{"id":"https://openalex.org/W3081237007","doi":"https://doi.org/10.7326/l20-0292","title":"MELAS Syndrome and MIDD Unmasked by Metformin Use: A Case Report","display_name":"MELAS Syndrome and MIDD Unmasked by Metformin Use: A Case Report","publication_year":2020,"publication_date":"2020-08-24","ids":{"openalex":"https://openalex.org/W3081237007","doi":"https://doi.org/10.7326/l20-0292","mag":"3081237007","pmid":"https://pubmed.ncbi.nlm.nih.gov/32833489"},"language":"en","primary_location":{"id":"doi:10.7326/l20-0292","doi":"https://doi.org/10.7326/l20-0292","is_oa":false,"landing_page_url":"https://doi.org/10.7326/l20-0292","pdf_url":null,"source":{"id":"https://openalex.org/S119722071","display_name":"Annals of Internal Medicine","issn_l":"0003-4819","issn":["0003-4819","1539-3704"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","doyens","jufo-3","ki-jl-3","medline","norway-2"],"host_organization":"https://openalex.org/P4310316812","host_organization_name":"American College of Physicians","host_organization_lineage":["https://openalex.org/P4310316812"],"host_organization_lineage_names":["American College of Physicians"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Annals of Internal Medicine","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5101780081","display_name":"Na Hyun Kim","orcid":"https://orcid.org/0000-0003-4293-4525","observed_orcids":["https://orcid.org/0000-0003-4293-4525"]},"institutions":[{"id":"https://openalex.org/I4210121601","display_name":"Amita Health","ror":"https://ror.org/02z7tpb72","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210121601"]},{"id":"https://openalex.org/I4210132418","display_name":"Saint Joseph Hospital","ror":"https://ror.org/02ttsvs52","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210121601","https://openalex.org/I4210132418"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Na Hyun Kim","raw_affiliation_strings":["Amita Health Saint Joseph Hospital, Chicago, Illinois (N.H.K., M.S., J.V.)"],"raw_orcid":"https://orcid.org/0000-0003-4293-4525","affiliations":[{"raw_affiliation_string":"Amita Health Saint Joseph Hospital, Chicago, Illinois (N.H.K., M.S., J.V.)","institution_ids":["https://openalex.org/I4210121601","https://openalex.org/I4210132418"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5016628868","display_name":"Mahrukh Siddiqui","orcid":"https://orcid.org/0000-0001-9405-8665","observed_orcids":["https://orcid.org/0000-0001-9405-8665"]},"institutions":[{"id":"https://openalex.org/I4210121601","display_name":"Amita Health","ror":"https://ror.org/02z7tpb72","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210121601"]},{"id":"https://openalex.org/I4210132418","display_name":"Saint Joseph Hospital","ror":"https://ror.org/02ttsvs52","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210121601","https://openalex.org/I4210132418"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Mahrukh Siddiqui","raw_affiliation_strings":["Amita Health Saint Joseph Hospital, Chicago, Illinois (N.H.K., M.S., J.V.)"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Amita Health Saint Joseph Hospital, Chicago, Illinois (N.H.K., M.S., J.V.)","institution_ids":["https://openalex.org/I4210121601","https://openalex.org/I4210132418"]}]},{"author_position":"last","author":{"id":null,"display_name":"Jonathan Vogel","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210121601","display_name":"Amita Health","ror":"https://ror.org/02z7tpb72","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210121601"]},{"id":"https://openalex.org/I4210132418","display_name":"Saint Joseph Hospital","ror":"https://ror.org/02ttsvs52","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210121601","https://openalex.org/I4210132418"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Jonathan Vogel","raw_affiliation_strings":["Amita Health Saint Joseph Hospital, Chicago, Illinois (N.H.K., M.S., J.V.)"