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We are Just providing Link from other Websites. Save my name, email, and website in this browser for the next time I comment. World history norman lowe pdf Book Download -Mastering world history pdf. By Ajit OmGhyan T Facebook Twitter Whatsapp. About the Author: Ajit OmGhyan. Related Posts. So what Deshbhratar September 13, at 2: Shekh December 10, at 3: Bharat January 30, at 2: Rajasekhar March 18, at Laboratory Analysis Liver and renal function and lipid profile tests were conducted in the biochemistry lab at Mubarak Hospital.
The results were obtained and compiled for further analysis. Differences in clothing style and BMD across the three groups were assessed by independent t-tests. In the final analysis, all three groups were combined to correlate changes between 25 OH D and iPTH, calcitonin, BMD, and bone turnover markers; iPTH and bone turnover markers; and calcitonin and bone turnover markers.
Results 3. Participant Demographics Biometric and demographic data were similar across all three groups Tables 1 and 2. Family history of osteoporosis and supplement intake was not significantly different Table 2. In addition, the duration of both indoor and outdoor sun exposure was similar across all three groups Table 3. The majority of study participants reported spending 30 to 60 minutes outdoors during the morning and noon hours, times when UVB intensity is high Table 3.
All three groups also reported similar percentages of sun protection usage. Overall, there were no significant differences in sun exposure across the three groups, suggesting that any observed variability is due to clothing style.
No significant differences were observed in any of the biochemical markers Table 4. Table 1: Biometric data. Table 3: Indoor and outdoor sun exposure. Table 4: Fasting biochemical variables. Table 5: Bone mineral density comparisons. Bone Turnover Markers Comparisons of bone turnover marker levels between the control and hejab groups and the control and veiled groups are reported in Table 6.
Modern World History By Norman Lowe
Table 6: Bone turnover marker comparisons between the unveiled and hejab groups. Consistent with this finding, a linear increasing trend was observed in iPTH Figure 2 and a linear decreasing trend was observed in calcitonin Figure 3 across the three groups.
Eight Normal iPTH and hyperparathyroidism were not significantly different across the three groups Table 7. Table 7: Intact parathyroid hormone levels across groups. A decreasing trend was observed across the three groups. An increasing trend was observed across the three groups. Discussion Vitamin D is known to impact bone health.
Vitamin D deficiency therefore plays an important role in osteoporosis and other bone ailments [ 4 ]. Vitamin D levels are influenced by several factors, including age, ethnicity, exposure to UVB radiation, diet, body mass index BMI , daily calcium intake, sunscreen use, and clothing style [ 18 ] Vitamin D deficiency is frequently reported in individuals from Middle Eastern countries, including those in the Arabian Gulf, which are predominantly sunny year-round [ 12 , 19 — 22 ].
In particular, vitamin D deficiency has been reported in Kuwaiti mothers and neonates [ 23 ] and adolescent Kuwaiti females [ 24 ].
The intent of the current study was to investigate whether clothing style plays a role vitamin D deficiency among Kuwaiti women. We focused on young, healthy, single Kuwaiti females in this study to control for other factors besides clothing style, such as menopausal status, that may cause discrepancies in vitamin D status.
The body requires minutes of exposure to solar UVB radiation between 10 am and 2 pm at least 2 to 3 times per week to synthesize adequate vitamin D levels [ 26 ]. All participants reported receiving at least 30 minutes of daily exposure to outdoor sunlight during the morning and noon hours, yet all groups exhibited vitamin D deficiency.
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We also asked about indoor sunlight exposure, as many women who wear the hejab or veil will remove these clothing items in their own homes, including in their gardens and yards, but did not detect significant differences in indoor sunlight exposure across the three groups. A decreasing trend in vitamin D levels was observed from the control to hejab to veiled groups, suggesting a role for clothing style in vitamin D deficiency.
Associations between clothing style and low vitamin D levels have also been reported in several other countries with adequate sunlight, including Turkey [ 4 ], Lebanon [ 19 ], Jordan [ 20 ], and Egypt [ 21 ]. Together these findings indicate that clothing style related to religious and cultural practices may be a fundamental risk factor for vitamin D deficiency. It has been postulated that UVB light is reflected via dust particles in polluted air, which is prominent during the summer months in most of the Gulf region.
