RESUMO
An 11-month-old female Saanen goat, weighing 12.7 kg, was taken to the Veterinary Hospital of the Federal University of Minas Gerais because of sternal recumbency. On clinical examination, the animal was much smaller than expected and had hair similar to that of puppies and areas of hyperpigmentation on the head and dorsocervical and dorsothoracic cranial regions. Radiographic examination revealed fractures in both femurs and severe generalized osteoporosis. Given the unfavourable prognosis, the animal was euthanized. Necropsy revealed generalized pallor, muscular atrophy of the pelvic limbs and little reserve of subcutaneous adipose tissue. Both femurs had complete and closed diaphyseal fractures. The second lumbar vertebra was severely reduced in length as a result of a fracture, with dorsal displacement of the vertebral body towards the vertebral canal and compression of the spinal cord. Long bones and vertebrae had severe cortical thinning, enlargement of the medullary canal and reduced resistance. The thyroid gland was not in its normal anatomical location. A pale red nodule (1.0 × 0.4 cm) in the serosa of the middle third of the trachea, close to the thoracic entrance, was confirmed as ectopic thyroid tissue. Microscopically, the bones had evidence of growth arrest and severe osteoporosis. The ectopic thyroid nodule was hyperplastic with severe hypertrophy of follicular cells. The spinal cord was compressed by vertebral fractures and had focally extensive and severe myelomalacia. Based on the pathological features, the case was diagnosed as thyroid dysgenesis characterized by eutopic thyroid agenesis and ectopic thyroid tissue, associated with interruption of bone growth with dwarfism, osteoporosis and spontaneous secondary fractures with compression of the lumbar spinal cord.
Assuntos
Nanismo , Doenças das Cabras , Cabras , Osteoporose , Animais , Feminino , Doenças das Cabras/patologia , Nanismo/veterinária , Nanismo/complicações , Nanismo/patologia , Osteoporose/veterinária , Osteoporose/complicações , Fraturas Espontâneas/veterinária , Glândula TireoideRESUMO
OBJECTIVE: To evaluate the clinical effect of sodium glycerophosphate (NaGP) in parenteral nutrition solutions on mineral metabolism in extremely low birth weight (ELBW) infants. STUDY DESIGN: NaGP was introduced for use in place of potassium phosphate (K3PO4) in January 2018; this retrospective cohort study included 95 ELBW infants treated with K3PO4 between January 2015 and December 2017 and 77 infants treated with NaGP between August 2018 and January 2021. Mineral intake over the first 14 days; changes in serum calcium, phosphorus, sodium, and alkaline phosphatase (ALP) levels over the first 1-3 months; and the rates of electrolyte imbalance and clinical morbidity were compared. High-risk infants who had nil per os (NPO) status for >14 days and prolonged parenteral nutrition exposure were further analyzed as a subgroup. RESULTS: The use of NaGP instead of K3PO4 significantly increased Ca and P intake, but intakes remained below the recommended range (Ca, 64-140 mg/kg/day; P, 50-108 mg/kg/day). Compared with levels in the K3PO4 group, the NaGP group had significantly higher serum Ca and P levels after day 14 and lower ALP levels after day 56. In the subgroup analysis, the NaGP group had significantly lower incidences of hypophosphatemia, hyponatremia, bronchopulmonary dysplasia, and ALP >500 IU/L. CONCLUSIONS: Although the administration of NaGP instead of K3PO4 in parenteral nutrition regimens still did not provide adequate Ca and P intake for ELBW infants, higher intake significantly improved serum Ca and P levels, especially in ELBW infants with prolonged parenteral nutrition exposure.
Assuntos
Recém-Nascido de Peso Extremamente Baixo ao Nascer , Nutrição Parenteral , Recém-Nascido , Lactente , Humanos , Estudos Retrospectivos , Minerais , Peso ao NascerRESUMO
Introdução: Recém-nascidos (RN) prematuros de muito baixo peso (MBP) apresentam um risco aumentado de desenvolver doença metabólica óssea (DMO). A realização de suplementação mineral e de triagem para DMO em UTI Neonatal auxilia na prevenção, no diagnóstico e no tratamento desta condição clínica. Objetivos: Avaliar a ocorrência de DMO, a realização de suplementação mineral e de investigação para DMO em prematuros de MBP internados em UTI Neonatal de um Serviço Hospitalar Materno-Infantil de alto risco, vinculado ao SUS. Métodos: Estudo transversal, a partir de dados secundários coletados de prontuários eletrônicos. Foram avaliados os recém-nascidos prematuros de muito baixo peso internados em UTI neonatal. Estudaram-se perfil do recém-nascido, realização da triagem para DMO, ocorrência de DMO, regime alimentar, intercorrências clínicas, uso de suplementação de vitaminas e minerais, idade, peso, sexo, via de parto e Apgar. Resultados: Foram incluídos 112 participantes. A triagem para DMO foi feita em 56 pacientes (50%), com dosagem sérica de fosfatase alcalina, cálcio, fósforo e magnésio séricos. A ocorrência de DMO foi de 8,9% (5 casos). Todos os participantes com DMO apresentaram doença respiratória, quadro infeccioso e estavam recebendo nutrição parenteral. Conclusão: A ocorrência de DMO em recém-nascidos de muito baixo peso internados em UTI neonatal foi de 8,9%, inferior à descrita na literatura. Identificamos como fatores associados à DMO a ocorrência concomitante de doença respiratória, a sepse e o uso de nutrição parenteral.