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Amita Health Saint Joseph Hospital, Chicago, Illinois (N.H.K., M.S., J.V.)","institution_ids":["https://openalex.org/I4210121601","https://openalex.org/I4210132418"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":0.8444,"has_fulltext":false,"cited_by_count":21,"citation_normalized_percentile":{"value":0.69105581,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":{"min":88,"max":98},"biblio":{"volume":"174","issue":"1","first_page":"124","last_page":"125"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10301","display_name":"Mitochondrial Function and Pathology","score":0.9634000062942505,"subfield":{"id":"https://openalex.org/subfields/1312","display_name":"Molecular Biology"},"field":{"id":"https://openalex.org/fields/13","display_name":"Biochemistry, Genetics and Molecular Biology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}},"topics":[{"id":"https://openalex.org/T10301","display_name":"Mitochondrial Function and Pathology","score":0.9634000062942505,"subfield":{"id":"https://openalex.org/subfields/1312","display_name":"Molecular Biology"},"field":{"id":"https://openalex.org/fields/13","display_name":"Biochemistry, Genetics and Molecular Biology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}},{"id":"https://openalex.org/T11027","display_name":"Metabolism and Genetic Disorders","score":0.010400000028312206,"subfield":{"id":"https://openalex.org/subfields/1308","display_name":"Clinical Biochemistry"},"field":{"id":"https://openalex.org/fields/13","display_name":"Biochemistry, Genetics and Molecular Biology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}},{"id":"https://openalex.org/T11339","display_name":"Metabolism, Diabetes, and Cancer","score":0.003100000089034438,"subfield":{"id":"https://openalex.org/subfields/1312","display_name":"Molecular Biology"},"field":{"id":"https://openalex.org/fields/13","display_name":"Biochemistry, Genetics and Molecular Biology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/melas","display_name":"MELAS","score":0.9950000047683716},{"id":"https://openalex.org/keywords/maternally-inherited-diabetes-and-deafness","display_name":"maternally inherited diabetes and deafness","score":0.9670000076293945},{"id":"https://openalex.org/keywords/metformin","display_name":"metformin","score":0.9319999814033508},{"id":"https://openalex.org/keywords/mtdna-mutations","display_name":"mitochondrial DNA mutations","score":0.550000011920929},{"id":"https://openalex.org/keywords/m-3243a-g","display_name":"m.3243A>G","score":0.8949999809265137},{"id":"https://openalex.org/keywords/mt-tl1","display_name":"MT-TL1","score":0.8500000238418579},{"id":"https://openalex.org/keywords/mitochondrial-encephalopathy","display_name":"mitochondrial encephalopathy","score":0.6460000276565552},{"id":"https://openalex.org/keywords/lactic-acidosis","display_name":"lactic acidosis","score":0.9070000052452087},{"id":"https://openalex.org/keywords/stroke-like-episodes","display_name":"stroke-like episodes","score":0.9470000267028809},{"id":"https://openalex.org/keywords/type-2-diabetes","display_name":"type 2 diabetes","score":0.6790000200271606},{"id":"https://openalex.org/keywords/metformin-overdose","display_name":"metformin overdose","score":0.6100000143051147},{"id":"https://openalex.org/keywords/adverse-drug-reactions","display_name":"adverse drug reactions","score":0.5709999799728394},{"id":"https://openalex.org/keywords/mitochondrial-respiration","display_name":"mitochondrial respiration","score":0.43799999356269836},{"id":"https://openalex.org/keywords/hepatocytes","display_name":"hepatocytes","score":0.5879999995231628}],"concepts":[{"id":"https://openalex.org/C2780323712","wikidata":"https://www.wikidata.org/wiki/Q19484","display_name":"Metformin","level":3,"score":0.9156818389892578},{"id":"https://openalex.org/C2780317664","wikidata":"https://www.wikidata.org/wiki/Q1500373","display_name":"Lactic acidosis","level":2,"score":0.9104522466659546},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8579994440078735},{"id":"https://openalex.org/C2776287708","wikidata":"https://www.wikidata.org/wiki/Q2666433","display_name":"MELAS syndrome","level":5,"score":0.7436571717262268},{"id":"https://openalex.org/C2777180221","wikidata":"https://www.wikidata.org/wiki/Q3025883","display_name":"Type 2 diabetes","level":3,"score":0.6354860067367554},{"id":"https://openalex.org/C2779799828","wikidata":"https://www.wikidata.org/wiki/Q6881866","display_name":"Mitochondrial