scholarly journals Impact of the 25-Hydroxycholecalciferol Concentration and Vitamin D Deficiency Treatment on Changes in the Bone Level at the Implant Site during the Process of Osseointegration: A Prospective, Randomized, Controlled Clinical Trial

2021 ◽  
Vol 10 (3) ◽  
pp. 526
Author(s):  
Jakub Kwiatek ◽  
Aleksandra Jaroń ◽  
Grzegorz Trybek
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Controlled Clinical Trial ◽  
Randomized Controlled ◽  
Group A ◽  
Bone Level ◽  
Group B ◽  
Implant Treatment ◽  
Correct Level ◽  
25 Hydroxycholecalciferol

Introduction: The most important factor which is responsible for the positive course of implant treatment is the process of osseointegration between the implant structure and the host’s bone tissue. The aim of this study was to assess what effect the 25-hydroxycholecalciferol concentration and vitamin D deficiency treatment have on changes in the bone level at the implant site during the process of osseointegration in the mandible. Materials and Methods: The study was with 122 people qualified for implant surgery, who were assigned to three research groups (A, B, and C). Laboratory, clinical, and radiological tests were performed on the day of surgery, and after 6 and 12 weeks. The bone level in the immediate proximity of the implant was determined by radiovisiography (RVG). Results: The bone level after 12 weeks in Groups B and C was significantly higher than after 6 weeks. The bone level in the study Group B was significantly higher than in Group A. The study showed that the higher the levels of 25-hydroxycholecalciferol were observed on the day of surgery, the higher was the level of bone surrounding the implant after 6 and 12 after surgery. Conclusion: The correct level of 25-hydroxycholecalciferol on the day of surgery and vitamin D deficiency treatment significantly increase the bone level at the implant site in the process of radiologically assessed osseointegration.

scholarly journals Vitamin D Supplementation during Pregnancy- A Double Blinded Randomized, Controlled, Dose-Comparison, Trial in Pakistan

2020 ◽  
Author(s):  
Sidrah Nausheen ◽  
Lumaan Shaikh ◽  
Atif Habib ◽  
Farhana Tabassum ◽  
Arjumand Rizvi ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Vitamin D Supplementation ◽  
Control Group ◽  
Randomized Controlled ◽  
Dose Comparison ◽  
Group A ◽  
Comparison Trial ◽  
Group B ◽  
Double Blinded

Abstract Vitamin D deficiency during pregnancy is a public health problem in Pakistan, and prevalent among most women of reproductive age in the country. Vitamin D supplementation during pregnancy is suggested to prevent adverse pregnancy outcomes and prevent vitamin D deficiency in both the mother and her newborn. However, there remains uncertainty surrounding the appropriate and safe dose for vitamin D supplementation in pregnant women who experience deficiency. We conducted a double-blinded, randomized, controlled, dose-comparison trial aimed to evaluate the relationship between different doses of vitamin D supplementation during pregnancy and pregnancy outcomes among women in a maternity hospital of the Aga Khan University (AKU) in Karachi, Pakistan. Pregnant women (n=350) in their first trimester were recruited and randomized to three treatment groups of vitamin D supplementation: 4,000 IU/day (Group A; n=120), 2,000 IU/day (Group B; n=115), or 400 IU/day (Group C – control; n=115). Deficiency in serum vitamin D (serum 25OHD <20ng/mL) at baseline was prevalent in more than 95% of women in each group. Participants in group A had the lowest vitamin D deficiency at endline and in newborns (endline: 75.9%; neonatal: 64.9%), followed by group B (endline: 84.9%; neonatal: 73.7%) and then the control group (endline: 90.2%; neonatal: 91.8%). Vitamin D deficiency was significantly lower in group A than group C (p=0.006) for women at endline, and lower in both group A and group B than the control group (p=0.001) in neonates. There were no adverse events attributable to vitamin D supplementation in all groups. Our study concluded that vitamin D supplementation with 4000 IU/day is safe and effective in reducing the risk of maternal and neonatal vitamin D deficiency.

