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Abstract
CASE A patient who had previously been diagnosed with fibrodysplasia ossificans progressiva was seen for hip pain and progressive soft tissue ossifications. Through a careful clinical examination, by which a subtype of brachydactyly was noted, the Albright hereditary osteodystrophy phenotype was recognized, and a new diagnosis of pseudopseudohypoparathyroidism was established. This paucisymptomatic condition often remains unidentified; however, its transmission can lead to more potentially serious diseases. CONCLUSIONS A careful diagnostic process, including physical examination, is essential. Even if advanced tests exist, small clinical findings can lead to the proper conclusion. In our case, a finger pointed us in the right direction.
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Affiliation(s)
- Paolo Arrigoni
- Dipartimento di Ortopedia e Traumatologia, Università degli Studi di Pavia, Pavia, Italy
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Johnson MP, Keyho R, Blackburn NB, Laston S, Kumar S, Peralta J, Thapa SS, Towne B, Subedi J, Blangero J, Williams-Blangero S. Glycated Serum Protein Genetics and Pleiotropy with Cardiometabolic Risk Factors. J Diabetes Res 2019; 2019:2310235. [PMID: 31089471 PMCID: PMC6476113 DOI: 10.1155/2019/2310235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/20/2018] [Accepted: 01/12/2019] [Indexed: 01/08/2023] Open
Abstract
Measurements of fasting glucose (FG) or glycated hemoglobin A1c (HbA1c) are two clinically approved approaches commonly used to determine glycemia, both of which are influenced by genetic factors. Obtaining accurate measurements of FG or HbA1c is not without its challenges, though. Measuring glycated serum protein (GSP) offers an alternative approach for assessing glycemia. The aim of this study was to estimate the heritability of GSP and GSP expressed as a percentage of total serum albumin (%GA) using a variance component approach and localize genomic regions (QTLs) that harbor genes likely to influence GSP and %GA trait variation in a large extended multigenerational pedigree from Jiri, Nepal (n = 1,800). We also performed quantitative bivariate analyses to assess the relationship between GSP or %GA and several cardiometabolic traits. Additive genetic effects significantly influence variation in GSP and %GA levels (p values: 1.15 × 10-5 and 3.39 × 10-5, respectively). We localized a significant (LOD score = 3.18) and novel GSP QTL on chromosome 11q, which has been previously linked to type 2 diabetes. Two common (MAF > 0.4) SNPs within the chromosome 11 QTL were associated with GSP (adjusted pvalue < 5.87 × 10-5): an intronic variant (rs10790184) in the DSCAML1 gene and a 3'UTR variant (rs8258) in the CEP164 gene. Significant positive correlations were observed between GSP or %GA and blood pressure, and lipid traits (p values: 0.0062 to 1.78 × 10-9). A significant negative correlation was observed between %GA and HDL cholesterol (p = 1.12 × 10-5). GSP is influenced by genetic factors and can be used to assess glycemia and diabetes risk. Thus, GSP measurements can facilitate glycemic studies when accurate FG and/or HbA1c measurements are difficult to obtain. GSP can also be measured from frozen blood (serum) samples, which allows the prospect of retrospective glycemic studies using archived samples.