encephalomyopathy","level":4,"score":0.5534164309501648},{"id":"https://openalex.org/C555293320","wikidata":"https://www.wikidata.org/wiki/Q12206","display_name":"Diabetes mellitus","level":2,"score":0.5423868298530579},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.5175561308860779},{"id":"https://openalex.org/C134018914","wikidata":"https://www.wikidata.org/wiki/Q162606","display_name":"Endocrinology","level":1,"score":0.4147907495498657},{"id":"https://openalex.org/C2910068830","wikidata":"https://www.wikidata.org/wiki/Q3025883","display_name":"Type 2 Diabetes Mellitus","level":3,"score":0.41208532452583313},{"id":"https://openalex.org/C24586158","wikidata":"https://www.wikidata.org/wiki/Q27075","display_name":"Mitochondrial DNA","level":3,"score":0.3677014708518982},{"id":"https://openalex.org/C90924648","wikidata":"https://www.wikidata.org/wiki/Q120569","display_name":"Gastroenterology","level":1,"score":0.330937922000885},{"id":"https://openalex.org/C2775833069","wikidata":"https://www.wikidata.org/wiki/Q6881881","display_name":"Mitochondrial myopathy","level":4,"score":0.271259069442749},{"id":"https://openalex.org/C54355233","wikidata":"https://www.wikidata.org/wiki/Q7162","display_name":"Genetics","level":1,"score":0.1841580867767334},{"id":"https://openalex.org/C104317684","wikidata":"https://www.wikidata.org/wiki/Q7187","display_name":"Gene","level":2,"score":0.10238370299339294},{"id":"https://openalex.org/C86803240","wikidata":"https://www.wikidata.org/wiki/Q420","display_name":"Biology","level":0,"score":0.0}],"mesh":[{"descriptor_ui":"D000328","descriptor_name":"Adult","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000328","descriptor_name":"Adult","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000328","descriptor_name":"Adult","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D001921","descriptor_name":"Brain","qualifier_ui":"Q000000981","qualifier_name":"diagnostic imaging","is_major_topic":false},{"descriptor_ui":"D001921","descriptor_name":"Brain","qualifier_ui":"Q000000981","qualifier_name":"diagnostic imaging","is_major_topic":false},{"descriptor_ui":"D001921","descriptor_name":"Brain","qualifier_ui":"Q000000981","qualifier_name":"diagnostic imaging","is_major_topic":false},{"descriptor_ui":"D003638","descriptor_name":"Deafness","qualifier_ui":"Q000150","qualifier_name":"complications","is_major_topic":false},{"descriptor_ui":"D003638","descriptor_name":"Deafness","qualifier_ui":"Q000150","qualifier_name":"complications","is_major_topic":false},{"descriptor_ui":"D003638","descriptor_name":"Deafness","qualifier_ui":"Q000150","qualifier_name":"complications","is_major_topic":false},{"descriptor_ui":"D003638","descriptor_name":"Deafness","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D003638","descriptor_name":"Deafness","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D003638","descriptor_name":"Deafness","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D003638","descriptor_name":"Deafness","qualifier_ui":"Q000188","qualifier_name":"drug therapy","is_major_topic":false},{"descriptor_ui":"D003638","descriptor_name":"Deafness","qualifier_ui":"Q000188","qualifier_name":"drug therapy","is_major_topic":false},{"descriptor_ui":"D003638","descriptor_name":"Deafness","qualifier_ui":"Q000188","qualifier_name":"drug therapy","is_major_topic":false},{"descriptor_ui":"D003924","descriptor_name":"Diabetes Mellitus, Type 2","qualifier_ui":"Q000150","qualifier_name":"complications","is_major_topic":false},{"descriptor_ui":"D003924","descriptor_name":"Diabetes Mellitus, Type 2","qualifier_ui":"Q000150","qualifier_name":"complications","is_major_topic":false},{"descriptor_ui":"D003924","descriptor_name":"Diabetes Mellitus, Type 2","qualifier_ui":"Q000150","qualifier_name":"complications","is_major_topic":false},{"descriptor_ui":"D003924","descriptor_name":"Diabetes Mellitus, Type 2","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D003924","descriptor_name":"Diabetes Mellitus, Type 2","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D003924","descriptor_name":"Diabetes Mellitus, Type 2","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D003924","descriptor_name":"Diabetes