P–662 Study on D-vitamin, AMH and insulin interrelation in Polycystic Ovary Syndrome (PCOS) patients

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
A Coc. Lizarraga ◽  
S Lindenberg ◽  
G Juu. Almind ◽  
F Lindenberg
Keyword(s):  
Insulin Resistance ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Group A ◽  
D Values ◽  
Group B

Abstract Study question Is vitamin D deficiency more prevalent in PCOS patients? Is there a link between vitamin D levels and metabolic status in PCOS subjects? Summary answer An inverse relationship between vitamin D levels and metabolic status was demonstrated and it is thought to be responsible of its pathogenesis. What is known already PCOS is a multifactorial condition, characterised by failure in oogenesis and anovulation. Obesity is a common condition linked to its clinical features and studies have reported inverse associations between BMI and severity of the condition. Furthermore, 67–85% of PCOS patients have vitamin D deficiency. Low levels of vitamin D have been found to be closely related to insulin resistance, obesity, or hyperandrogenism and there is a significant association between serum vitamin D levels and reproductive function. Other factors such as AMH have also been described as possibly involved in the pathophysiology. Study design, size, duration We performed a retrospective, analytical and observational study in the Copenhagen Fertility Center. Patients referred with cycle abnormalities, hirsutism, and infertility were evaluated. A total of 778 women were enrolled consecutively from January 2019 to October 2020. Subjects who had major medical disorders were excluded. We selected those in which vitamin D was measured in the baseline analysis selecting a total of 396 patients. The further analysis has been carried out from 100 randomly selected patients. Participants/materials, setting, methods Blood samples were drawn after overnight fasting. They were all assayed in the same laboratory. Biochemical parameters were analyzed using descriptive statistics. Same parameters were studied after dividing into vitamin D deficiency group or optimal levels using a multiple t-test. Correlation between variables was determined. Graphpad Prism program version 8 was used to perform the calculations. The level of statistical significance was set at P-value &lt; 0.05. Main results and the role of chance A total of 100 subjects fulfilling the inclusion criteria were selected randomly from 396 PCOS women. Serum vitamin D concentrations were highly variable ranging from 16 nmol/L to 175 nmol/L. The prevalence of vitamin D deficiency was 24% and 41% of the subjects were classified as vitamin D insufficient. Only 35% of our patients had optimal vitamin D values. We compared data between the group with optimal values of vitamin D (Group A) versus the group with insufficient/deficient vitamin D values (Group B). We found statistical difference between groups in PTH values, being notably higher in group B compared with group A. Despite no statistically significant difference was obtained, it is important to highlight that the mean of SHBG was lower in group B and the mean of androstenedione, AMH, FAI and HOMA-IR were much higher in this group as well. Following the HOMA-IR criteria, 55% of patients had insulin resistance. Specifically, 26% had moderate insulin resistance and 29% severe insulin resistance. Levels of vitamin D were negatively correlated with FAI, AMH and HOMA-IR and positively correlated with HDL-Cholesterol and SHBG. Statistically significant differences were evidenced in the correlation between vitamin D and FAI and SHBG. Limitations, reasons for caution This is a retrospective observational study on a consecutive admitted patient group with a lack of a control group. Another limitation is the small sample size. It is difficult to generalize with other degrees of severity. We didn’t assess seasonal variability or if they were taking any vitamin D supplementation. Wider implications of the findings: Properly randomized clinical trials are mandatory to achieve more conclusive results about the role of vitamin D. Available evidence is promising but not sufficient to draw final conclusions. The aim is to better understand the pathophysiology of the condition and the factors involved and to find new target treatments. Trial registration number 1

scholarly journals Is There a Relationship Between Vitamin D Deficiency Status and PCOS in Infertile Women?

