Global, regional and national burden of alopecia areata and its associated diseases, 1990-2019: A systematic analysis of the Global Burden of Disease Study 2019.

BACKGROUND: No study to date has concomitantly reported the global burden of alopecia areata (AA) and its associated diseases. METHODS: The crude and age-standardized rates of prevalence (ASPR), incidence (ASIR) and years lived with disability (YLDs) of AA were extracted from the global burden of disease, injuries and risk factors study (GBD) database between 1990 and 2019 for 204 countries and territories. We stratified the analysis by global region, nation, sex, age and sociodemographic index (SDI) to dissect the epidemiology of AA and its associated diseases. RESULTS: Alopecia areata was responsible for 0.024% of the total DALYs. Age-standardized DALYs rate of AA was 7.51 [4.73-11.14] per 100,000. Overall ASPR, ASIR and age-standardized YLDs rates were stable from 1990 to 2019 globally. All three rates were about two times higher in females compared to males and had a bimodal distribution with peaks at age 30-34 years and 60-64 years. AA burden was positively correlated with SDI (r = .375, p < .001) and was most prevalent in high-income countries, especially North America. Countries with a high AA incidence were more likely to have high incidences of autoimmune diseases and low incidences of ischaemic heart disease and ischaemic stroke. CONCLUSIONS: The burden of AA was prominent in females, young adults, high sociodemographic countries and North Americans. The study corroborates sex- and region-specific implications and public health measures for AA and its associated burdens. These epidemiological data on AA burden can guide future research efforts, prevention strategies and allocation of resources.

Retropharyngeal Ectopic Parathyroid Adenoma Localized by 18F-Fluorocholine Positron Emission Tomography/Computed Tomography: A Case Report.

Ectopic parathyroid adenomas of the retropharyngeal space are relatively rare. Herein, we report a case of primary hyperparathyroidism (PHPT) secondary to a retropharyngeal parathyroid adenoma. A 22-year-old woman presented with elevated serum calcium and parathyroid hormone (PTH) levels, revealed during a medical check-up. The patient had a history of ureteral stones and a confirmed low bone mass. Neck 99mTechnetium-sestamibi singlephoton emission computed tomography (CT) and ultrasonography did not reveal any suspicious lesions. There was no evidence of hereditary PHPT based on the results of targeted gene sequencing. Surgical exploration was unsuccessful, and the PHPT persisted after the first surgery. Approximately a year after the failed operation, 18F-fluorocholine (FCH) positron emission tomography/CT (PET-CT) became available, and when performed, it revealed increased uptake in the retropharyngeal space of the right side of the neck. The results of parathyroid venous sampling were concordant with a >2-fold elevation of PTH level in the veins on the right side of the neck compared to the peripheral veins. The 1.8 cm-diameter mass was successfully removed resulting in an 87% reduction in intraoperative PTH level (198.0-26.5 pg/mL). Subsequently, normalizations of calcium and PTH levels were achieved. In summary, ectopic parathyroid adenomas, including retropharyngeal lesions, should also be suspected when investigating an elusive case of PHPT. 18F-FCH PET-CT can be a useful complementary modality for detecting culprit lesions.

Engaging social activities prevent stroke and myocardial infraction by raising awareness of warning symptoms: A cross-sectional survey study.

Background: Stroke and myocardial infarction (MI) are medical emergencies, and early treatment within the golden hour is crucial for good prognosis. Adequate knowledge about the warning symptoms can shorten the onset-to-door time. Various factors affect the level of awareness, including social activity. This study aimed to determine if engaging in social activity is associated with the awareness of the warning symptoms of stroke and MI. Methods: This cross-sectional study analyzed 451,793 participants from the 2017 and 2019 Korea Community Health Survey. Based on five questions for each of stroke and MI symptoms, participants were divided into an awareness group (replied "Yes" to all five questions) and unawareness group. Engagement in social activities (i.e., religious, friendship, leisure, and volunteer activity) was evaluated through a questionnaire. Multiple logistic regression analysis was performed to evaluate the relation between social activity and awareness of warning symptoms. Results: Overall, 52.6% participants were aware of the warning symptoms of stroke, and 45.8% of MI. Regular engagement in at least one social activity, particularly friendship or volunteer activity, was associated with better awareness of the warning symptoms, both stroke (OR: 1.21, 95% CI: 1.20-1.23) and MI (OR: 1.22, 95% CI: 1.20-1.24). Additionally, more diverse types of social activities were associated with higher levels of awareness. Relationship between social activity and awareness showed positive association with participants older than 60 years, rural residents, or with low socioeconomic status. Conclusion: Engagement in social activity was significantly associated with better knowledge about the warning symptoms of stroke and MI. For early hospital treatment after symptom onset, participation in social activities could be beneficial.

Association between Breastfeeding and Restrictive Spirometric Pattern in Women Aged over 40 Years: A Cross-Sectional Study.

Objectives: Restrictive spirometric pattern (RSP) has a prevalence of 5.4−9.2% and is associated with various respiratory symptoms, comorbidities, and increased mortality. Breastfeeding has important effects on maternal health; however, the effects of breastfeeding on pulmonary function remain unclear. This study aimed to investigate the effects of breastfeeding on maternal pulmonary function, particularly the risk of RSP. Methods: Retrospective, cross-sectional observational study enrolling parous women aged >40 years who participated in the Korea National Health and Nutrition Examination Survey from 2013−2018. RSP was defined using the FEV1/FVC ratio and FVC outcomes of the pulmonary function test. The adjusted odds ratios (OR) for RSP were calculated using multivariate logistic regression. Results: Of 9261 parous women, 913 (9.9%) had RSP. Breastfeeding (≥1 month) was associated with a reduced risk of RSP (OR: 0.75 [0.60−0.92]) when adjusted for age, body mass index, smoking status, other diseases, socioeconomic status, and maternal risk factors. The adjusted ORs for RSP for women decreased further with increasing duration of breastfeeding (p for trend: 0.0004). The FEV1, FVC, and FVC% were higher in women who breastfed than in those who did not breastfeed (by 0.0390 L, 0.0521 L, 0.9540% p, respectively). Conclusions: There is an association between breastfeeding and pulmonary function in parous women. Breastfeeding was associated with a lower prevalence of RSP in parous women aged >40 years old, suggesting that breastfeeding may have a beneficial effect on maternal pulmonary function.