Introduction: Extremely low birth weight (ELBW) premature infants have an increased risk of developing metabolic bone disease (MBD). The use of mineral supplementation and MBD screening in the neonatal ICU helps prevent, diagnose, and treat this clinical condition. Objectives: To evaluate the occurrence of MBD, as well as the presence of mineral supplementation and MBD screening in premature infants with MBD admitted to the neonatal ICU of a high-risk maternal-child hospital associated with the Brazilian Unified Health System. Methods: This was a cross-sectional study based on secondary data from electronic medical records. We evaluated ELBW premature infants admitted to a neonatal ICU. Infant profile, MBD screening, MBD occurrence, diet, clinical complications, vitamin and mineral supplementation use, age, weight, sex, delivery method, and Apgar score were assessed. Results: We included 112 participants in the study. MBD screening was conducted in 56 patients (50%) with serum levels of alkaline phosphatase, calcium, phosphorus, and magnesium. The rate of MBD occurrence was 8.9% (5 cases). All participants with MBD had respiratory disease, infection, and were receiving parenteral nutrition. Conclusions: The occurrence rate of MBD in ELBW infants admitted to a neonatal ICU was 8,9%, lower than that found in the literature. Factors associated with MBD were the concomitant occurrence of respiratory disease, sepsis, and parenteral nutrition.
Assuntos
Doenças Ósseas Metabólicas , Recém-Nascido PrematuroRESUMO
STUDY DESIGN: Cross-sectional study. OBJECTIVES: Thus, this study aimed to assess the epidemiological profile of a patient sample that underwent spinal surgery regarding their nutritional and vitamin D status. METHODS: Serum albumin and vitamin D (25-hydroxyvitamin D) levels were measured in patients with different spinal surgical approaches and various pathologies at a single institution. 112 patients were retrospectively identified for inclusion and stratified by age into 4 age groups and by pathology. The nutritional status of the patients was classified in vitamin D inadequacy (< 30ng/mL), vitamin D deficiency (<20ng/mL), and hypoalbuminemia (<3.5g/dL). Data was analyzed comparing vitamin D, and albumin means considering gender, age group, and pathologies. RESULTS: Twenty-eight (25.2%) patients had hypoalbuminemia. There was no difference between gender (p = 0.988); there was a significant decrease in albumin concentration increasing the age (p < 0.001). The prevalence of hypoalbuminemia was significantly higher in patients with trauma, tumor and infection than in those patients with degenerative and deformity diseases (p = 0.003). The prevalence of vitamin D inadequacy was 33.7%, and that of deficiency was 62.2%, while severe deficiency (< 10 ng/mL) in 16.3%. The vitamin D concentration was significantly different among the pathologies (P = 0.047), the lower concentration occurring in patients with tumor. CONCLUSION: Older patients, as well as patients with tumor and infectious pathologies, seem to have a higher prevalence of hypoalbuminemia, inferring malnutrition. There was a low epidemic level of vitamin D concentration, almost all patients presenting some degree of hypovitaminosis D, independent of age, gender and nutritional status.