Although study participants asserted that they received more than 30 minutes of sunlight exposure each day, reflected UVB light due to air pollution and sun blocker usage may have limited their exposure. These practices additionally limit sunlight exposure and may independently be associated with low vitamin D levels among Kuwaiti females.
Vitamin D and PTH Bone remodelling is a continuous process by which old bone is replaced with new tissue to maintain skeletal shape, size, and quality. This process is regulated by a number of biochemical factors, including hormones and proteins secreted by both haemopoietin bone marrow cells and bone cells [ 34 ].
Vitamin D is involved in the regulation of calcium and phosphate levels in the blood by regulating their intestinal absorption, renal excretion, and bone calcium mobilization.
Any drop in calcium levels stimulates PTH secretion, which in turn activates vitamin D synthesis. Vitamin D and PTH production enhances renal calcium reabsorption and calcium mobilization by bone resorption. However, elevated blood calcium levels promote a reduction in PTH secretion and consequently lead to a decrease in vitamin D synthesis and calcium mobilization.
Increased blood calcium also stimulates parafollicular cells in the thyroid to secrete calcitonin, which inhibits calcium mobilization from the bone and stimulates calcium and phosphorous excretion. Thus, vitamin D, PTH, and calcitonin maintain calcium within normal levels [ 35 , 36 ]. No significant difference in iPTH concentrations was observed across the groups in our study.
A significant difference may have been observed if there had been a substantial difference in 25 OH D concentrations across the groups and if the number of subjects was larger. Nevertheless, vitamin D status was negatively correlated with iPTH across all participants. These findings are consistent with studies among women in Turkey, in which higher levels of PTH were observed in women who wore the veil and gloves compared to those who wore the hejab or Western-style clothing [ 4 , 19 ].
The correlation between vitamin D and PTH hormone was further demonstrated in a cross-sectional study, in which data were collected between and for vitamin and PTH in Brazil, and the results obtained showed high prevalence of vitamin D deficiency and insufficiency, mainly among older people, yet younger people had been affected as well; the low vitamin D levels were found to be negatively correlated with PTH [ 40 ].
International Journal of Endocrinology
Consequently, it is difficult to conclude the type of relationship between vitamin D status and PTH; this is because of differences in methods used for assaying hydroxy vitamin D and PTH, in addition, latitude, diet, race, age, and gender; all may have an impact on the correlation between vitamin D and serum PTH [ 45 ].
As mentioned earlier, the small number of participants in this study may have contributed to the lack of significant relationship between vitamin D and serum PTH.
In addition, comparative changes were observed in both serum calcitonin and 25 OH D in all three groups.
Serum calcitonin was lowest in the veiled group, which is consistent with the notion that calcitonin may play a role in stimulating vitamin D production under normocalcaemic conditions [ 46 ]. Reduced BMD, which is also known as osteopenia, may lead to osteoporosis and an increased risk of fracture if left untreated [ 48 , 49 ].
Vitamin D deficiency is prevalent among patients with osteoporosis [ 50 ]. Supplementation with vitamin D and calcium has been shown to reduce the risk of hip fractures among elderly women [ 51 ]. Prior studies are equivocal, however, regarding the direct relationship between vitamin D and BMD [ 49 , 50 , 52 , 53 ]. In addition, high levels of bone turnover markers in the blood may indicate increased bone loss [ 54 ]. A cross-sectional study revealed that patients with fractures had higher bone turnover marker levels than individuals without fractures [ 55 ].
Another study reported that elevated levels of bone resorption markers can predict the likelihood of a future hip fracture even when bone density and mobility are unaffected [ 56 ]. In the present study, a significant difference in bone turnover marker levels was observed in both the hejab and veiled groups compared with the control group, suggesting that participants in both the hejab and veiled groups had higher bone turnover than participants in the control group.
Several studies have reported that women have lower bone density than men [ 57 ]. Moreover, a year longitudinal study in older women mean age of 65 years revealed that an increase in bone turnover markers, such as osteocalcin, was associated with a twofold increase in the risk of rapid bone loss [ 59 ].
Another study identified high levels of bone turnover markers as a risk factor for spinal fracture and osteoporosis [ 60 ], suggesting that routine bone turnover marker measurements may predict bone loss, future fractures, and the effectiveness of drugs. In contrast to these studies, our study was performed on young premenopausal female participants. Despite significant differences in bone turnover markers across the three groups of participants in our study, no participants exceeded the normal range for any bone marker.
