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Bosnar D, Zagorec MK, Bušić M. Comment on "Central retinal artery occlusion in rhino-orbital-cerebral mucormycosis: An inflammatory-prothrombotic state". Asia Pac J Ophthalmol (Phila) 2024; 13:100045. [PMID: 38331219 DOI: 10.1097/apo.0000000000000615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Affiliation(s)
- Damir Bosnar
- Department of Ophthalmology, Reference Center of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies, Reference Center of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Zagreb, Croatia; Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Mira Knežić Zagorec
- Department of Ophthalmology, Reference Center of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies, Reference Center of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Zagreb, Croatia; Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
| | - Mladen Bušić
- Department of Ophthalmology, Reference Center of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies, Reference Center of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Zagreb, Croatia; Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Meier ME, Hagelstein-Rotman M, van de Ven AC, Van der Geest ICM, Donker O, Pichardo SEC, Hissink Muller PCE, van der Meeren SW, Dorleijn DMJ, Winter EM, van de Sande MAJ, Appelman-Dijkstra NM. A multidisciplinary care pathway improves quality of life and reduces pain in patients with fibrous dysplasia/McCune-Albright syndrome: a multicenter prospective observational study. Orphanet J Rare Dis 2022; 17:439. [PMID: 36528764 PMCID: PMC9758844 DOI: 10.1186/s13023-022-02588-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Fibrous dysplasia/McCune-Albright syndrome (FD/MAS) may cause pain, impaired ambulation and decreased quality of life (QoL). International guidelines advocate management of FD/MAS in a tertiary multidisciplinary care pathway, but no longitudinal data are available to support this recommendation. This multicenter prospective observational study aimed to evaluate effects of 1 year of treatment in the FD/MAS care pathway in 2 tertiary clinics on QoL and pain, assessed by change in Short Form 36 and Brief Pain Inventory between baseline and follow-up. Patients completing baseline questionnaires < 1 year after intake were classified as new referrals, others as under chronic care. RESULTS 92 patients were included, 61 females (66%). 22 patients (24%) had monostotic disease, 16 (17%) isolated craniofacial FD, 27 (40%) polyostotic FD and 17 (19%) MAS. 26 were new referrals (28%) and 66 chronic patients (72%). Median age at baseline was 47 years (Q1-Q3 36-56). Skeletal burden correlated with baseline Physical Function (rs = - 0.281, p = 0.007). QoL was in all domains lower compared to the general population. New referrals reported clinically important differences (CID) over time in domains Physical Function (mean 67 ± SD24 to 74 ± 21, effect size (ES) 0.31, p = 0.020), Role Physical (39 ± 41 to 53 ± 43, ES 0.35, p = 0.066), Social Functioning (64 ± 24 to 76 ± 23, ES 0.49, p = 0.054), and Health Change (39 ± 19 to 53 ± 24, ES 0.76, p = 0.016), chronic patients in Physical Function (52 ± 46 to 66 ± 43, ES 0.31, p = 0.023) and Emotional Wellbeing (54 ± 27 to 70 ± 15, ES 0.59, p < 0.001). New referrals reported a CID of 1 point in maximum pain, average pain and pain interference, chronic patients reported stable scores. Change in pain interference and Role Physical were correlated (rs = - 0.472, p < 0.001). Patients with limited disease extent improved more than patients with severe disease. Patients receiving FD-related therapy had lower baseline scores than patients not receiving therapy and reported improvements in QoL after 1 year. Yet also patients without FD-related therapy improved in Physical Function. CONCLUSIONS All FD-subtypes may induce pain and reduced QoL. A multidisciplinary care pathway for FD/MAS may improve pain and QoL, mainly in new referrals without MAS comorbidities with low baseline scores. Therefore, we recommend referral of patients with all subtypes of FD/MAS to specialized academic centers.