Mellitus, Type 2","qualifier_ui":"Q000188","qualifier_name":"drug therapy","is_major_topic":false},{"descriptor_ui":"D003924","descriptor_name":"Diabetes Mellitus, Type 2","qualifier_ui":"Q000188","qualifier_name":"drug therapy","is_major_topic":false},{"descriptor_ui":"D003924","descriptor_name":"Diabetes Mellitus, Type 2","qualifier_ui":"Q000188","qualifier_name":"drug therapy","is_major_topic":false},{"descriptor_ui":"D003937","descriptor_name":"Diagnosis, Differential","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D003937","descriptor_name":"Diagnosis, Differential","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D003937","descriptor_name":"Diagnosis, Differential","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D004569","descriptor_name":"Electroencephalography","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D004569","descriptor_name":"Electroencephalography","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D004569","descriptor_name":"Electroencephalography","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007004","descriptor_name":"Hypoglycemic Agents","qualifier_ui":"Q000494","qualifier_name":"pharmacology","is_major_topic":false},{"descriptor_ui":"D007004","descriptor_name":"Hypoglycemic Agents","qualifier_ui":"Q000494","qualifier_name":"pharmacology","is_major_topic":false},{"descriptor_ui":"D007004","descriptor_name":"Hypoglycemic Agents","qualifier_ui":"Q000494","qualifier_name":"pharmacology","is_major_topic":false},{"descriptor_ui":"D008279","descriptor_name":"Magnetic Resonance Imaging","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008279","descriptor_name":"Magnetic Resonance Imaging","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008279","descriptor_name":"Magnetic Resonance Imaging","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008687","descriptor_name":"Metformin","qualifier_ui":"Q000494","qualifier_name":"pharmacology","is_major_topic":false},{"descriptor_ui":"D008687","descriptor_name":"Metformin","qualifier_ui":"Q000494","qualifier_name":"pharmacology","is_major_topic":false},{"descriptor_ui":"D008687","descriptor_name":"Metformin","qualifier_ui":"Q000494","qualifier_name":"pharmacology","is_major_topic":false},{"descriptor_ui":"D017241","descriptor_name":"MELAS Syndrome","qualifier_ui":"Q000150","qualifier_name":"complications","is_major_topic":false},{"descriptor_ui":"D017241","descriptor_name":"MELAS Syndrome","qualifier_ui":"Q000150","qualifier_name":"complications","is_major_topic":false},{"descriptor_ui":"D017241","descriptor_name":"MELAS Syndrome","qualifier_ui":"Q000150","qualifier_name":"complications","is_major_topic":false},{"descriptor_ui":"D017241","descriptor_name":"MELAS Syndrome","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D017241","descriptor_name":"MELAS Syndrome","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D017241","descriptor_name":"MELAS Syndrome","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D028361","descriptor_name":"Mitochondrial Diseases","qualifier_ui":"Q000150","qualifier_name":"complications","is_major_topic":false},{"descriptor_ui":"D028361","descriptor_name":"Mitochondrial Diseases","qualifier_ui":"Q000150","qualifier_name":"complications","is_major_topic":false},{"descriptor_ui":"D028361","descriptor_name":"Mitochondrial Diseases","qualifier_ui":"Q000150","qualifier_name":"complications","is_major_topic":false},{"descriptor_ui":"D028361","descriptor_name":"Mitochondrial Diseases","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D028361","descriptor_name":"Mitochondrial Diseases","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D028361","descriptor_name":"Mitochondrial Diseases","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D028361","descriptor_name":"Mitochondrial Diseases","qualifier_ui":"Q000188","qualifier_name":"drug therapy","is_major_topic":false},{"descriptor_ui":"D028361","descriptor_name":"Mitochondrial Diseases","qualifier_ui":"Q000188","qualifier_name":"drug therapy","is_major_topic":false},{"descriptor_ui":"D028361","descriptor_name":"Mitochondrial Diseases","qualifier_ui":"Q000188","qualifier_name":"drug