2019 ◽  
Vol 79 (07) ◽  
pp. 723-730 ◽  
Author(s):  
Emine Arslan ◽  
Umit Gorkem ◽  
Cihan Togrul
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Polycystic Ovary ◽  
Total Testosterone ◽  
Anthropometric Parameters ◽  
Infertile Women ◽  
Vitamin D Levels ◽  
Pcos Group ◽  
Group A ◽  
Group B

Abstract Introduction It is still unclear in the literature whether low vitamin D levels play a role in the pathogenesis of polycystic ovary syndrome (PCOS), especially with respect to the regulation of anti-Müllerian hormone (AMH). Therefore, we aimed to investigate whether there could be a relationship between vitamin D deficiency status and PCOS. Materials and Methods A total of 146 infertile women were divided into two groups according to their ovarian reserve patterns: (i) normal (NOR), and (ii) high (PCOS). The participants were also categorized into two groups according to vitamin D concentrations: (i) Group A < 10 ng/mL, and (ii) Group B 10 – 20 ng/mL. Samples were obtained and analyzed for estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), 17-hydroxyprogesterone (17-OHP), dehydroepiandrosterone sulfate (DHEA-S) and AMH. Results In the NOR group, there were significant differences between Group A and Group B in terms of anthropometric characteristics (p < 0.05, for all). The women in both Group A and Group B had similar AMH concentrations (p > 0.005). Only the NOR group showed a significant though moderate negative correlation between 25(OH)D levels and anthropometric parameters. AMH levels were not correlated with 25(OH)D levels in the NOR or the PCOS group (r = − 0.112, p = 0.008; r = 0.027, p = 0.836). Multivariate regression analysis showed no impact of 25(OH)D on other study parameters. Only AMH measurements were significant enough (p < 0.001) to differentiate between PCOS and NOR patterns. Conclusion We found no difference in serum 25(OH)D and AMH levels between women with and women without PCOS. No correlation could be demonstrated between 25(OH)D and AMH in the PCOS group or controls.

scholarly journals Randomized Controlled Clinical Trial Comparing Transurethral Eneucleation and Resection of Prostate and Trans-urethral Resection of Prostate in the Management of Benign Prostatic Hyperplasia

2017 ◽  
Vol 7 (3) ◽  
pp. 216-220
Author(s):  
Md Mehedi Hasan ◽  
Samira Rahat Afroze ◽  
Muhammad Abdur Rahim ◽  
Muhammad Abdus Salam
Keyword(s):  
Controlled Trial ◽  
Ethical Review ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Transurethral Resection Of Prostate ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Transurethral resection of prostate (TURP) is the predominant surgical procedure for benign prostatic hypertension (BPH) but is not devoid of complications like capsular perforation, drop in Hb%, drop in Na+, residual adenoma; hence endeavors are evolving to combat such complications. A newer technique transurethral enucleation and resection of prostate (TUERP) has been devised to solve these problems. This study was designed to compare the safety and the efficacy of newer technique, TUERP with widely practiced TURP Methods: This randomized controlled trial was done at BSMMU, after getting ethical approval from the ethical review committee of the institute, from January to October, 2009. A total of 60 BPH patients were purposively enrolled in this study, after obtaining informed written consent and they were randomized as control, Group A (30 patients, underwent TURP) and experimental group, Group B (30 patients, underwent TEURP).Results: The mean preoperative Hb% level of Group A was 15.1 gm% (SD ± 0.5) and perioperative Hb% level was 13.04 gm% (SD ± 6.06). There was significant difference (P <0.05). The mean preoperative Hb% of Group B was 15.2 gm% (SD ± 0.5) and perioperative Hb% was 15.2 gm% (SD ± 0.48). There was no difference (P >0.05). The mean preoperative Na + of Group A was 140 mmol/l (SD ± 4.1) and perioperative Na+ was 126 mmol/l (SD ± 6.8). There was significant difference (P<0.01). The mean preoperative Na+ of Group B was 136 mmol/l (SD ± 4) and perioperative Na+ was 136 mmol/l (SD ± 2.70). There was no difference (P >0.05).Conclusion: TUERP eliminates drop in Hb% and Na+which are usual consequences following TURP. Thus TUERP can be advocated in the treatment of BPH as it also allows completeresection down to surgical capsule.Birdem Med J 2017; 7(3): 216-220

Plasma Ca influences vitamin D metabolite levels as rats develop vitamin D deficiency

