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do Espírito Santo RB, Serafim RA, Loureiro RM, Gonçalves DVC, Sumi DV, de Mello RAF, Collin SM, Deps PD. Clinical and radiological evaluation of maxillofacial and otorhinolaryngological manifestations of Hansen's disease. Sci Rep 2022; 12:14912. [PMID: 36050504 PMCID: PMC9436959 DOI: 10.1038/s41598-022-19072-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/24/2022] [Indexed: 11/09/2022] Open
Abstract
To characterize maxillofacial, otorhinolaryngological and oral manifestations of Hansen's disease (HD), we conducted a cross-sectional study in 21 current patients attending the Unidade Básica de Saúde de Jardim América, Espírito Santo, Brazil and 16 former patients resident at Pedro Fontes Hospital using data from computed tomography imaging, rhinoscopy, and oroscopy. Maxillofacial characteristics were compared with 37 controls. Differences in bone alterations across the three groups were determined mainly by severe resorption/atrophy being more frequent in former HD patients, with severe resorption/atrophy of the anterior alveolar process of maxilla in 50.0% (8/16) of former patients, 28.6% (6/21) of current patients and 10.8% (4/37) of controls and of nasal bones and aperture in 31.3% (5/16) of former patients compared with 0/21 current patients and two controls. There were no substantial differences in otorhinolaryngological and oroscopic findings between the two patient groups. HD patients had more tooth loss than the age-matched control group. Maxillofacial, otorhinolaryngological and oroscopic finding scores were strongly correlated only in current HD patients. Correlation between otorhinolaryngological and maxillofacial scores suggests that protocols for HD patient assessment and follow-up could include otorhinolaryngological evaluation, with radiological imaging where necessary, subject to replication of our findings in a larger study.
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Affiliation(s)
| | - Rachel Azevedo Serafim
- Postgraduate Programme in Infectious Diseases, Universidade Federal do Espírito Santo, Vitoria, Espírito Santo, Brazil
| | | | | | | | | | - Simon M Collin
- Postgraduate Programme in Infectious Diseases, Universidade Federal do Espírito Santo, Vitoria, Espírito Santo, Brazil
- Department of Social Medicine, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Avenida Marechal Campos, 1468. Maruípe, Vitoria, Espírito Santo, CEP: 29047-105, Brazil
| | - Patrícia D Deps
- Postgraduate Programme in Infectious Diseases, Universidade Federal do Espírito Santo, Vitoria, Espírito Santo, Brazil.
- Department of Social Medicine, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Avenida Marechal Campos, 1468. Maruípe, Vitoria, Espírito Santo, CEP: 29047-105, Brazil.
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VDR polymorphism, gene expression and vitamin D levels in leprosy patients from North Indian population. PLoS Negl Trop Dis 2018; 12:e0006823. [PMID: 30481178 PMCID: PMC6286024 DOI: 10.1371/journal.pntd.0006823] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 12/07/2018] [Accepted: 10/15/2018] [Indexed: 12/31/2022] Open
Abstract
Background Leprosy is a chronic infectious disease caused by Mycobacterium leprae and mainly affects skin, peripheral nerves. Vitamin D receptor (VDR) gene polymorphism has been found to be associated with leprosy. Vitamin D has been shown to control several host immunomodulating properties through VDR gene. Vitamin D deficiency was also found to be linked to an increased risk for several infections and metabolic diseases. Objective In the present study, we investigated the association of VDR gene polymorphism, mRNA gene expression of VDR and the vitamin D levels with leprosy and its reactional states. Methodology A total of 305 leprosy patients consisting of tuberculoid (TT), borderline tuberculoid (BT), borderline lepromatous (BL), lepromatous leprosy (LL), as well as 200 healthy controls were enrolled in the study. We identified single nucleotide polymorphisms (SNPs) of VDR Taq1, Fok1 and Apa1, as well as the expression of VDR mRNA gene using PCR-based restriction fragment length polymorphism (RFLP) analysis and real-time PCR respectively. We also performed ELISA to measure vitamin D levels. Result We observed that SNP of VDR gene (Fok1 and Taq1) are associated with the leprosy disease. The allelic frequency distribution of T and t allele (p = 0.0037), F and f allele (p = 0.0024) was significantly higher in leprosy patients and healthy controls. ff genotype of Fok1 was found to be associated with leprosy patients [p = 0.0004; OR (95% CI) 3.148 (1.662–5.965)]. The recessive model of Fok1 genotype was also found to be significantly associated in leprosy patients in comparison to healthy controls [p = 0.00004; OR (95% CI) 2.85 (1.56–5.22)]. Leprosy patients are significantly associated with t-F-a haplotype. Further, VDR gene expression was found to be lower in non-reaction group compared to that of reaction group of leprosy and healthy controls. Paradoxically, we noted no difference in the levels of vitamin D between leprosy patients and healthy controls. Conclusion Blood levels of vitamin D do not play any role in clinical manifestations of any forms of leprosy. ff genotype of Fok1 and tt genotype of Taq1 was found to be associated with leprosy per se. Association of t-F-a haplotype with leprosy was found to be significant and could be used as a genetic marker to identify individuals at high risk for developing leprosy. VDR gene expression was lower in TT/BT and BL/LL groups of leprosy in comparison to that of healthy controls. Present study was carried out to find out the association of vitamin D receptor (VDR) gene polymorphism, mRNA gene expression of VDR gene and level of vitamin D with leprosy reactions and leprosy patients. Surprisingly, level of vitamin D in leprosy patients was not found to be associated with the disease and its manifestations. VDR genotypes (Fok1 and Taq1) were found to be associated with leprosy patients. t-F-a haplotype was significantly associated with leprosy patients. Gene expression of vitamin D receptor was lower in leprosy patients in comparison to healthy controls.