therapy","is_major_topic":false}],"locations_count":2,"locations":[{"id":"doi:10.7326/l20-0292","doi":"https://doi.org/10.7326/l20-0292","is_oa":false,"landing_page_url":"https://doi.org/10.7326/l20-0292","pdf_url":null,"source":{"id":"https://openalex.org/S119722071","display_name":"Annals of Internal Medicine","issn_l":"0003-4819","issn":["0003-4819","1539-3704"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","doyens","jufo-3","ki-jl-3","medline","norway-2"],"host_organization":"https://openalex.org/P4310316812","host_organization_name":"American College of Physicians","host_organization_lineage":["https://openalex.org/P4310316812"],"host_organization_lineage_names":["American College of Physicians"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Annals of Internal Medicine","raw_type":"journal-article"},{"id":"pmid:32833489","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/32833489","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Annals of internal medicine","raw_type":"Case Reports"}],"best_oa_location":null,"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":1.0,"display_name":"Good health and well-being"}],"sustainable_development_goals_aurora":[{"id":"https://metadata.un.org/sdg/2","score":0.44999998807907104,"display_name":"Zero hunger"}],"study_designs":[{"id":"https://openalex.org/study-designs/case-report","display_name":"Case Report"}],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":4,"referenced_works":["https://openalex.org/W1981744720","https://openalex.org/W2047516613","https://openalex.org/W2101206115","https://openalex.org/W2743010525"],"related_works":["https://openalex.org/W2088388188","https://openalex.org/W2400905961","https://openalex.org/W251901857","https://openalex.org/W2049577644","https://openalex.org/W4376278381","https://openalex.org/W2056601949","https://openalex.org/W4296051312","https://openalex.org/W3187078914","https://openalex.org/W2751303821","https://openalex.org/W2591883184"],"abstract_inverted_index":{"LettersJanuary":[0],"2021MELAS":[1],"Syndrome":[2],"and":[3,18,46,60,76,124,140,203,282,352,362,414,421],"MIDD":[4,373],"Unmasked":[5],"by":[6,84,249,388,411,464],"Metformin":[7,152,222,246,389],"Use:":[8],"A":[9],"Case":[10],"ReportNa":[11],"Hyun":[12,22,310],"Kim,":[13,23,311],"MBBS,":[14,17,312],"Mahrukh":[15,34],"Siddiqui,":[16,35],"Jonathan":[19,47],"Vogel,":[20,48],"MDNa":[21],"MBBSAmita":[24,36],"Health":[25,37,50,286,314],"Saint":[26,38,51,287,315],"Joseph":[27,39,52,288,316],"Hospital,":[28,40,53,289,317],"Chicago,":[29,41,54,290,322],"Illinois":[30,42,55,291],"(N.H.K.,":[31,43,56,292],"M.S.,":[32,44,57,293],"J.V.),":[33,45],"MDAmita":[49],"J.V.)Author,":[58],"Article,":[59,281],"Disclosure":[61,283],"Informationhttps://doi.org/10.7326/L20-0292":[62],"SectionsAboutFull":[63],"TextPDF":[64],"ToolsAdd":[65],"to":[66],"favoritesDownload":[67],"CitationsTrack":[68],"CitationsPermissions":[69],"ShareFacebookTwitterLinkedInRedditEmail":[70],"Background:":[71],"Mitochondrial":[72,198,385],"encephalopathy,":[73],"lactic":[74,201,350,363],"acidosis,":[75,351],"stroke-like":[77,204,353,429],"episodes":[78,354,430],"(MELAS)":[79,355],"is":[80,99,110,127,146,165],"a":[81,114,345,365,375,392,432],"syndrome":[82,98,268,356],"caused":[83],"genetic":[85],"defects":[86],"in":[87,104,149,157,167,228,343,374,391,401,407,417,431],"mitochondrial":[88,147,160,226,251,348,435],"DNA.":[89],"The":[90,177],"most":[91],"common":[92],"gene":[93],"variant":[94,109],"associated":[95],"with":[96,159,200,347,359,379,434],"this":[97],"the":[100,105,131],"m.3243A>G":[101],"point":[102],"mutation":[103],"MT-TL1":[106],"gene.":[107],"This":[108],"also":[111],"responsible":[112],"for":[113,135],"rare":[115],"type":[116,136],"of":[117,142,179,181,300,372,399,425,467],"diabetes":[118,123,138],"known":[119],"as":[120,130,270],"maternally":[121],"inherited":[122],"deafness":[125],"(MIDD).Metformin":[126],"widely":[128],"prescribed":[129],"initial":[132],"drug":[133],"treatment":[134],"2":[137],"mellitus,":[139],"one":[141],"its":[143,163],"cellular":[144],"targets":[145],"respiration":[148],"hepatocytes":[150],"(1).":[151],"has":[153],"not":[154],"been":[155],"studied":[156],"patients":[158,169],"dysfunction