RESUMO
Background: Rickets is a deficiency pathology that occurs in young and growing animals, leading to deficient bone mineralization. Rickets has been reported in several species producing numerous economic losses. The disease is caused by nutritional imbalance of calcium (Ca), phosphorus (P) and vitamin D. The aim of this work was to report two outbreaks of rickets in commercial weaning farms in the Seara city, in the western region of Santa Catarina State (SC), Brazil. Case: In August 2016, the Veterinary Pathology Laboratory (LPV) at the Concórdia Campus of the Catarinense Federal Institute (IFC) diagnosed two outbreaks of rickets in pigs in the weaning phase in Seara, SC. The clinical history was obtained by interviewing the field veterinarian and the farmers. In the anamnesis, both pig farmers stated having used a feed premix product from the same company, starting three months ago, and after that the pigs presented clinical signs of posterior paralysis and progressive weight loss. Six animals were submitted to necropsy and organs were collected from the abdominal and thoracic cavities; central nervous system and bones; fixed in 10% buffered formalin, routinely processed, paraffin embedded and stained with hematoxylin and eosin (HE) for histopathological analysis. Bone specimens were decalcified in nitric acid working solution 20 times their volume, during 5 days. In addition, samples of the premix product containing minerals and vitamins were sent to a specialized laboratory to analyze macroelements levels through the atomic absorption methodology. In property 1, there was a batch of 100 animals, the morbidity rate was 15% and lethality was 5%. In property 2, among 30 animals, the morbidity and lethality rate were 33%. Five animals from property 1 and one...(AU)
Assuntos
Animais , Suínos/crescimento & desenvolvimento , Raquitismo/epidemiologia , Raquitismo/veterinária , Hipocalcemia/veterinária , Deficiência de Vitamina D/diagnóstico , Brasil , Doenças Ósseas Metabólicas/veterináriaRESUMO
Two young opossums were necropsied and diagnosed with rickets. This study aims to describe the clinical-pathological aspects of rickets in Didelphis albiventris. Macroscopically, the opossums presented kyphosis and scoliosis, lateral deviation of the limbs in varus, locomotion difficulty, and enlargement with softening of costochondral junctions (rickety rosary). Samples of bones and joints were processed for hematoxylin and eosin staining and Masson's trichrome. Microscopically, we observed thickening of the epiphyseal plate, characterized by irregular and multifocal proliferation of serialized and hypertrophic cartilage zones, which formed circular groups of large, dysplastic chondrocytes towards the spongy zone, often surrounded by non-mineralized osteoid tissue. In the cortical bone, there were pale eosinophilic zones around the Havers channels consistent with non-mineralized osteoid. The staining of Masson's trichrome evidenced the accumulation of osteoid tissue in cortical and trabecular bones. It is possible that a mixed cause of absorption deficiency of vitamin D3 associated with an unbalanced Ca:P diet based on lactose-free milk and fruits may have triggered the disease.(AU)
Dois gambás jovens foram necropsiados e diagnosticados com raquitismo. O objetivo do trabalho é descrever os aspectos clínico-patológicos de raquitismo em Didelphis albiventris. Macroscopicamente os gambás apresentaram cifose e escoliose, desvio lateral dos membros em varus, dificuldade de locomoção e alargamento com amolecimento das junções costocondrais (rosário raquítico). Amostras dos ossos e articulações foram processadas para coloração de hematoxilina e eosina e Tricrômico de Masson. Microscopicamente havia espessamento da placa epifisária, caracterizada pela proliferação irregular e multifocal das zonas de cartilagem seriada e hipertrófica, que formavam grupos circulares de condrócitos grandes, displásicos em direção a zona esponjosa frequentemente cercados por tecido osteoide não mineralizado. No osso cortical haviam zonas eosinofílicas pálidas ao redor dos canais de Havers consistentes com osteoide não mineralizado. A coloração de Tricrômico de Masson evidenciou o acúmulo de tecido osteoide no nosso cortical e trabecular. Acredita-se que uma causa mista de déficit de absorção de vitamina D3 associada a uma dieta desbalanceada em Ca:P a base de leite sem lactose e frutas tenha desencadeado a doença.(AU)
Assuntos
Animais , Fósforo , Raquitismo/veterinária , Deficiência de Vitamina D/veterinária , Cálcio , DidelphisRESUMO
Two young opossums were necropsied and diagnosed with rickets. This study aims to describe the clinical-pathological aspects of rickets in Didelphis albiventris. Macroscopically, the opossums presented kyphosis and scoliosis, lateral deviation of the limbs in varus, locomotion difficulty, and enlargement with softening of costochondral junctions (rickety rosary). Samples of bones and joints were processed for hematoxylin and eosin staining and Masson's trichrome. Microscopically, we observed thickening of the epiphyseal plate, characterized by irregular and multifocal proliferation of serialized and hypertrophic cartilage zones, which formed circular groups of large, dysplastic chondrocytes towards the spongy zone, often surrounded by non-mineralized osteoid tissue. In the cortical bone, there were pale eosinophilic zones around the Havers channels consistent with non-mineralized osteoid. The staining of Masson's trichrome evidenced the accumulation of osteoid tissue in cortical and trabecular bones. It is possible that a mixed cause of absorption deficiency of vitamin D3 associated with an unbalanced Ca:P diet based on lactose-free milk and fruits may have triggered the disease.(AU)
