Investigation and management of hypotonic polyura is a common challenge in clinical endocrinology. The three main causes, recently renamed to arginine vasopressin deficiency (AVP-D, formerly central diabetes insipidus), AVP-resistance (AVP-R, formerly nephrogenic diabetes insipidus), and primary polydipsia (PP) require accurate diagnosis as management differs for each. This new nomenclature more accurately reflects pathophysiology, and has now been adopted by the Systemised Nomenclature of Medicine (SNOMED). Advances in diagnosis over the last few years have centered around the use of copeptin measurement. Here, we use three patient case histories to highlight the use of this approach, and to demonstrate how it can succeed where other approaches, such as the water deprivation test, sometimes fail. We discuss the overall approach to each type of patient and the strengths and limitations of diagnostic strategies, illustrating the use of the new nomenclature.

UNASSIGNED: Vitamin D deficiency is a serious health problem that is associated with many health consequences. The study aimed to assess the knowledge, attitudes, and practices of medical students at Qassim University, Saudi Arabia, regarding vitamin D deficiency.
UNASSIGNED: An observational cross-sectional study was conducted among students of Unaizah Colleges of Pharmacy (UCP) and Medicine (UCM) at Qassim University, Saudi Arabia, over a period of 3 months. A well-structured self-administered questionnaire was used for the data collection. Statistical analysis was applied by using SPSS version 22. A 0/1 scoring process was employed to assess the KAP of the participants. The midpoint is considered the cutoff point.
UNASSIGNED: A total of 337 complete responses were received. The majority of participants (62.3%) were female. 291 (86.3%) were considered to have good knowledge, with a mean score of 6.326 out of 9. Moreover, 220 (65.2%) of participants had positive attitudes, with a mean score of 4.077 out of 7. Unfortunately, only 9 (2.6%) participants demonstrated satisfactory practices, with a mean score a 0.911 out of 6. Female participants were significantly better than male participants in terms of knowledge and attitudes, but worse in terms of practices. Sun exposure during safe daytime hours is considered the main cause of vitamin D deficiency. Nearly 60% confirmed that KSA indoor activities and the COVID-19 lockdown might maximise vitamin D deficiency.
UNASSIGNED: The study reveals a gap in vitamin D knowledge among participants influenced by gender and study year. It suggests educational initiatives for male students to enhance their knowledge regarding vitamin D, while female students are encouraged to prioritise safe sun exposure, minimising the use of umbrellas and sunscreen. It also highlights the role of educational institutions as reliable sources of information and the influence of the COVID-19 pandemic on participants\' attitudes and practices towards vitamin D.

An adequate vitamin D level is essential for optimal bone mass formation during growth. The present study aimed to assess (i) the sex-specific, age-specific, and potential seasonal (spring, summer, winter) influences on the pediatric circulating levels of 25-hydroxyvitamin D (25(OH)D); (ii) determine the frequency of pediatric patients with vitamin D deficiency (VDD) or insufficiency (VDI); and (iii) quantify the association between age category, sex, and season types and susceptibility to VDD and VDI, respectively. Laboratory data were collected on serum 25(OH)D levels in children aged between 2 and 18 years (n = 1674) who underwent blood sampling following admission to a university pediatric hospital in Cluj-Napoca (Romania) between January and June 2023. VDD (<20 ng/mL) was observed in 27% of pediatric patients. Among toddlers and preschoolers (2-5 years), VDD was 11%, while it was 33% among school-aged children (6-11 years) and 39% among adolescents (12-18 years). We found a significant difference in the frequencies of vitamin D status between females and males (p = 0.006). Also, we found significant associations of vitamin D status with age categories (p < 0.0001) and seasonal variations (p = 0.03). After adjusting for season of blood collection, the multinomial logistic regression model showed that children aged 6-11 years old (adjusted OR = 7, 95% CI: (4.9, 9.4)), children aged 12-18 years old (adjusted OR = 14, 95% CI: (9.3, 19.6)), and females (adjusted OR = 1.43, 95% CI: (1.10, 1.86)) were significantly associated with higher odds of VDD. In conclusion, the study revealed a significant difference in the frequency of VDD and VDI among pediatric patients older than six years, with a significant difference according to sex and season, being more pronounced among girls and during the winter and spring seasons.

(1) Background: Multiple sclerosis (MS) is a chronic, complex, and demyelinating disease closely associated with altered levels of trace elements. Although the first studies into the role of trace elements in MS were published in the 1970s, for five decades it has remained unknown whether trace elements can be part of this heterogeneous neurological disease. (2) Materials and methods: To drive toward at a potential solution, we conducted a systematic review and meta-analysis to elucidate whether there were differences in circulating levels of neurologically important essential trace elements (Zn, Fe, Co, Cu, Mn, and Se) between MS cases and controls. (3) Results: This study revealed significantly lower serum/plasma Zn and Fe levels and higher Cu levels in MS-affected individuals compared to controls. At the same time, no significant differences were found between the MS cases and controls regarding their serum/plasma levels of Co, Mn, or Se. Thus, the loss of Fe and Zn should be considered in supplementation/nutrition strategies for MS patients. On the other hand, since high serum Cu levels indicate a burden on the bloodstreams of MS patients, Cu should be excluded from mineral supplement strategies. Furthermore, all three trace elements (Fe, Zn, and Cu) should be considered from an etiological point of view, and, most importantly, their levels in the bloodstreams of MS patients should be monitored. (4) Conclusions: This study highlights the way for personalized and targeted strategies in the management of MS.

