.), Mayo Clinic, Rochester, Minnesota; Division of Pediatric Endocrinology and Metabolism (A.A.N., A.J., A.N.L.), Mayo Clinic, Rochester, Minnesota; Division of General Internal Medicine (E.K.), Mayo Clinic, Rochester, Minnesota 55905
| | - Neena Natt
- Evidence-Based Practice Research Program (N.S.O., A.A.N., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Knowledge and Evaluation Research Unit (N.S.O., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Division of Endocrinology, Diabetes, Metabolism, and Nutrition (N.S.O., N.N., I.B.), Mayo Clinic, Rochester, Minnesota; Division of Pediatric Endocrinology and Metabolism (A.A.N., A.J., A.N.L.), Mayo Clinic, Rochester, Minnesota; Division of General Internal Medicine (E.K.), Mayo Clinic, Rochester, Minnesota 55905
| | - M Hassan Murad
- Evidence-Based Practice Research Program (N.S.O., A.A.N., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Knowledge and Evaluation Research Unit (N.S.O., K.B., M.H.M.), Mayo Clinic, Rochester, Minnesota; Division of Endocrinology, Diabetes, Metabolism, and Nutrition (N.S.O., N.N., I.B.), Mayo Clinic, Rochester, Minnesota; Division of Pediatric Endocrinology and Metabolism (A.A.N., A.J., A.N.L.), Mayo Clinic, Rochester, Minnesota; Division of General Internal Medicine (E.K.), Mayo Clinic, Rochester, Minnesota 55905
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Mohammed K, Abu Dabrh AM, Benkhadra K, Al Nofal A, Carranza Leon BG, Prokop LJ, Montori VM, Faubion SS, Murad MH. Oral vs Transdermal Estrogen Therapy and Vascular Events: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2015; 100:4012-20. [PMID: 26544651 DOI: 10.1210/jc.2015-2237] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Menopausal hormone therapy is widely used to alleviate climacteric symptoms but may increase the risk of venous and arterial vascular events. OBJECTIVE The objective was to synthesize the evidence about the risk of vascular events in postmenopausal women who use oral estrogen therapy (ET) and transdermal ET. METHODS We searched bibliographical databases through August 2013 for longitudinal comparative studies that enrolled postmenopausal women using either oral or transdermal ET and reported the outcomes of interest: venous thromboembolism (VTE), pulmonary embolism, deep venous thrombosis (DVT), myocardial infarction (MI), and stroke. Two reviewers independently selected and appraised studies. Outcomes were pooled using random effects meta-analysis and were reported as risk ratio (RR) and 95% confidence interval (CI). RESULTS We included 15 observational studies at moderate risk of bias with follow-up of 3 to 20.25 years. When compared to transdermal ET, oral ET was associated with increased risk of a first episode of VTE (RR, 1.63; 95% CI, 1.40-1.90; I(2) = 53%), DVT (RR, 2.09; 95% CI, 1.35-3.23; I(2) = 0 %), and possibly stroke (RR, 1.24; 95% CI, 1.03-1.48; a single case-controlled study), but not MI (RR, 1.17; 95% CI, 0.80-1.71; I(2) = 74%). CONCLUSION Observational evidence warranting low confidence suggests that compared to transdermal ET, oral ET may be associated with increased risk of VTE and DVT, but not MI.