1991 ◽  
Vol 260 (3) ◽  
pp. E447-E452 ◽  
Author(s):  
U. Kollenkirchen ◽  
M. R. Walters ◽  
J. Fox
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Bone Mineralization ◽  
Complete Characterization ◽  
Vitamin D Metabolites ◽  
Dihydroxyvitamin D3 ◽  
Dietary Regimen ◽  
Group A ◽  
Group B ◽  
Group D

The hypocalcemia that accompanies vitamin D deficiency is a major obstacle to proper interpretation of the role(s) of vitamin D metabolites in Ca-sensitive tissues. This paper describes the development and complete characterization of a dietary regimen with which normocalcemia was maintained in rats throughout the development of vitamin D deficiency. Normal weanling rats were fed diets containing 0.8% Ca, 0.5% P, and vitamin D3 (group A), or vitamin D-deficient diets containing 0.8% Ca and 0.5% P (group B); 2.0% Ca and 1.25% P (group C); or 2.0% Ca, 1.25% P, and 20% lactose (group D) for 19 wk. Group D rats were normocalcemic and normophosphatemic with normal parathyroid hormone (PTH) levels throughout the study. In contrast, from 4-19 diet wk, groups B and C were hypocalcemic with elevated PTH. Initially, plasma 25-hydroxyvitamin D3 [25(OH)D3] levels decreased most rapidly, and 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] levels decreased least rapidly in group B rats, such that plasma 25(OH)D3 levels were reduced to 200-300 pg/ml before a decrease in 1,25(OH)2D3 levels was observed. However, vitamin D metabolite levels were similar in groups B, C, and D from 4-19 wk. Duodenal active Ca transport mirrored changes in plasma 1,25(OH)2D3 levels and was abolished after 10 wk. The results also suggested that vitamin D may not be necessary for normal bone mineralization since tibia mineral content and plasma alkaline phosphatase levels were similar in normocalcemic groups A and D throughout the study.

scholarly journals Efficacy and safety of intralesional triamcinolone acetonide in the treatment of chronic hand eczema

2017 ◽  
Vol 10 (3) ◽  
pp. 129
Author(s):  
Tasnuva Ashraf ◽  
Harashit Kumar Paul ◽  
Md. Shahidullah Sikder ◽  
A. S. M. Zakaria ◽  
Saiful Islam Bhuiyan ◽  
...  
Keyword(s):  
Triamcinolone Acetonide ◽  
Severity Index ◽  
Hand Eczema ◽  
Clobetasol Propionate ◽  
Controlled Clinical Trial ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
Chronic Hand Eczema ◽  
Group A ◽  
Group B

<p class="Abstract">This randomized controlled clinical trial was conducted to assess the efficacy and safety of intralesional triamcinolone acetonide in the treatment of chronic hand eczema comparing with topical clobetasol propionate. A total 60 patients of chronic hand eczema were recruited in the study. Thirty patients (Group A) were treated with intralesional triamcinolone acetonide and the rest 30 (Group B) with topical clobetasol propionate. Severity and improvement were assessed using Hand Eczema Severity Index (HECSI) score. The patients of both groups were followed up at 4<sup>th</sup> week and 12<sup>th</sup> week. In Group A, median HECSI score at baseline, 4<sup>th</sup> week and 12<sup>th</sup> week were 3, 20 and 20 respectively; whereas these scores were 54, 10 and 8 in Group B. In both groups, HECSI score was decreased gradually but the rate was higher in Group B than Group A (p&lt;0.05). Thinning of skin, an adverse effect, was seen in patients of both the intralesional triamcinolone acetonide (10%) and topical clobetasol propionate (16.7%) groups (p&gt;0.05). The result of this study demonstrates that intralesional triamcinolone acetonide is effective and safe in treating chronic hand eczema but less effective than the topical clobetasol.</p>

scholarly journals VITAMIN D AND PNEUMONIA

2018 ◽  
Vol 25 (04) ◽  
pp. 532-537
Author(s):  
Muhammad Shamaoon ◽  
Dr Maryam ◽  
Muhammad Ahsan ◽  
Rahman Ahmad
Keyword(s):  
Vitamin D ◽  
Controlled Trial ◽  
Intervention Group ◽  
Vitamin D Supplementation ◽  
Hospital Treatment ◽  
Randomized Controlled ◽  
Inflammatory Conditions ◽  
Group A ◽  
Group B