Selenium (Se) plays crucial roles in human, animal, and plant physiology, but its varied plant functions remain complex and not fully understood. While Se deficiency affects over a billion people worldwide, excessive Se levels can be toxic, presenting substantial risks to ecosystem health and public safety. The delicate balance between Se\'s beneficial and harmful effects necessitates a deeper understanding of its speciation dynamics and how different organisms within ecosystems respond to Se. Since humans primarily consume Se through Se-rich foods, exploring Se\'s behavior, uptake, and transport within agroecosystems is critical to creating effective management strategies. Traditional physicochemical methods for Se remediation are often expensive and potentially harmful to the environment, pushing the need for more sustainable solutions. In recent years, phytotechnologies have gained traction as a promising approach to Se management by harnessing plants\' natural abilities to absorb, accumulate, metabolize, and volatilize Se. These strategies range from boosting Se uptake and tolerance in plants to releasing Se as less toxic volatile compounds or utilizing it as a biofortified supplement, opening up diverse possibilities for managing Se, offering sustainable pathways to improve crop nutritional quality, and protecting human health in different environmental contexts. However, closing the gaps in our understanding of Se dynamics within agricultural systems calls for a united front of interdisciplinary collaboration from biology to environmental science, agriculture, and public health, which has a crucial role to play. Phytotechnologies offer a sustainable bridge between Se deficiency and toxicity, but further research is needed to optimize these methods and explore their potential in various agricultural and environmental settings. By shedding light on Se\'s multifaceted roles and refining management strategies, this review contributes to developing cost-effective and eco-friendly approaches for Se management in agroecosystems. It aims to lead the way toward a healthier and more sustainable future by balancing the need to address Se deficiency and mitigate the risks of Se toxicity.

BACKGROUND: 17-Hydroxylase deficiency is the rarest form of congenital adrenal hyperplasia, a disorder that affects steroidogenesis, causing abnormal hormone levels. Studies have shown a clear association between 17-hydroxylase deficiency and primary infertility, but a definite protocol to treat the disorder has not been determined yet.
METHODS: Case I presents a 24-year-old Caucasian Israeli-Arab female who experienced 6 years of infertility. Before her initial visit to our clinic, she underwent three laparoscopic ovarian cystectomies, had an unsuccessful in vitro fertilization cycle, and was treated with combined oral contraceptives. Her hormonal profile was tested, and the results led to genetic counseling and the diagnosis of non-classical congenital adrenal hyperplasia. She was treated with estradiol, glucocorticoids, and transdermal testosterone. After hormonal levels were lowered, in vitro fertilization cycles were initiated, and the patient had a spontaneous ovulation. In case II, a 20-year-old Caucasian Israeli-Arab female presented for infertility evaluation owing to her oligomenorrhea. Her vitals and physical examination had normal results. The investigation of her abnormal hormonal profile led her to be referred to genetic testing, where the results showed the same genetic mutation as seen in case I.
CONCLUSIONS: Both cases highlight the distinctiveness of the condition, where an identical mutation in the gene responsible for the same enzyme can bring about diverse phenotypes. Case I offers a potential treatment protocol for this rare disorder.

Magnesium (Mg2+) is a commonly used dietary supplement for the prevention and treatment of diseases. However, the efficacy and mechanisms of action of Mg2+ in most diseases have been controversial because of conflicting findings in earlier studies. Recent clinical and preclinical studies provide novel insights into the use of Mg2+ for the treatment and prevention of diseases affecting different organ systems. In this review, we provide an overview of recent clinical evidence for, and controversies over, the medical benefits of Mg2+. In addition, we critically discuss recent advances in understanding the mechanisms of action of Mg2+, which could enable the development of novel targeted therapies.

