No abstract

BackgroundVitamin D deficiency has become an important public health problem, however few studies have been conducted in subtropical countries, and the predictors of vitamin D deficiency in people with healthy renal function are unclear. The objective of this study was to evaluate the prevalence and factors associated with vitamin D deficiency in northern Taiwan.MethodsThe cross-sectional study was performed between August 2013 and August 2017, and included 3954 participants without chronic kidney disease (CKD) aged ≥30 years in northern Taiwan. Serum 25-hydroxyvitamin D [25(OH)-D] levels, biochemistry, sociodemographic variables (age, sex, education, occupation) and lifestyle habits (tea, coffee consumption and physical activities) were recorded. Associations between vitamin D status and these variables were examined using a regression model. The definition of deficiency was defined as a serum 25(OH)-D level < 20 ng/mL (50 nmol/L).ResultsThe mean 25(OH)-D concentration was 28.9 ng/mL, and 22.4% of the study population had vitamin D deficiency. There was a significantly higher vitamin D deficiency ratio in the women compared to the men (22.9% vs 9.9%, p < 0.001). Vitamin D deficiency was most prevalent (38.4%) in those aged 30–39 years. Those with a graduate degree had the highest rate of vitamin D deficiency (31.5%). The predictors of vitamin D deficiency included female sex, young age, high education level, living in an urban area and physical inactivity. Tea consumption was negatively associated with vitamin D deficiency.ConclusionsVitamin D deficiency is prevalent in subtropical areas such as northern Taiwan in healthy individuals without CKD.

To demonstrate the residual pituitary function of patients with Sheehan's syndrome years after the obstetric complication, 14 patients with postpartum hemorrhage followed by secondary amenorrhea and agalactia were included in this review. Due to their unfamiliarity with the clinical symptoms, these patients did not receive pretreatment hormonal therapy. The mean age at their last delivery was 29 years (range 21-38 years). The mean duration between postpartum hemorrhage and the subsequent clinical manifestations leading to the endocrine investigation was 18 years (range 1-33 years). Eight patients presented with symptoms of severe hyponatremia (serum sodium less than 125 mmol/l) more than 16 years (mean 23 +/- 10) after the occurrence of postpartum hemorrhage. The electrolyte abnormality was primarily due to adrenal dysfunction. Seven out of 14 patients had normal basal luteinizing hormone (LH) levels and adequate LH responses to gonadotropin releasing hormone stimulation. Administration of thyrotropin releasing hormone provoked thyrotropin release and/or prolactin secretion in four cases. The manifestation of clinical hypopituitarism and the degree of empty sella on computed tomography scanning did not accurately indicate the secreting ability of the pituitary in patients with Sheehan's syndrome. Although all the patients had amenorrhea, the gonadotropic functions of the pituitary still remain in some patients. Various degrees of other pituitary functions can also been demonstrated even several decades after the occurrence of obstetric complications. Our data suggest that the amenorrhea of Sheehan's patients is not simply due to a dysfunction of the pituitary gonadotrophs.

Acta Ophthalmol. 2010: 88: 753–758 Abstract. Purpose:  This study aimed to examine the correlation between glycosylated haemoglobin (HbA1c) level and macular volume in diabetes patients without diabetic macular oedema (DMO). Methods:  We carried out an observational, cross‐sectional study. Patients who had diabetes mellitus (DM) of ≥ 10 years duration without DMO were included. Only one eye of each patient was selected for analysis. Eyes with proliferative diabetic retinopathy were excluded. Central subfield thickness (CST), central subfield volume (CSV) and total macular volume (TMV) were measured by optical coherence tomography (OCT). Chronic HbA1c level was defined as the mean HbA1c value in the year prior to enrolment. Results:  We included 97 eyes from 97 patients (47 women, 50 men; mean age 62.2 years). They included eight type 1 and 89 type 2 DM patients. The mean duration of DM was 15.5 years. Forty‐two (43%) eyes had no diabetic retinopathy and 55 (57%) eyes had non‐proliferative diabetic retinopathy. In statistical analysis, CST (mean 188.80 ± 27.64 μm; r = 0.220, p = 0.030), CSV (mean 0.149 ± 0.021 mm3; r = 0.213, p = 0.036) and TMV (mean 6.497 ± 0.715 mm3; r = 0.299, p = 0.003) positively correlated with chronic HbA1c level (7.95 ± 1.29%). The linear regression model showed that chronic HbA1c level (standardized coefficient 0.253; p = 0.013) and age (standardized coefficient − 0.206; p = 0.040) were factors significantly related to TMV. Conclusions:  Chronic HbA1c level positively correlates with macular thickness and volume in patients with DM of ≥ 10 years duration without DMO. Our results suggest that subclinical macular volume and thickness changes may occur before DMO becomes clinically evident. Early tight glycaemic control prior to the onset of DMO may play an important role in preventing the deterioration of macular function by altering macular haemodynamics.