To the Editor: The study by Ms Rosario and colleagues1 reports a relationship between low postmortem brain testosterone levels and preceding dementia in men. To be able to interpret these data it would have been valuable to know the potential impact on their results of body mass index, the intensity of care over the interval immediately preceding death, and recent opioid use.
Obesity is associated with diminished serum testosterone and elevated serum estradiol.2 Expectant care, with no therapeutic interventions for several days immediately preceding death, may have modified tissue hormone levels in comparison with the levels of patients dying while undergoing active therapy. Opioid-induced androgen deficiency usually develops within a few hours of administration of relatively small doses of opioid medications, with plasma testosterone levels occasionally reaching near-castrate range within 24 hours.3 - 5 These low levels are maintained during continued opioid administration. Although tissue concentrations of sex hormones have not been measured during opioid use, the frequent use of these medications during end-of-life patient management suggests that their administration should be considered in interpreting postmortem tissue sex hormone levels. In contrast to levels of testosterone, opioid-induced lowering of serum estradiol develops much more slowly, a difference that could have contributed to the observations reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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