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Affiliation(s)
- Matthew P. Johnson
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
| | - Ryan Keyho
- The University of Texas at Austin, Austin, Texas 78705, USA
| | - Nicholas B. Blackburn
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
| | - Sandra Laston
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
| | - Satish Kumar
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
| | - Juan Peralta
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Suman S. Thapa
- Tilganga Institute of Ophthalmology, Gaushala, Bagmati Bridge, P.O. Box 561, Kathmandu, Nepal
| | - Bradford Towne
- Department of Population Health and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Kettering, Ohio 45435, USA
| | - Janardan Subedi
- Department of Sociology and Gerontology, College of Arts and Science, Miami University, Oxford, Ohio 45056, USA
| | - John Blangero
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
| | - Sarah Williams-Blangero
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
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Williams KD, Blangero J, Mahaney MC, Subedi J, Jha B, Williams-Blangero S, Towne B. Axial quantitative ultrasound assessment of pediatric bone quality in eastern Nepal. Osteoporos Int 2015; 26:2319-28. [PMID: 25862355 DOI: 10.1007/s00198-015-3115-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 03/18/2015] [Indexed: 12/29/2022]
Abstract
UNLABELLED This study presents quantitative ultrasonography (QUS) bone quality data for an underrepresented, south Asian pediatric population from Nepal. Data were collected as part of a longitudinal study of growth and development. This study offers normative data and documents the effect of stunting, wasting, and underweight on the bone properties measured by QUS. INTRODUCTION The purpose of this study was to (1) examine the bone quality of a rural, non-Western pediatric population using QUS, (2) explore variation in the trajectory of bone quality development between males and females, and (3) examine the impact of growth disruption(s) on bone quality. METHODS A cross-sectional study of 860 children and adolescents aged 5-18 years from the Jirel ethnic group in eastern Nepal was performed. The Sunlight Omnisense 7000P was used to assess bone quality of the distal 1/3 radius and midshaft tibia. WHO reference standards were used to assess growth disruptions of height, weight, and BMI. RESULTS QUS bone quality data for an underrepresented, non-Western pediatric population are presented for the radius and tibia. A sizable portion of the study participants were classified as stunted, wasted, and/or underweight. Despite this prevalence of growth disruption in the study sample, bone quality data conform to other documented populations with less growth disruption. Thus, this study offers normative data and documents the minimal effect of stunting, wasting, and underweight on the bone properties measured by QUS. CONCLUSIONS Non-Western pediatric populations are significantly underserved with regard to simple, non-invasive screening tools that may help identify developmental disorders and assess bone health. The children and adolescents examined here represent normal growth and development for an underrepresented south Asian population. While this work demonstrates that stunting, wasting, or underweight status at time of QUS assessment is not associated with poor bone quality, we do suggest that further study is needed to examine possible cumulative effects of persistent disruptions that may lead to compromised bone quality in later adolescence.
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Affiliation(s)
- K D Williams
- Department of Anthropology, Temple University, 1115 Polett Walk, 210 Gladfelter Hall, Philadelphia, PA, 19120, USA,
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Williams KD, Subedi J, Jha B, Blangero J, Williams-Blangero S, Towne B. Quantitative physical activity assessment of children and adolescents in a rural population from Eastern Nepal. Am J Hum Biol 2015; 28:129-37. [PMID: 26179444 DOI: 10.1002/ajhb.22762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/27/2015] [Accepted: 06/16/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES We report cross-sectional, objectively measured physical activity data for 399 children and adolescents aged 6 to 18 years. We evaluated physical activity of children and adolescents, considered time spent in each activity intensity category, and explored the impact of growth disruption (stunting and wasting) on physical activity patterns. METHODS Participants wore an Actical (Mini-Mitter, Bend, OR) omnidirectional accelerometer for one week as part of their annual visit to the Jiri Growth Study. The percentage of time spent in standard activity intensities were computed using standard metabolic equivalents (METS) cutpoints and compared by chronological age, sex, and school versus non-school days. RESULTS Primary findings include (1) children are more active on non-school days and adolescents are more active during the school week; (2) Jirel children do not exhibit the reduction in physical activity that most Western populations experience during the transition from childhood to adolescence; and (3) Jirel children and adolescents routinely meet the suggested one hour/day MVPA threshold; (4) Stunting is prevalent and factors leading to this growth disruption may contribute to the amount of time in sedentary or light physical activity. CONCLUSIONS We report child and adolescent physical activity patterns from the Jirel population of eastern Nepal. In this rural context, children and adolescents are more active than populations reported from Western contexts. This key finding has important biomedical implications for the maintenance of healthy body composition, skeletal health, and other health traits.
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Affiliation(s)
- Kimberly D Williams
- Department of Anthropology, Temple University, Philadelphia, Pennsylvania.,Institute for Genomic and Evolutionary Medicine, Temple University, Philadelphia, Pennsylvania
| | - Janardan Subedi
- Department of Sociology and Gerontology, Miami University, Oxford, Ohio
| | - Bharat Jha
- Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - John Blangero
- South Texas Diabetes and Obesity Institute, University of Texas Health Science Center Regional Academic Health Center, Harlingen, Texas
| | - Sarah Williams-Blangero
- South Texas Diabetes and Obesity Institute, University of Texas Health Science Center Regional Academic Health Center, Harlingen, Texas
| | - Bradford Towne
- Department of Community Health, Lifespan Health Research Center, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
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