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Affiliation(s)
- Khaled Mohammed
- Evidence-Based Practice Research Program (K.M., K.B., A.A.N., V.M.M., M.H.M.), Knowledge and Evaluation Research, Center for the Science of Health Care Delivery (K.M., A.M.A.D., K.B., A.A.N., V.M.M., M.H.M.), Division of Preventive, Occupational, and Aerospace Medicine (K.M., K.B., M.H.M.), Division of Pediatric Endocrinology (A.A.N.), Division of Endocrinology, Diabetes, Metabolism and Nutrition (B.G.C.L., V.M.M.), Library Public Services (L.J.P.), and Division of General Internal Medicine, Women's Health Clinic (S.S.F.), Mayo Clinic, Rochester, Minnesota 55905
| | - Abd Moain Abu Dabrh
- Evidence-Based Practice Research Program (K.M., K.B., A.A.N., V.M.M., M.H.M.), Knowledge and Evaluation Research, Center for the Science of Health Care Delivery (K.M., A.M.A.D., K.B., A.A.N., V.M.M., M.H.M.), Division of Preventive, Occupational, and Aerospace Medicine (K.M., K.B., M.H.M.), Division of Pediatric Endocrinology (A.A.N.), Division of Endocrinology, Diabetes, Metabolism and Nutrition (B.G.C.L., V.M.M.), Library Public Services (L.J.P.), and Division of General Internal Medicine, Women's Health Clinic (S.S.F.), Mayo Clinic, Rochester, Minnesota 55905
| | - Khalid Benkhadra
- Evidence-Based Practice Research Program (K.M., K.B., A.A.N., V.M.M., M.H.M.), Knowledge and Evaluation Research, Center for the Science of Health Care Delivery (K.M., A.M.A.D., K.B., A.A.N., V.M.M., M.H.M.), Division of Preventive, Occupational, and Aerospace Medicine (K.M., K.B., M.H.M.), Division of Pediatric Endocrinology (A.A.N.), Division of Endocrinology, Diabetes, Metabolism and Nutrition (B.G.C.L., V.M.M.), Library Public Services (L.J.P.), and Division of General Internal Medicine, Women's Health Clinic (S.S.F.), Mayo Clinic, Rochester, Minnesota 55905
| | - Alaa Al Nofal
- Evidence-Based Practice Research Program (K.M., K.B., A.A.N., V.M.M., M.H.M.), Knowledge and Evaluation Research, Center for the Science of Health Care Delivery (K.M., A.M.A.D., K.B., A.A.N., V.M.M., M.H.M.), Division of Preventive, Occupational, and Aerospace Medicine (K.M., K.B., M.H.M.), Division of Pediatric Endocrinology (A.A.N.), Division of Endocrinology, Diabetes, Metabolism and Nutrition (B.G.C.L., V.M.M.), Library Public Services (L.J.P.), and Division of General Internal Medicine, Women's Health Clinic (S.S.F.), Mayo Clinic, Rochester, Minnesota 55905
| | - Barbara G Carranza Leon
- Evidence-Based Practice Research Program (K.M., K.B., A.A.N., V.M.M., M.H.M.), Knowledge and Evaluation Research, Center for the Science of Health Care Delivery (K.M., A.M.A.D., K.B., A.A.N., V.M.M., M.H.M.), Division of Preventive, Occupational, and Aerospace Medicine (K.M., K.B., M.H.M.), Division of Pediatric Endocrinology (A.A.N.), Division of Endocrinology, Diabetes, Metabolism and Nutrition (B.G.C.L., V.M.M.), Library Public Services (L.J.P.), and Division of General Internal Medicine, Women's Health Clinic (S.S.F.), Mayo Clinic, Rochester, Minnesota 55905
| | - Larry J Prokop
- Evidence-Based Practice Research Program (K.M., K.B., A.A.N., V.M.M., M.H.M.), Knowledge and Evaluation Research, Center for the Science of Health Care Delivery (K.M., A.M.A.D., K.B., A.A.N., V.M.M., M.H.M.), Division of Preventive, Occupational, and Aerospace Medicine (K.M., K.B., M.H.M.), Division of Pediatric Endocrinology (A.A.N.), Division of Endocrinology, Diabetes, Metabolism and Nutrition (B.G.C.L., V.M.M.), Library Public Services (L.J.P.), and Division of General Internal Medicine, Women's Health Clinic (S.S.F.), Mayo Clinic, Rochester, Minnesota 55905
| | - Victor M Montori