,":[161],"so":[162],"use":[164],"discouraged":[166],"these":[168],"...References1.":[170],"Rena":[171],"G,":[172],"Hardie":[173],"DG,":[174],"Pearson":[175],"ER.":[176],"mechanisms":[178],"action":[180],"metformin.":[182],"Diabetologia.":[183],"2017;60:1577-85.":[184],"[PMID:":[185,210,233,256,276],"28776086]":[186],"doi:10.1007/s00125-017-4342-z":[187],"CrossrefMedlineGoogle":[188,236,259,278],"Scholar2.":[189],"Henry":[190],"C,":[191],"Patel":[192],"N,":[193],"Shaffer":[194],"W,":[195],"et":[196,220,244],"al.":[197,221,245],"encephalomyopathy":[199],"acidosis":[202],"episodes-MELAS":[205],"syndrome.":[206],"Ochsner":[207],"J.":[208],"2017;17:296-301.":[209],"29026367]":[211],"MedlineGoogle":[212],"Scholar3.":[213],"Protti":[214],"A,":[215,217],"Lecchi":[216],"Fortunato":[218],"F,":[219],"overdose":[223],"causes":[224],"platelet":[225],"dysfunction":[227],"humans.":[229],"Crit":[230],"Care.":[231],"2012;16:R180.":[232],"23034133]":[234],"doi:10.1186/cc11663":[235],"Scholar4.":[237],"Madiraju":[238],"AK,":[239],"Erion":[240],"DM,":[241],"Rahimi":[242],"Y,":[243],"suppresses":[247],"gluconeogenesis":[248],"inhibiting":[250],"glycerophosphate":[252],"dehydrogenase.":[253],"Nature.":[254],"2014;510:542-6.":[255],"24847880]":[257],"doi:10.1038/nature13270":[258],"Scholar5.":[260],"Johns":[261],"DR,":[262],"Stein":[263],"AG,":[264],"Wityk":[265],"R.":[266],"MELAS":[267,402],"masquerading":[269],"herpes":[271],"simplex":[272],"encephalitis.":[273],"Neurology.":[274],"1993;43:2471-3.":[275],"8255441]":[277],"Scholar":[279],"Author,":[280],"InformationAffiliations:":[284],"Amita":[285,313],"J.V.)Disclosures:":[294],"Authors":[295],"have":[296],"disclosed":[297],"no":[298],"conflicts":[299],"interest.":[301],"Forms":[302],"can":[303],"be":[304],"viewed":[305],"at":[306,331],"www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-0292.Corresponding":[307],"Author:":[308],"Na":[309],"2900":[318],"North":[319],"Lakeshore":[320],"Drive,":[321],"IL":[323],"60657;":[324],"e-mail,":[325],"Nahyun.[email":[326],"protected]org.This":[327],"article":[328],"was":[329],"published":[330],"Annals.org":[332],"on":[333],"25":[334,452],"August":[335,453],"2020.":[336],"PreviousarticleNextarticle":[337],"Advertisement":[338],"FiguresReferencesRelatedDetails":[339],"Metrics":[340],"Cited":[341],"byDelay":[342],"diagnosing":[344],"patient":[346,378,433],"encephalomyopathy,":[349],"who":[357],"presented":[358],"status":[360],"epilepticus":[361],"acidosis:":[364],"case":[366],"reportMacular":[367],"findings":[368],"expedite":[369],"accurate":[370],"diagnosis":[371],"young":[376],"female":[377],"newly":[380],"diagnosed":[381],"diabetesCase":[382],"Report:":[383],"Late-Onset":[384],"Disease":[386],"Uncovered":[387],"Use":[390],"Patient":[393],"With":[394],"Acute":[395],"Verbal":[396],"Auditory":[397],"AgnosiaInitiation":[398],"metformin":[400],"patient\u2013a":[403],"dangerous":[404],"combinationNeurological":[405],"manifestations":[406],"m.3243A>G-related":[408],"disease":[409],"triggered":[410],"metforminThe":[412],"Mutations":[413],"Clinical":[415],"Variability":[416],"Maternally":[418],"Inherited":[419],"Diabetes":[420],"Deafness:":[422],"An":[423],"Analysis":[424],"161":[426],"PatientsMetformin":[427],"induces":[428],"diseaseMetformin":[436],"January":[437,457],"2021Volume":[438],"174,":[439],"Issue":[440,455],"1Page:":[441],"124-125KeywordsEncephalitisEpileptic":[442],"seizuresHerpes":[443],"simplexLactatesLactic":[444],"acidLactic":[445],"acidosisMagnetic":[446],"resonance":[447],"imagingMitochondrial":[448],"DNARespirationTemporal":[449],"lobe":[450],"ePublished:":[451],"2020":[454,463],"Published:":[456],"2021":[458],"Copyright":[459],"&":[460],"PermissionsCopyright":[461],"\u00a9":[462],"American":[465],"College":[466],"Physicians.":[468],"All":[469],"Rights":[470],"Reserved.PDF":[471],"downloadLoading":[472],"...":[473]},"counts_by_year":[{"year":2026,"cited_by_count":2},{"year":2025,"cited_by_count":4},{"year":2024,"cited_by_count":3},{"year":2023,"cited_by_count":4},{"year":2022,"cited_by_count":3},{"year":2021,"cited_by_count":4},{"year":2020,"cited_by_count":1}],"updated_date":"2026-09-27T08:07:27.782135","created_date":"2025-10-10T00:00:00"}