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Affiliation(s)
- Maartje E. Meier
- grid.10419.3d0000000089452978Center for Bone Quality, Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Marlous Hagelstein-Rotman
- grid.10419.3d0000000089452978Division of Endocrinology, Department of Internal Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - Annenienke C. van de Ven
- grid.10417.330000 0004 0444 9382Department of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ingrid C. M. Van der Geest
- grid.10417.330000 0004 0444 9382Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olav Donker
- grid.10419.3d0000000089452978Center for Bone Quality, Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Sarina E. C. Pichardo
- grid.10419.3d0000000089452978Department of Oral and Maxillofacial Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Petra C. E. Hissink Muller
- grid.508552.fDepartment of Paediatric Rheumatology, Willem Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Stijn W. van der Meeren
- grid.10419.3d0000000089452978Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Desirée M. J. Dorleijn
- grid.10419.3d0000000089452978Division of Endocrinology, Department of Internal Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - Elizabeth M. Winter
- grid.10419.3d0000000089452978Division of Endocrinology, Department of Internal Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel A. J. van de Sande
- grid.10419.3d0000000089452978Center for Bone Quality, Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Natasha M. Appelman-Dijkstra
- grid.10419.3d0000000089452978Division of Endocrinology, Department of Internal Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
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Melo MA, Borges LP, Salvatori R, Souza DRV, Santos-Júnior HT, de R Neto JM, Campos VC, Santos AA, Oliveira CRP, da Invenção GB, Batista VO, Matos ILS, Barros-Oliveira CS, Dos Santos KA, Santos EG, Souza NAA, Melo EV, Borges PC, Santos SEFS, de Oliveira BM, Oliveira-Santos AA, de Jesus AR, Aguiar-Oliveira MH. Individuals with isolated congenital GH deficiency due to a GHRH receptor gene mutation appear to cope better with SARS-CoV-2 infection than controls. Endocrine 2021; 72:349-355. [PMID: 33860882 PMCID: PMC8050633 DOI: 10.1007/s12020-021-02728-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Several interactions exist between the GH/IGF axis and the immune system, including effects on innate immunity and humoral and cellular response. Acquired GH deficiency (GHD) has been recently proposed as a risk factor for severity of COVID-19 infections. However, acquired GHD is often associated to other factors, including pituitary tumors, surgery, radiotherapy, and additional pituitary hormones deficits and their replacements, which, together, may hinder an accurate analysis of the relationship between GHD and COVID-19. Therefore, we decided to assess the seroprevalence of SARS-CoV-2 antibodies and the frequency of symptomatic cases of COVID-19 in adults subjects with untreated isolated GHD (IGHD) due to a homozygous null mutation in the GHRH receptor gene. METHODS A cross-sectional study was carried out in 27 adult IGHD subjects and 27 age- and gender-matched local controls. Interview, physical examination, bio-impedance, hematological and SARS-CoV-2 IgM and IgG antibodies were analyzed. RESULTS There was no difference in the prevalence of positivity of anti-SARS-CoV-2 IgM and IgG antibodies between the two groups. Conversely, no IGHD individual had a previous clinical diagnosis of COVID-19 infection, while 6 control subjects did (p = 0.023). CONCLUSION The production of anti-SARS-CoV-2 antibodies was similar between IGHD subjects due to a GHRH receptor gene mutation and controls, but the evolution to symptomatic stages of the infection and the frequency of confirmed cases was lower in IGHD subjects than in GH sufficient individuals.