- Evidence-Based Practice Research Program (K.M., K.B., A.A.N., V.M.M., M.H.M.), Knowledge and Evaluation Research, Center for the Science of Health Care Delivery (K.M., A.M.A.D., K.B., A.A.N., V.M.M., M.H.M.), Division of Preventive, Occupational, and Aerospace Medicine (K.M., K.B., M.H.M.), Division of Pediatric Endocrinology (A.A.N.), Division of Endocrinology, Diabetes, Metabolism and Nutrition (B.G.C.L., V.M.M.), Library Public Services (L.J.P.), and Division of General Internal Medicine, Women's Health Clinic (S.S.F.), Mayo Clinic, Rochester, Minnesota 55905
| | - Stephanie S Faubion
- Evidence-Based Practice Research Program (K.M., K.B., A.A.N., V.M.M., M.H.M.), Knowledge and Evaluation Research, Center for the Science of Health Care Delivery (K.M., A.M.A.D., K.B., A.A.N., V.M.M., M.H.M.), Division of Preventive, Occupational, and Aerospace Medicine (K.M., K.B., M.H.M.), Division of Pediatric Endocrinology (A.A.N.), Division of Endocrinology, Diabetes, Metabolism and Nutrition (B.G.C.L., V.M.M.), Library Public Services (L.J.P.), and Division of General Internal Medicine, Women's Health Clinic (S.S.F.), Mayo Clinic, Rochester, Minnesota 55905
| | - Mohammad Hassan Murad
- Evidence-Based Practice Research Program (K.M., K.B., A.A.N., V.M.M., M.H.M.), Knowledge and Evaluation Research, Center for the Science of Health Care Delivery (K.M., A.M.A.D., K.B., A.A.N., V.M.M., M.H.M.), Division of Preventive, Occupational, and Aerospace Medicine (K.M., K.B., M.H.M.), Division of Pediatric Endocrinology (A.A.N.), Division of Endocrinology, Diabetes, Metabolism and Nutrition (B.G.C.L., V.M.M.), Library Public Services (L.J.P.), and Division of General Internal Medicine, Women's Health Clinic (S.S.F.), Mayo Clinic, Rochester, Minnesota 55905
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Benkhadra K, Mohammed K, Al Nofal A, Carranza Leon BG, Alahdab F, Faubion S, Montori VM, Abu Dabrh AM, Zúñiga Hernández JA, Prokop LJ, Murad MH. Menopausal Hormone Therapy and Mortality: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2015; 100:4021-8. [PMID: 26544652 DOI: 10.1210/jc.2015-2238] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVES The objective was to assess the effect of menopausal hormonal therapy (MHT) on all-cause and cause-specific mortality. METHODS We conducted a comprehensive search of several databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus) from inception until August 2013. We included randomized controlled trials (RCTs) of more than 6 months of duration comparing MHT with no treatment. Pairs of independent reviewers selected trials, assessed risk of bias and extracted data. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) using the random-effects model. RESULTS We included 43 RCTs at moderate risk of bias. Meta-analysis showed no effect on mortality (RR 0.99 [95% CI, 0.94-1.05]), regardless of MHT type or history of preexisting heart disease. No association was found between MHT and cardiac death (RR 1.04 [95% CI 0.87-1.23]) or stroke (RR 1.49 [95% CI 0.95-2.31]). Estrogen plus progesterone use was associated with a likely increase in breast cancer mortality (RR 1.96 [95% CI 0.98-3.94]), whereas estrogen use was not. MHT use was not associated with mortality of other types of cancer. In 5 trials, MHT was likely started at a younger age: 2 RCTs with mean age less than 60 and 3 RCTs with MHT started less than 10 years after menopause. Meta-analysis of these 5 RCTs showed a reduction of mortality with MHT (RR 0.70 [95% CI 0.52-0.95]). CONCLUSION The current evidence suggests that MHT does not affect the risk of death from all causes, cardiac death and death from stroke or cancer. These data may be used to support clinical and policy deliberations about the role of MHT in the care of symptomatic postmenopausal women.