Background: Pneumonia is lower respiratory tract infection (LRTI) andrepresents inflammatory conditions of the lungs i.e of the lower respiratory tracts, air sacs andlung parenchyma.1 Objectives: To determine the role of vitamin D supplementation in reducingmorbidity in children with pneumonia. Study Design: Randomized Controlled trial. Place andDuration of Study: Pediatric Department, Mayo Hospital Lahore from December 2014 to May2015. Patient & Methods: Two hundred children of age 2 – 59 months with pneumonia (fever,cough, tachypnea, and subcostal recessions) and low vitamin D level (< 20 ng/ml) were includedin the study. One Hundred pneumonia patients received antibiotics (group A) and vitamins D(100,000 IU) while another group of hundred patients received only antibiotics without vitaminsupplementation (group B). When respiratory distress settled, length of stay in hospital wascalculated at the time of discharged. All patients were followed in pediatric OPDs for 3 monthsafter in-hospital treatment to pick recurrence of pneumonia symptoms (if any). Results: Themean recovery time for vitamin D group (5.7 +2.8 days) and non-vitamin D (6.1+2.8 days)was almost same with P=0.29. But the frequency of repeated episodes of pneumonia within30 days of treatment was lower in intervention group n=4 (2%) than the non-intervention groupn=18 (9%) (P = 0.002). Conclusion: 100,000 IU of vitamin D given once during treatment ofpneumonia decreases the chances of recurrence in the next 30 days.

scholarly journals Increase of PlGF (Placental Growth Factor) Level After Administration of Dydrogesterone in Pregnancy

KnE Medicine ◽  
2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Dewi Karlina Rusly
Keyword(s):  
Folic Acid ◽  
Controlled Clinical Trial ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Before And After ◽  
Group A ◽  
Study Population ◽  
The Mean ◽  
Group B ◽  
In Pregnancy

<p><strong>Aim:</strong> To observe the effect of Dydrogesterone administration in pregnancy on PlGF level</p><p><strong>Methods:</strong> This is a randomized controlled clinical trial. Study population has been divided into two groups. Group A consists of 20 women who receive only Folic acid 5 mg a day for 4 weeks time. Group B consists of 20 women who receive Dydrogesterone 2x10 mg a day and Folic acid 5 mg a day for 4 weeks. PlGF has been measured twice. First measurement was done before drug administration, while the second measurement has been done during 18<sup>th</sup> weeks of pregnancy. The changes on PlGF level before and after treatment from each group has been analyzed using SPSS 17.</p><p><strong>Results:</strong> 40 pregnant women have been recruited for this study. There are no differences based on the patient’s age, number of pregnancy and parity, gestational age and body weight between each group.  The mean levels of PlGF in both groups before intervention shows no significant difference (p = 0091 or p&gt; 0.05), 40.80 pg/mL vs.  25.95 pg / mL. The mean levels of PlGF in group A after 4 weeks administration of Folic acid is 89.60 pg / mL. It shows the escalation of 48.8 pg / mL. The elevation of PlGF level in group A shows significant difference (p = 0.000 or p &lt;0.05) after 4 weeks Folic acid treatment.The mean levels of PlGF in group B after 4 weeks administration of Dydrogesterone and Folic acid is 212.15 pg / mL. It shows the escalation of 186.20 pg / mL. The elevation of PlGF level in group B shows significant difference (p = 0.000 or p &lt;0.05) after 4 weeks Dydrogesterone and Folic acid treatment.</p><p><strong>Conclusion:</strong> Dydrogesterone treatment can increase the level of PlGF.</p>

scholarly journals Impact evaluation of the efficacy of different doses of vitamin D supplementation during pregnancy on pregnancy and birth outcomes: a randomised, controlled, dose comparison trial in Pakistan

