RESUMO
INTRODUCTION: Sarcoidosis is a multisystemic disease of unknown etiology, characterized by non caseating granulomas in different organs. The respiratory system is the most frequently involved organ system. Up to 90% of patients with sarcoidosis have pulmonary involvement. The neurological involvement is rare and only occurs in the 5 7% of the patients. CASE REPORT: We present the case of a 41 years old woman who had severe headache and a sixth nerve palsy. Diagnosis of sarcoidosis was made in association with idiopathic intracranial hypertension (IIH). CONCLUSIONS: Sarcoidosis can involve any portion of the nervous system. An etiologic association between sarcoidosis and IIH could be identified in this case. Treatment with corticosteroids, repeated lumbar punctures and diuretics were prescribed and induced a significant clinical improvement.
Assuntos
Doenças do Sistema Nervoso/fisiopatologia , Pseudotumor Cerebral/complicações , Sarcoidose/etiologia , Corticosteroides/uso terapêutico , Adulto , Comorbidade , Diagnóstico Diferencial , Diuréticos/uso terapêutico , Feminino , Humanos , Doenças do Sistema Nervoso/tratamento farmacológico , Pseudotumor Cerebral/tratamento farmacológico , Pseudotumor Cerebral/fisiopatologia , Sarcoidose/tratamento farmacológico , Sarcoidose/fisiopatologiaRESUMO
PRIMARY OBJECTIVE: The prevalence of osteoporotic fracture is higher in non-Hispanic Caucasian (NHC) than Mexican-American (MA) women in the USA. The present study examined bone mineral density (BMD) in these two ethnic groups and the association between BMD and body composition. RESEARCH DESIGN: Cross-sectional. SUBJECTS: Sixty-two NHC and 54 MA women, aged 60-86 years, with a body mass index (kgm(-2)) of <30. METHODS: BMD (gcm(-2)) of the spine (L2-4), hip (femoral neck, trochanter, Ward's triangle) and whole body was determined by dual-energy X-ray absorptiometry (DXA). Bone mineral-free lean mass (LM) and fat mass (FM) and several ratios of body fat distribution were also assessed by DXA. RESULTS: There was no difference in age (NHC, 69.5+/-0.7; MA 69.5+/-0.9 years; mean +/- SEM) or body mass, but MA women were shorter with a higher truncal adiposity (p < 0.001). There was no significant difference in BMD between groups, however, adjusting for height resulted in higher hip and whole body BMD in MA women (p < 0.01). When volumetric bone density was calculated (bone mineral apparent density; BMAD, gcm(-3)), a trend for higher values in MA women was observed at the femoral neck (p = 0.018). LM contributed independently to BMD at the spine and hip in NHC women, with FM also contributing at the femoral neck. In MA women, LM was an independent contributor to lumbar spine and trochanter BMD, and both LM and FM contributed to whole body BMD. However, the effects of LM and FM were removed in both groups when BMD was adjusted for body or bone size, the only exception being at the trochanter in NHC women. CONCLUSIONS: These results indicate that MA women have higher bone density at the proximal femur than NHC women, which may partially account for their lower rate of hip fracture. Further, differences in bone density between the two ethnic groups do not appear to be dependent on soft-tissue composition.