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Affiliation(s)
- Khalid Benkhadra
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Khaled Mohammed
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Alaa Al Nofal
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Barbara G Carranza Leon
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Fares Alahdab
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Stephanie Faubion
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Victor M Montori
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Abd Moain Abu Dabrh
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Jorge Alberto Zúñiga Hernández
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Larry J Prokop
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Mohammad Hassan Murad
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
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23
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Al Nofal A, Lteif A. Thiazide Diuretics in the Management of Young Children with Central Diabetes Insipidus. J Pediatr 2015; 167:658-61. [PMID: 26130110 DOI: 10.1016/j.jpeds.2015.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/06/2015] [Accepted: 06/02/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To report our experience in treating infants and toddlers with central diabetes insipidus (DI) with thiazide diuretics. STUDY DESIGN A retrospective chart review of all infants and toddlers who were treated with thiazide diuretics for central DI at the Mayo Clinic between 1996 and 2014. RESULTS Our cohort consisted of 13 patients. The median age at the start of therapy was 6 months (IQR, 1-14 months). Eight patients were given chlorothiazide at a starting dose of 5-10 mg/kg/day, and 5 patients were treated with hydrochlorothiazide at a starting dose of 1-2 mg/kg/day. The median age at the cessation of thiazide therapy was 18 months (IQR, 11.5-39 months). The main reason for stopping was the lack of continued response, in addition to hypernatremia. There was no hospitalization secondary to hyponatremia and only 1 hospitalization secondary to hypernatremia while receiving thiazide therapy. Calcium was checked periodically in 7 of the 13 patients, and 2 of these 7 patients had persistent hypercalcemia. CONCLUSION Thiazide diuretics appear to be safe and effective in treating infants with central DI. They can be continued after the introduction of solid food, and until a lack of response is observed.
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Affiliation(s)
- Alaa Al Nofal
- Division of Pediatric Endocrinology, Mayo Clinic, Rochester, MN; Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.
| | - Aida Lteif
- Division of Pediatric Endocrinology, Mayo Clinic, Rochester, MN
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Brito JP, Al Nofal A, Montori VM, Hay ID, Morris JC. The Impact of Subclinical Disease and Mechanism of Detection on the Rise in Thyroid Cancer Incidence: A Population-Based Study in Olmsted County, Minnesota During 1935 Through 2012. Thyroid 2015; 25:999-1007. [PMID: 26103159 PMCID: PMC4560845 DOI: 10.1089/thy.2014.0594] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND An ongoing epidemic of thyroid carcinoma (TC) has affected Americans since 1975. Understanding the contribution of subclinical disease and the mechanism of such disease detection may help to alter the course of this epidemic. METHODS We used Rochester Epidemiology Project resources to examine the incidence of TC cases, disease specific mortality, and method of diagnosis during 1935 through 2012. During 2000-2012, we also extracted the mechanism of detection of clinically occult tumors. RESULTS The age-adjusted incidence (AAI) for TC increased from 7.1 [95% confidence interval (CI) 5.5-8.8] per 100,000 person-years (p-y) during 1990-1999 to 13.7 [CI 11.8-15.6] per 100,000 p-y during 2000-2012, with no change in disease-specific mortality since 1935. The incidence trend analysis stratified by the mechanism of detection revealed the AAI of clinically recognized TC was 5.5 per 100,000 p-y [CI 3.4-7.5] in 1960-1969, a rate similar to the incidence seen during 2000-2012. However, AAI of clinically occult TC increased from 0.2 per 100,000 p-y [CI 0.0-0.6] in 1935-1949 to 1.9 per 100,000 p-y [CI 1.2-2.9] in 1990-1999 and to 7.4 per 100,000 p-y [CI 6.0-8.8] in 2000-2012. During 2000-2012, the most frequent reasons for recognition of "occult" tumors were (1) incidental discovery during diagnostic neck imaging in 40 (19%), (2) pathology review of specimens from thyroid surgery for benign conditions in 29 (14%), and (3) investigations of patients with symptoms or palpable nodules that were clearly not associated with coexistent but occult TC but triggered the use of diagnostic neck imaging in 37 (27%). CONCLUSIONS In this population-based study conducted in Olmsted County, Minnesota, the rapid increased incidence of TC during 2000-2012 can be completely attributed to the increased diagnosis of occult TCs, which are mainly found through the use of diagnostic neck imaging. The incidence of clinical TC and disease-specific TC mortality remains stable since 1970, implying that the observed increased incidence is due to the increased detection of subclinical lesions.