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Affiliation(s)
- Manuela A Melo
- Division of Endocrinology, Health Sciences Graduate Program, Aracaju, Brazil
| | | | - Roberto Salvatori
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | | | | | - José M de R Neto
- Laboratory of Biochemistry and Clinical Immunology, Aracaju, Brazil
| | - Viviane C Campos
- Division of Endocrinology, Health Sciences Graduate Program, Aracaju, Brazil
| | - Aryanne A Santos
- Laboratory of Biochemistry and Clinical Immunology, Aracaju, Brazil
| | - Carla R P Oliveira
- Division of Endocrinology, Health Sciences Graduate Program, Aracaju, Brazil
| | | | - Vanderlan O Batista
- Division of Endocrinology, Health Sciences Graduate Program, Aracaju, Brazil
| | - Igor L S Matos
- Laboratory of Biochemistry and Clinical Immunology, Aracaju, Brazil
| | | | | | - Elenilde G Santos
- Division of Endocrinology, Health Sciences Graduate Program, Aracaju, Brazil
| | | | - Enaldo V Melo
- Division of Endocrinology, Health Sciences Graduate Program, Aracaju, Brazil
| | - Pamela C Borges
- Laboratory of Biochemistry and Clinical Immunology, Aracaju, Brazil
| | - Saulo E F S Santos
- Division of Endocrinology, Health Sciences Graduate Program, Aracaju, Brazil
| | | | | | - Amélia R de Jesus
- Division of Immunology, Health Sciences Graduate Program Federal University of Sergipe, Aracaju, 49060-100, Sergipe, Brazil
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Marinho CG, Melo HA, Salvatori R, Nunes MAP, Oliveira CRP, Campos VC, Barros-Oliveira CS, Oliveira-Santos AA, Menezes NV, Santos-Júnior HT, Santos EG, Melo MA, Oliveira JLM, Melo EV, Aguiar-Oliveira MH. Cerebral vasoreactivity, a surrogate marker of cerebrovascular disease, is not impaired in subjects with lifetime, untreated, congenital isolated GH deficiency. Endocrine 2020; 70:388-395. [PMID: 32656695 DOI: 10.1007/s12020-020-02415-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/04/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Cerebrovascular disease (CeVD) is a major cause of death and disability. The role of the GH/IGF-I axis on CeVD risk is controversial. Patients with GH deficiency (GHD) in the setting of hypopituitarism often exhibit CeVD predisposing factors, like low nitric oxide generation, endothelial dysfunction, increased visceral fat mass, increased levels of LDL cholesterol, and increased intima-media thickness, a surrogate marker of atherosclerosis. However, several confounders such as the primary hypothalamic-pituitary lesion, hormonal replacement therapies, consequences of surgery and radiotherapy, may influence this relationship. Therefore, we decided to assess cerebral vasoreactivity, a surrogate marker of CeVD, in adult subjects with untreated isolated GHD (IGHD) due to the same homozygous null mutation in the GHRH receptor gene. METHODS A cross-sectional study was carried out in 25 adult IGHD subjects and 25 age- and gender-matched controls. Interview, physical examination, laboratory data, intima-media thickness measurement, and transcranial Doppler were performed. The intracranial hemodynamics (mean flow velocity, pulsatility and resistance indexes) were measured, and the response to the vasodilatory stimulus by breath-holding maneuver (breath-holding index) was calculated. RESULTS IGHD and control groups were similar in Framingham risk score and intima-media thickness. Similarly, there was no difference in mean flow velocity, pulsatility, resistance, and breath-holding index. CONCLUSIONS Lifetime, untreated IGHD does not cause impaired cerebral vasoreactivity.
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Affiliation(s)
- Cindi G Marinho
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, 49060-100, Brazil
| | - Hyder A Melo
- Service of Transcranial Doppler, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, 49060-100, Brazil
| | - Roberto Salvatori
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Marco A P Nunes
- Division of Angiology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, 49060-100, Brazil
| | - Carla R P Oliveira
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, 49060-100, Brazil
| | - Viviane C Campos
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, 49060-100, Brazil
| | - Cynthia S Barros-Oliveira
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, 49060-100, Brazil
| | - Alécia A Oliveira-Santos
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, 49060-100, Brazil
| | - Nelmo V Menezes
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, 49060-100, Brazil
| | - Hertz T Santos-Júnior
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, 49060-100, Brazil
| | - Elenilde G Santos
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, 49060-100, Brazil
| | - Manuela A Melo
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, 49060-100, Brazil
| | - Joselina L M Oliveira
- Division of Cardiology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, 49060-100, Brazil
| | - Enaldo V Melo
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, 49060-100, Brazil
| | - Manuel H Aguiar-Oliveira
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, 49060-100, Brazil
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