Assuntos
Densidade Óssea , Gorduras/metabolismo , Americanos Mexicanos , População Branca , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/metabolismo , Composição Corporal , Colesterol/metabolismo , Estudos Transversais , Feminino , Fêmur/fisiologia , Colo do Fêmur/fisiologia , Humanos , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/metabolismo , Fator de Crescimento Insulin-Like I/metabolismo , Vértebras Lombares , Triglicerídeos/metabolismoRESUMO
OBJECTIVE: To determine the frequency of falls and identify risk factors for falls among older Mexican-American women. DESIGN: A prospective cohort study with an average follow-up of 2.7 years. SETTING: A clinical center at the Palo Alto Veterans Affairs Medical Center, California. PARTICIPANTS: 152 community-dwelling Mexican-American Caucasian women aged 59 years or older. OUTCOME MEASURES: Falls and injurious falls, as determined by monthly telephone interviews. RESULTS: The rate of falls was 508 per 1000 person-years (95% confidence interval (CI), 440-577). Injurious falls requiring medical attention occurred at a rate of 79 per 1000 person-years (95% CI, 52-107). Factors that were associated independently with an increased risk of falling were older age, a history of arthritis or rheumatism, a history of high thyroid, having fainted at least once in the year before baseline, current use of psychotropic medications, and walking fewer than 5 blocks a day. Those persons with an average time for the chair stand test had a lower risk of falling than those with the slowest times or the fastest times. CONCLUSIONS: The frequency of falls and injurious falls in this cohort of 152 relatively acculturated, healthy, older Mexican-American women was similar or slightly higher than previously reported rates for non-Hispanic Caucasian(s). Many of the factors associated with falls in this study were similar to those reported for non-Hispanic Caucasian women, suggesting that fall prevention measures tested mainly among non-Hispanic Caucasian women would also be appropriate for Mexican-American women.
Assuntos
Acidentes por Quedas , Americanos Mexicanos , Saúde da Mulher , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artrite/complicações , California , Estudos de Coortes , Intervalos de Confiança , Feminino , Seguimentos , Humanos , Hipertireoidismo/complicações , Entrevistas como Assunto , Pessoa de Meia-Idade , Postura/fisiologia , Estudos Prospectivos , Psicotrópicos/uso terapêutico , Doenças Reumáticas/complicações , Fatores de Risco , Síncope/complicações , Caminhada/fisiologia , População Branca , Ferimentos e Lesões/etiologiaRESUMO
Common polymorphisms in the vitamin D receptor (VDR) gene have been shown to correlate with bone mineral density (BMD). However, attempts to replicate the original findings in other populations have yielded variable results. These disparities may reflect ethnic or environmental differences in the expression of the VDR effect upon BMD. We examined a relatively ethnically homogeneous group of 103 healthy postmenopausal Caucasian women of Mexican descent living in Northern California. We determined the VDR genotype and measured the BMD at the lumbar spine and femoral neck by dual-energy X-ray absorptiometry, as well as several biochemical indices of mineral metabolism. The prevalence of the BB genotype, associated in previous studies with the lowest BMD, was 8% and highly linked to the tt genotype. Absolute and age-adjusted BMD at both hip and spine showed a trend toward lower BMD in the BB, AA, and tt genotypes, but this trend did not achieve statistical significance. There were no consistent intergroup differences in change in BMD over 2 years of follow-up, nor in mean serum concentrations of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, osteocalcin, or total urinary pyridinolines. Intact parathyroid hormone concentrations were significantly higher in subjects with the AA genotype, with a trend toward higher values in those with the BB and tt genotypes as well. Our data suggest that there may be a decrease in BMD associated with the B, A, and t alleles, but the intergroup difference in BMD is 0.2-0.5 standard deviations (SD) at the lumbar spine and 0.3 SD at the femoral neck, decreases that are smaller than previously reported. Given the relatively low prevalence of the BB/tt genotype in Mexican-American Caucasians, a larger sample would be required to detect a significant association between VDR alleles and differences in BMD of the magnitude suggested by our data. We conclude that a genotype effect of this magnitude, if present, would be clinically relevant, but the impact on BMD is too small to detect with statistical significance in a study of this size.