Most prior studies have indicated that bone resorption markers are better predictors of bone loss than bone formation markers [ 59 , 61 ]. Another study showed a significant correlation between spinal fractures and both of these bone turnover markers. These participants also exhibited higher rates of bone loss than participants in the control group. Therefore it is expected to notice a significant drop in osteocalcin levels among the veiled group as they have the lowest vitamin D levels; however, all groups expressed vitamin D deficiency with no significant differences between them.
Thus using osteocalcin as a bone marker is not advisable in case of vitamin D deficiency.
Several studies have shown that biochemical bone turnover markers increase at puberty and then return to normal levels as bone formation and resorption reach equilibrium [ 56 , 64 ]. These bone markers then become unbalanced again after the age of Thus, high bone turnover markers are not always predictors of bone loss.
Elevation of these markers may occur as a result of growth or during treatment with PTH [ 59 ].
In the present study, our subjects were young but postpubertal years old. Whereas bone markers provide an overall picture of bone turnover, BMD measures specific areas of the skeletal system. Although there were no significant differences observed in overall BMD across the three groups in our study, mean femoral neck BMD was lower in the hejab and veiled groups compared with the control group.
Nevertheless, bone turnover markers may predict changes in bone before any significant change can be detected in BMD.
For example, in a study by Bauer and colleagues, patients with osteoporosis were treated for 1 year with alendronate, a bisphosphonate. Significant changes in biochemical bone markers were observed 3 to 6 months after the start of treatment, whereas significant changes in BMD were not observed for 18 months [ 65 ]. A similar observation has been reported by Melton et al. In addition, the negative correlation between BMD and bone markers becomes stronger as age increases [ 56 ].
Thus, in our study, participants may have been too young to exhibit significant changes in bone density. Bone turnover markers therefore provide an instantaneous measure of bone turnover that can be obtained more rapidly than BMD [ 67 ]. Because study participation involved providing blood samples and exposure to radiation for bone mineral densitometry, a limited sample size of 30 volunteers from each group was analysed.
Therefore, the results of our study should be interpreted with caution, and larger sample sizes are required in future studies to generate results with adequate statistical power to unravel the effect of clothing style on vitamin D and bone turnover. Conclusion The present study is one of the few studies in the existing literature to evaluate both bone markers and BMD in relation to clothing style. The findings from this study revealed a positive association between high bone turnover markers and traditional or cultural clothing style.
These high bone turnover marker levels may be predictors of increased risk of low bone density, which in turn may lead to a higher risk of osteoporosis. Most food products in Kuwait and many other countries in the Middle East are not fortified with vitamin D.
Residents of these countries therefore must rely on vitamin D3 synthesis via sunlight exposure. Our cohort revealed low vitamin D levels, low calcitonin levels, and high iPTH levels in all participants, even those who wore Western-style clothing. Although the majority of our participants had vitamin D deficiency, participants who wore the hejab or were veiled had lower vitamin D levels than those who wore Western-style clothing. This study therefore suggests that clothing style may contribute to vitamin D deficiency.
Clothing style, however, is not considered the primary causative factor of low vitamin D levels among the Kuwaiti population. Intense heat during the summer months limits direct outdoor exposure to sunlight. Thus, the primary causes of vitamin D deficiency vary worldwide and may include factors such as ethnicity, lifestyle, living conditions, dietary status, and physical movement.
Data Availability The authors confirm that the data supporting the finding of this study are available with the article as tables and figures. Conflicts of Interest The authors declare that they have no conflicts of interest. References A. Lowe and I. Bonilla, A. Ness, A. Wills, D. Lawlor, S.
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Zhang, S.The first specialist team manager was goalkeeper Archie Montgomery who was appointed on 1 February Biswas et al. Palgrave Macmillan Language: Another study showed a significant correlation between spinal fractures and both of these bone turnover markers. It has been suggested that the high prevalence of vitamin D deficiency in Arab women, especially those residing in the Gulf region, is due to low exposure to sunlight.
Prior studies are equivocal, however, regarding the direct relationship between vitamin D and BMD [ 49 , 50 , 52 , 53 ]. Fang, and J.
Alkhenizan, A. Hoteit, and G. Organizations The H-World discussion list serves as a network of communication among practitioners of it, with discussions among scholars, announcements, syllabi, bibliographies and book reviews.