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Affiliation(s)
- Juan P. Brito
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Victor M. Montori
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Ian D. Hay
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - John C. Morris
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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25
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Brito JP, Gionfriddo MR, Al Nofal A, Boehmer KR, Leppin AL, Reading C, Callstrom M, Elraiyah TA, Prokop LJ, Stan MN, Murad MH, Morris JC, Montori VM. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab 2014; 99:1253-63. [PMID: 24276450 PMCID: PMC3973781 DOI: 10.1210/jc.2013-2928] [Citation(s) in RCA: 287] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Significant uncertainty remains surrounding the diagnostic accuracy of sonographic features used to predict the malignant potential of thyroid nodules. OBJECTIVE The objective of the study was to summarize the available literature related to the accuracy of thyroid nodule ultrasound (US) in the prediction of thyroid cancer. METHODS We searched multiple databases and reference lists for cohort studies that enrolled adults with thyroid nodules with reported diagnostic measures of sonography. A total of 14 relevant US features were analyzed. RESULTS We included 31 studies between 1985 and 2012 (number of nodules studied 18,288; average size 15 mm). The frequency of thyroid cancer was 20%. The most common type of cancer was papillary thyroid cancer (84%). The US nodule features with the highest diagnostic odds ratio for malignancy was being taller than wider [11.14 (95% confidence interval 6.6-18.9)]. Conversely, the US nodule features with the highest diagnostic odds ratio for benign nodules was spongiform appearance [12 (95% confidence interval 0.61-234.3)]. Heterogeneity across studies was substantial. Estimates of accuracy depended on the experience of the physician interpreting the US, the type of cancer and nodule (indeterminate), and type of reference standard. In a threshold model, spongiform appearance and cystic nodules were the only two features that, if present, could have avoided the use of fine-needle aspiration biopsy. CONCLUSIONS Low- to moderate-quality evidence suggests that individual ultrasound features are not accurate predictors of thyroid cancer. Two features, cystic content and spongiform appearance, however, might predict benign nodules, but this has limited applicability to clinical practice due to their infrequent occurrence.
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Affiliation(s)
- Juan P Brito
- Departments of Diabetes, Metabolism, and Nutrition (J.P.B., M.N.S., J.C.M., V.M.M.), Pediatric Endocrinology and Metabolism (A.A.N.), and Radiology (C.R., M.C.), Knowledge and Evaluation Research Unit (J.P.B., M.R.G., K.R.B., A.L.L., T.A.E., L.J.P., M.H.M., V.M.M.), Mayo Graduate School (M.R.G.), and Division of Preventive Medicine (M.H.M.), Mayo Clinic, Rochester, Minnesota 55905
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Abstract
One of the most important aspects of a well-child examination is an assessment of a child's growth. Children who are failing to grow are often labeled "failure to thrive." However, close examination of the pattern of growth on standardized growth charts often allows the caregiver to characterize the growth failure as failure to grow, failure to gain weight, or failure to grow and gain weight. Such refinement of the pattern of growth failure allows for a more specific differential diagnosis and helps to focus laboratory and radiographic evaluation.
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Affiliation(s)
- Alaa Al Nofal
- W. Frederick Schwenk, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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