Assuntos
Densidade Óssea/genética , Osso e Ossos/metabolismo , Americanos Mexicanos , Polimorfismo Genético , Pós-Menopausa/genética , Receptores de Calcitriol/genética , Receptores de Calcitriol/metabolismo , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Densidade Óssea/fisiologia , Feminino , Genótipo , Humanos , Pessoa de Meia-Idade , Pós-Menopausa/fisiologia , Receptores de Calcitriol/sangueRESUMO
BACKGROUND: This study was initiated to test the hypothesis that older, healthy, nondiabetic Mexican American women would be relatively resistant to insulin-mediated glucose disposal, hyperinsulinemic, and dyslipidemic as compared to a matched group of non-Hispanic White (NHW) women. METHODS: The study, cross-sectional in nature, involved 14 Mexican American and 19 NHW healthy, normotensive nondiabetic, postmenopausal women of similar age and body mass index. It took place in the General Clinical Research Center at Stanford Medical Center. Measurements were made of fasting plasma glucose, insulin and lipid concentrations, and plasma glucose and insulin concentrations following a 75 gram oral glucose challenge. Resistance to insulin-mediated glucose disposal was estimated by the steady-state plasma glucose (SSPG) concentration achieved at the end of a 3-hour constant infusion of glucose, insulin, and somatostatin. RESULTS: Mexican American women had significantly greater glucose (p < .001) and insulin (p < .001) responses to the oral glucose challenge than did the NHW women. Resistance to insulin-mediated glucose disposal was increased in Mexican American women (SSPG 195 +/- 25 mg/dl compared to 137 +/- 18 mg/dl in NHW; p < .001). While total cholesterol, low density lipoprotein (LDL)-cholesterol, and triglyceride concentrations were not significantly different in the two ethnic groups, high density lipoprotein (HDL)-cholesterol was significantly lower in the Mexican American women (51 mg/dl vs 61 mg/dl; p = .04). CONCLUSION: Older Mexican American women are more insulin resistant, glucose intolerant, and hyperinsulinemic, and have a lower HDL-cholesterol than a matched group of non-Hispanic White peers. These results were observed despite the exclusion of individuals with non-insulin dependent diabetes mellitus (NIDDM).
Assuntos
Envelhecimento/fisiologia , Hispânico ou Latino , Resistência à Insulina , População Branca , Administração Oral , Idoso , Glicemia/análise , Estudos Transversais , Feminino , Glucose/farmacologia , Homeostase , Humanos , Insulina/sangue , Lipídeos/sangue , México/etnologia , Pessoa de Meia-Idade , Concentração Osmolar , Somatostatina/farmacologiaRESUMO
We examined the association of bone mineral density (BMD) with a polymorphism in the gene encoding the vitamin D receptor (VDR) that causes a change in the predicted protein sequence. The polymorphism results from a C-to-T transition and creates an initiation codon (ATG) three codons proximal to a downstream start site. The polymorphism can be defined by a restriction fragment length polymorphism (RFLP) using the restriction endonuclease FokI. The presence of a FokI site, designated f, allows protein translation to initiate from the first ATG. The allele lacking the site (designated F), initiates from a second ATG site. Thus, translation products from these alleles are predicted to differ by three amino acids with the f variant elongated. In a group of 100 postmenopausal Mexican-American Caucasian women, subjects with the ff genotype (15% of the study population) had a 12.8% lower BMD at the lumbar spine than FF subjects (37% of the population) (p = 0.01). Heterozygote (Ff) subjects (48% of the population) had an intermediate BMD. This association between BMD and genotype was not apparent at the femoral neck or forearm. Over a 2-year follow-up period, a decrease in BMD at the femoral neck was greater in ff compared with FF subjects (-4.7% vs. -0.5%, p = 0.005). This trend was not apparent at the lumbar spine or forearm. There were no differences between genotype groups in measurements of 25-hydroxyvitamin D (25(OH)D), calcitriol, parathyroid hormone (PTH), osteocalcin, or urinary pyridinolines. We conclude that the FokI polymorphism of the VDR gene correlates significantly with decreased BMD at the lumbar spine and with an increased rate of bone loss at the hip in ff subjects. We emphasize that these initial data should be interpreted with caution but that the utility of this polymorphism as a genetic marker to determine BMD and osteoporosis risk warrants further study in larger populations with subjects of diverse ethnic backgrounds.