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Mendonça ML, Pereira FA, Nogueira-Barbosa MH, Monsignore LM, Teixeira SR, Watanabe PCA, Maciel LMZ, de Paula FJA. Increased vertebral morphometric fracture in patients with postsurgical hypoparathyroidism despite normal bone mineral density. BMC Endocr Disord 2013; 13:1. [PMID: 23286605 PMCID: PMC3546901 DOI: 10.1186/1472-6823-13-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/27/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The mechanism behind parathyroid hormone (PTH) activation of bone remodeling is intimately dependent on the time of exposure of bone cells to hormone levels. Sustained high PTH levels trigger catabolism, while transitory elevations induce anabolism. The effects of hypoparathyroidism (PhPT) on bone are unknown. The objective was to study the impact of PhPT on bone mineral density (BMD), on the frequency of subclinical vertebral fracture and on mandible morphometry. METHODS The study comprised thirty-three postmenopausal women, 17 controls (CG) and 16 with PhPT (PhPTG) matched for age, weight and height. Bone mineral density (BMD) of lumbar spine, total hip and 1/3 radius, radiographic evaluation of vertebral morphometry, panoramic radiography of the mandible, and biochemical evaluation of mineral metabolism and bone remodeling were evaluated in both groups. RESULTS There were no significant differences in lumbar spine or total hip BMD between groups. There was marked heterogeneity of lumbar spine BMD in PhPTG (high = 4, normal = 9, osteopenia = 1, and osteoporosis = 2 patients). BMD was decreased in the 1/3 radius in PhPTG P < 0.005). The PhPTG group exhibited an increased frequency of morphometric vertebral fractures and decreased mandible cortical thickness. CONCLUSION The study suggests that vertebral fragility occurs in PhPT despite normal or even high BMD. The current results encourage further studies to evaluate the use of panoramic radiography in the identification of osteometabolic disorders, such as PhPT and the development of a more physiological treatment for PhPT.
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Affiliation(s)
- Maira L Mendonça
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Francisco A Pereira
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Marcello H Nogueira-Barbosa
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Lucas M Monsignore
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Sara R Teixeira
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Plauto CA Watanabe
- Department of Radiology, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Lea MZ Maciel
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Francisco JA de Paula
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
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Foss NT, Motta ACF. Leprosy, a neglected disease that causes a wide variety of clinical conditions in tropical countries. Mem Inst Oswaldo Cruz 2012; 107 Suppl 1:28-33. [DOI: 10.1590/s0074-02762012000900006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 08/14/2012] [Indexed: 11/22/2022] Open
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de Paula FJA, Rosen CJ. Vitamin D safety and requirements. Arch Biochem Biophys 2011; 523:64-72. [PMID: 22179017 DOI: 10.1016/j.abb.2011.12.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 12/22/2022]
Abstract
Vitamin D an ancient secosteroid is essential for mineral homeostasis, bone remodeling, immune modulation, and energy metabolism. Recently, debates have emerged about the daily vitamin D requirements for healthy and elderly adults, the safety and efficacy of long term supplementation and the role of vitamin D deficiency in several chronic disease states. Since this molecule acts as both a vitamin and a hormone, it should not be surprising that the effects of supplementation are multi-faceted and complex. Yet despite significant progress in the last decade, our understanding of vitamin D physiology and the clinical relevance of low circulating levels of this vitamin remains incomplete. The present review provides the reader with a comprehensive and up-to-date understanding of vitamin D requirements and safety. It also raises some provocative research questions.