2021 ◽  
pp. bmjnph-2021-000304
Author(s):  
Sidrah Nausheen ◽  
Atif Habib ◽  
Maria Bhura ◽  
Arjumand Rizvi ◽  
Fariha Shaheen ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Vitamin D Supplementation ◽  
Control Group ◽  
Pregnancy And Birth Outcomes ◽  
Group A ◽  
Group B ◽  
Randomised Controlled ◽  
Different Doses ◽  
Pregnancy And Birth

BackgroundVitamin D deficiency during pregnancy is a public health problem in Pakistan and is prevalent among most women of reproductive age in the country. Vitamin D supplementation during pregnancy is suggested to prevent adverse pregnancy outcomes and vitamin D deficiency in both the mother and her newborn.MethodsWe conducted a double-blinded, randomised controlled trial in Karachi, Pakistan to evaluate the effect of different doses of vitamin D supplementation during pregnancy on biochemical markers (serum 25(OH)D, calcium, phosphorus and alkaline phosphatase) in women and neonates, and on pregnancy and birth outcomes (gestational diabetes, pre-eclampsia, low birth weight, preterm births and stillbirths).ResultsPregnant women (N=350) in their first trimester were recruited and randomised to three treatment groups of vitamin D supplementation: 4000 IU/day (group A, n=120), 2000 IU/day (group B, n=115) or 400 IU/day (group C, n=115). Women and their newborn in group A had the lowest vitamin D deficiency at endline (endline: 75.9%; neonatal: 64.9%), followed by group B (endline: 84.9%; neonatal: 73.7%) and then the control group (endline: 90.2%; neonatal: 91.8%). Vitamin D deficiency was significantly lower in group A than in group C (p=0.006) among women at endline and lower in both groups A and B than in the control group (p=0.001) in neonates. Within groups, serum 25(OH)D was significantly higher between baseline and endline in group A and between maternal baseline and neonatal levels in groups A and B. Participant serum 25(OH)D levels at the end of the trial were positively correlated with those in intervention group A (4000 IU/day) (β=4.16, 95% CI 1.6 to 6.7, p=0.002), with food group consumption (β=0.95, 95% CI 0.01 to 1.89, p=0.047) and with baseline levels of serum 25(OH)D (β=0.43, 95% CI 0.29 to 0.58, p<0.0001).ConclusionThe evidence provided in our study indicates that vitamin D supplementation of 4000 IU/day was more effective in reducing vitamin D deficiency among pregnant women and in improving serum 25(OH)D levels in mothers and their neonates compared with 2000 IU/day and 400 IU/day.Trial registration numberNCT02215213.

scholarly journals Comparative study of rise of vitamin D in hypovitaminosis D babies after two different dosage recommendations

2018 ◽  
Vol 6 (1) ◽  
pp. 230
Author(s):  
Bijal Shrivastava ◽  
Rashi Aryan ◽  
Abhinav Tiwari ◽  
Lekha Tiwari ◽  
Nimmkayala Pravallika
Keyword(s):  
Vitamin D ◽  
American Academy ◽  
Vitamin D Deficiency ◽  
Hypovitaminosis D ◽  
Endocrine Society ◽  
American Academy Of Pediatrics ◽  
Vitamin D Levels ◽  
Study Results ◽  
Group A ◽  
Group B

Background: There are currently two different guidelines for treatment of Vitamin D deficiency in infants, one is that of American Academy of Pediatrics and the other being Clinical Practice Guidelines of the Endocrine Society. This study was done to compare the two guidelines for treatment of Vitamin D deficiency in infants.Methods: A hospital based, longitudinal interventional study was conducted for 2 years and 115 babies having vitamin d deficiency (Vitamin D less than or equal to 20ng/dl) were divided into group A and group B. Group A babies were treated as per American Academy of Pediatrics Guidelines whereas Group Cases were treated as per International Endocrine Society guidelines. All babies were followed up after 3-4 months when repeat Vitamin D levels were checked and then compared.Results: In present study, Vitamin D level had increased by 0.6 times in Group A whereas it had increased by 1.3 times in group B and it was significant.Conclusions: Study results were in favour of the guidelines recommended by the International Endocrine Society.

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