Assuntos
Densidade Óssea/genética , Americanos Mexicanos/genética , Iniciação Traducional da Cadeia Peptídica/genética , Polimorfismo Genético , Pós-Menopausa/genética , Receptores de Calcitriol/genética , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , California , Feminino , Humanos , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de RestriçãoRESUMO
Incidence rates of hip fracture are lower in Hispanic (HC) than non-Hispanic Caucasians (NHC). To investigate factors that may affect skeletal health of Hispanics, we recruited 152 healthy community-dwelling Mexican-American Caucasian women into a 4-year longitudinal study that evaluates bone mass, nutritional status, muscle strength, mobility, falls, and other factors that may contribute to fracture risk. Results from the baseline component of the study are reported herein. Average bone mineral densities (BMD) evaluated by dual-energy X-ray absorptiometry (DXA) in this study group did not differ from BMDs in healthy, NHC women of similar age. Hip axis length (HAL), however, was significantly shorter than that reported for nonosteoporotic NHC. Factors independently associated with greater BMD and BMC at certain skeletal sites were lean body mass, fat mass, acculturation, years of estrogen use, sun exposure, hip adductor strength, grip strength, erythrocyte folate, and serum glucose concentrations. Factors independently associated with lower BMD and BMC at certain skeletal sites were age, parity, and vertebral deformities (all p < 0.05). Thus, the decreased risk of hip fracture in HC compared with NHC does not appear to be due to high bone mass. However, other factors such as HAL and body composition may play a role in maintenance of skeletal integrity.
Assuntos
Densidade Óssea/fisiologia , Fraturas do Quadril/etnologia , Americanos Mexicanos , Absorciometria de Fóton , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Composição Corporal/fisiologia , Peso Corporal/fisiologia , Desenvolvimento Ósseo/fisiologia , Estudos de Coortes , Feminino , Fêmur/fisiologia , Antebraço/fisiologia , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/fisiopatologia , Humanos , Estilo de Vida , Estudos Longitudinais , Pessoa de Meia-Idade , Fenômenos Fisiológicos da Nutrição , Reprodução/fisiologia , Fatores de Risco , População BrancaRESUMO
Cytokine production of unstimulated and mitogen-stimulated peripheral blood mononuclear cells of 31 children vertically infected with human immunodeficiency virus type 1 (HIV) and with different patterns of disease progression was evaluated to establish possible correlations between the immunologic and the clinical findings. Production of interferon gamma and interleukin-2 (type 1 cytokines), and of interleukin-4 and interleukin-10 (type 2 cytokines), was analyzed in seven symptom-free patients (Centers for Disease Control and Prevention class P-1B), 10 patients with mild symptoms (class P-2A), and 14 patients with severe symptoms (class P-2B-F). Cytokine production was compared with that of 10 age- and sex-matched control subjects who were seronegative for HIV. The HIV-infected patients produced significantly fewer type 1 cytokines and significantly more type 2 cytokines than the uninfected control subjects. No differences in the production of interferon gamma and interleukin-2 were detected among the different clinical categories of HIV-infected patients. In contrast, interleukin-4 production was augmented in the patients with class P-2A (p < 0.05) and class P-2B-F HIV infection (p < 0.03), in comparison with the children with class P-1B infection. The increase in interleukin-4 production was paralleled by an increase in the number of children with hyperimmunoglobulinemia E in each of the clinical groups (0% in class P-1B; 40% in class P-2A; and 71% in class P-2 B-F infection). Similarly, interleukin-10 production was increased both in patients with class P-2A and in those with class P-2B-F infection, in comparison with the children with class P-1B disease (p < 0.006 and < 0.04, respectively). These data indicate (1) that vertically acquired HIV infection results in decreased production of type 1 cytokines and in increased production of type 2 cytokines, and (2) that an increased production of type 2 cytokines correlates with hyperimmunoglobulinemia E and is present in, and may be characteristic of, the symptomatic phases of childhood HIV infection.