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Affiliation(s)
- Francisco J A de Paula
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, 14049-900 SP, Brazil.
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Silva SRB, Tempone AJ, Silva TP, Costa MRSN, Pereira GMB, Lara FA, Pessolani MCV, Esquenazi D. Mycobacterium leprae downregulates the expression of PHEX in Schwann cells and osteoblasts. Mem Inst Oswaldo Cruz 2010; 105:627-32. [DOI: 10.1590/s0074-02762010000500005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 05/19/2010] [Indexed: 12/31/2022] Open
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de Paula FJA, Góis-Júnior MB, Aguiar-Oliveira MH, de A. Pereira F, Oliveira CRP, Pereira RMC, Farias CT, Vicente TAR, Salvatori R. Consequences of lifetime isolated growth hormone (GH) deficiency and effects of short-term GH treatment on bone in adults with a mutation in the GHRH-receptor gene. Clin Endocrinol (Oxf) 2009; 70:35-40. [PMID: 18494866 PMCID: PMC2615796 DOI: 10.1111/j.1365-2265.2008.03302.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Growth hormone (GH) influences bone mass maintenance. However, the consequences of lifetime isolated GH deficiency (IGHD) on bone are not well established. We assessed the bone status and the effect of 6 months of GH replacement in GH-naive adults with IGHD due to a homozygous mutation of the GH-releasing hormone (GHRH)-receptor gene (GHRHR). PATIENTS AND METHODS We studied 20 individuals (10 men) with IGHD at baseline, after 6 months of depot GH treatment, and 6 and 12 months after discontinuation of GH. Quantitative ultrasound (QUS) of the heel was performed and serum osteocalcin (OC) and C-terminal cross-linking telopeptide of type I collagen (ICTP) were measured. QUS was also performed at baseline and 12 months later in a group of 20 normal control individuals (CO), who did not receive GH treatment. RESULTS At baseline, the IGHD group had a lower T-score on QUS than CO (-1.15 +/- 0.9 vs.-0.07 +/- 0.9, P < 0.001). GH treatment improved this parameter, with improvement persisting for 12 months post-treatment (T-score for IGHD = -0.59 +/- 0.9, P < 0.05). GH also caused an increase in serum OC (baseline vs. pGH, P < 0.001) and ICTP (baseline vs. pGH, P < 0.01). The increase in OC was more marked during treatment and its reduction was slower after GH discontinuation than in ICTP. CONCLUSIONS These data suggest that lifetime severe IGHD is associated with significant reduction in QUS parameters, which are partially reversed by short-term depot GH treatment. The treatment induces a biochemical pattern of bone anabolism that persists for at least 6 months after treatment discontinuation.
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Affiliation(s)
- Francisco J. A. de Paula
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Miburge B. Góis-Júnior
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Manuel H. Aguiar-Oliveira
- Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, Federal University of Sergipe, Brazil
| | - Francisco de A. Pereira
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Carla R. P. Oliveira
- Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, Federal University of Sergipe, Brazil
| | - Rossana M. C. Pereira
- Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, Federal University of Sergipe, Brazil
| | - Catarine T. Farias
- Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, Federal University of Sergipe, Brazil
| | - Tábita A. R. Vicente
- Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, Federal University of Sergipe, Brazil
| | - Roberto Salvatori
- Division of Endocrinology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Leal AMO, Foss NT. Endocrine dysfunction in leprosy. Eur J Clin Microbiol Infect Dis 2008; 28:1-7. [PMID: 18629555 DOI: 10.1007/s10096-008-0576-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2008] [Accepted: 06/06/2008] [Indexed: 10/21/2022]
Abstract
Leprosy is still an endemic disease, especially in Third World countries, and, because of migration, it still persists in Europe and the United States. The disease affects the peripheral nerves, skin, and multiple internal organs, making its clinical recognition difficult. In particular, the endocrine manifestations caused by leprosy have been underestimated, even by specialists. The endocrine changes present in leprosy include hypogonadism, sterility, and osteoporosis. In addition, the spectral immune nature of leprosy offers an attractive model to investigate the pathogenetic correlation between the patterns of inflammation in the poles of its spectrum and the hormonal disarrangements observed in this disease. It is important that those involved in leprosy management be aware of the potential endocrine changes and their treatment to address the disease in all of its aspects. In this article, we review the findings on endocrine dysfunction in leprosy, including a survey of the literature and of our own work.
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Affiliation(s)
- A M O Leal
- Department of Medicine, Federal University of São Carlos, São Carlos, Brazil.
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