BACKGROUND: Significant links between low serum levels of vitamin D3 and insufficient glycemic control in patients with type 2 diabetes mellitus (T2DM) have been reported previously in the literature. However, there is no exciting evidence on the association between glycated hemoglobin (HbA1c) and vitamin D levels in T2DM individuals in our nation (Yemen). This study aimed to investigate the relationship between HbA1c and vitamin D levels in T2DM patients in a resource-limited setting.
METHODS: A retrospective cross-sectional study was conducted at the Al-Raffa Center, Ibb, Yemen between June 2018 and September 2023 including 396 patients diagnosed with T2DM. The patient characteristics, comorbidities, HbA1c, and vitamin D levels were gathered from patients\' medical profiles. Linear regression analysis was used to find the factors associated with vitamin D deficiency (serum 25(OH)D levels < 20 ng/mL) among T2DM patients. Subsequently, the correlation between HbA1c and vitamin D levels was examined using receiver operating characteristic (ROC) curve analysis.
RESULTS: The mean age was 44.6 ±14.6 years and most of them (n= 227, 57.3%) were female and from a rural area (n= 229, 57.8%). Comorbidities were hypertension, dyslipidemia disease, and cardiovascular disease in 176 (44.4%), 63 (15.9%), and 88 (22.2%) cases, respectively. The mean HbA1c was 8.1 ±2.5%. The mean vitamin D level was 26.9 ±16.5 ng/mL and low vitamin D was present in 260 (65.7%) (vitamin D deficiency in 160 (40.4%) and vitamin D insufficiency in 100 (25.3%) cases). In regression analysis, obesity (>30 kg/m2) (odds ratio (OR): 299.49; 95% confidence interval (CI): 72.66 - 1234.42, p <0.0001), higher HbA1c levels (OR: 1.61; 95% CI: 1.26 - 2.05, p =0.0001), and urban residence (OR: 23.98; 95% CI: 5.62 - 102.42, p <0.0001) were associated with vitamin D deficiency. There was a negative correlation between the vitamin D level and HbA1c which was statistically significant (correlation coefficient r: -0.5452; 95% CI: -0.6109 to -0.4720, p <0.0001). Using the ROC analysis, the serum vitamin D value of ≤18.42 ng/ml was the best cut-off point to predict hyperglycemia (area under the curve: 0.633, 95% CI: 0.672 to 0.770, sensitivity: 52%, specificity: 84.71 %, Yoden\'s index: 0.3671, p <0.001). Based on this cut-off, 39.4% of individuals (37.5% in the normoglycemic group and 90.9% in the hyperglycemic group) were vitamin D deficient.
CONCLUSIONS: In this study, low vitamin D was common among T2DM patients, especially those with poor glycemic control. We observed a link between HbA1c levels, urban residency, and BMI with vitamin D deficiency in T2DM patients. The association was distinguished by low vitamin D levels and elevated HbA1c. Additionally, we found that the serum vitamin D value of ≤18.42 ng/ml was the best cut-off point to predict hyperglycemia in T2DM patients with moderate agreement. To manage their disease, patients with T2DM should take their medications as prescribed and live a healthy lifestyle. This will increase their overall health, especially their vitamin D levels.

Small intestinal bacterial overgrowth (SIBO) is a pathology of the small intestine and may predispose individuals to various nutritional deficiencies. Little is known about whether specific subtypes of SIBO, such as the hydrogen-dominant (H+), methane-dominant (M+), or hydrogen/methane-dominant (H+/M+), impact nutritional status and dietary intake in SIBO patients. The aim of this study was to investigate possible correlations between biochemical parameters, dietary nutrient intake, and distinct SIBO subtypes. This observational study included 67 patients who were newly diagnosed with SIBO. Biochemical parameters and diet were studied utilizing laboratory tests and food records, respectively. The H+/M+ group was associated with low serum vitamin D (p < 0.001), low serum ferritin (p = 0.001) and low fiber intake (p = 0.001). The M+ group was correlated with high serum folic acid (p = 0.002) and low intakes of fiber (p = 0.001) and lactose (p = 0.002). The H+ group was associated with low lactose intake (p = 0.027). These results suggest that the subtype of SIBO may have varying effects on dietary intake, leading to a range of biochemical deficiencies. Conversely, specific dietary patterns may predispose one to the development of a SIBO subtype. The assessment of nutritional status and diet, along with the diagnosis of SIBO subtypes, are believed to be key components of SIBO therapy.

Fat-soluble vitamins, including vitamins A, D, E, and K, are energy-free molecules that are essential to the body\'s functioning and life. Their intake is almost exclusively exogenous, i.e., dietary. As a result, fat-soluble vitamin deficiencies are rarer in industrialized countries than in countries with limited resources. Certain groups of people are particularly affected, such as newborns or growing children, pregnant or breastfeeding women, and elderly or isolated individuals. Deficiencies in vitamins A, D, E, and K are also relatively frequent in subjects with digestive tract disorders, liver diseases, chronic pathologies, or in intensive care patients. Deficiencies or excesses of fat-soluble vitamins are responsible for a variety of more or less specific clinical pictures. Certain syndromes are typical of fat-soluble vitamin deficiency, such as the combination of ophthalmological and immunity impairments in the case of vitamin A deficiency or hemorrhagic syndrome and osteopenia in the case of vitamin E deficiency. This is also the case for osteomalacia, muscular weakness, even falls, and rickets in the case of vitamin D deficiency. Diagnosis of a deficiency in one of the fat-soluble vitamins relies on blood tests, which are not always essential for routine use. In this context, a therapeutic test may be proposed. Treatment of deficiencies requires vitamin supplementation, a well-balanced diet, and treatment of the cause.