Dois gambás jovens foram necropsiados e diagnosticados com raquitismo. O objetivo do trabalho é descrever os aspectos clínico-patológicos de raquitismo em Didelphis albiventris. Macroscopicamente os gambás apresentaram cifose e escoliose, desvio lateral dos membros em varus, dificuldade de locomoção e alargamento com amolecimento das junções costocondrais (rosário raquítico). Amostras dos ossos e articulações foram processadas para coloração de hematoxilina e eosina e Tricrômico de Masson. Microscopicamente havia espessamento da placa epifisária, caracterizada pela proliferação irregular e multifocal das zonas de cartilagem seriada e hipertrófica, que formavam grupos circulares de condrócitos grandes, displásicos em direção a zona esponjosa frequentemente cercados por tecido osteoide não mineralizado. No osso cortical haviam zonas eosinofílicas pálidas ao redor dos canais de Havers consistentes com osteoide não mineralizado. A coloração de Tricrômico de Masson evidenciou o acúmulo de tecido osteoide no nosso cortical e trabecular. Acredita-se que uma causa mista de déficit de absorção de vitamina D3 associada a uma dieta desbalanceada em Ca:P a base de leite sem lactose e frutas tenha desencadeado a doença.(AU)
Assuntos
Animais , Fósforo , Raquitismo/veterinária , Deficiência de Vitamina D/veterinária , Cálcio , DidelphisRESUMO
Background: Rickets is a deficiency pathology that occurs in young and growing animals, leading to deficient bone mineralization. Rickets has been reported in several species producing numerous economic losses. The disease is caused by nutritional imbalance of calcium (Ca), phosphorus (P) and vitamin D. The aim of this work was to report two outbreaks of rickets in commercial weaning farms in the Seara city, in the western region of Santa Catarina State (SC), Brazil. Case: In August 2016, the Veterinary Pathology Laboratory (LPV) at the Concórdia Campus of the Catarinense Federal Institute (IFC) diagnosed two outbreaks of rickets in pigs in the weaning phase in Seara, SC. The clinical history was obtained by interviewing the field veterinarian and the farmers. In the anamnesis, both pig farmers stated having used a feed premix product from the same company, starting three months ago, and after that the pigs presented clinical signs of posterior paralysis and progressive weight loss. Six animals were submitted to necropsy and organs were collected from the abdominal and thoracic cavities; central nervous system and bones; fixed in 10% buffered formalin, routinely processed, paraffin embedded and stained with hematoxylin and eosin (HE) for histopathological analysis. Bone specimens were decalcified in nitric acid working solution 20 times their volume, during 5 days. In addition, samples of the premix product containing minerals and vitamins were sent to a specialized laboratory to analyze macroelements levels through the atomic absorption methodology. In property 1, there was a batch of 100 animals, the morbidity rate was 15% and lethality was 5%. In property 2, among 30 animals, the morbidity and lethality rate were 33%. Five animals from property 1 and one...
Assuntos
Animais , Deficiência de Vitamina D/diagnóstico , Hipocalcemia/veterinária , Raquitismo/epidemiologia , Raquitismo/veterinária , Suínos/crescimento & desenvolvimento , Brasil , Doenças Ósseas Metabólicas/veterináriaRESUMO
OBJECTIVE: To report clinical characteristics and medical history data obtained retrospectively for a large cohort of pediatric patients with perinatal and infantile hypophosphatasia. STUDY DESIGN: Medical records from academic medical centers known to diagnose and/or treat hypophosphatasia were reviewed. Patients born between 1970 and 2011 with hypophosphatasia and any of the following signs/symptoms at age <6 months were eligible: vitamin B6-dependent seizures, respiratory compromise, or rachitic chest deformity (NCT01419028). Patient demographics and characteristics, respiratory support requirements, invasive ventilator-free survival, and further complications of hypophosphatasia were followed for up to the first 5 years of life. RESULTS: Forty-eight patients represented 12 study sites in 7 countries; 13 patients were alive, and 35 were dead (including 1 stillborn). Chest deformity, respiratory distress, respiratory failure (as conditioned by the eligibility criteria), failure to thrive, and elevated calcium levels were present in >70% of patients between birth and age 5 years. Vitamin B6-dependent seizures and respiratory distress and failure were associated significantly (P < .05) with the risk of early death. Serum alkaline phosphatase activity in all 41 patients tested (mean [SD]: 18.1 [15.4] U/L) was below the mean lower limit of normal of the reference ranges of the various laboratories (88.2 U/L). Among the 45 patients with relevant data, 29 had received respiratory support, of whom 26 had died at the time of data collection. The likelihood of invasive ventilator-free survival for this cohort decreased to 63% at 3 months, 54% at 6 months, 31% at 12 months, and 25% at 5 years. CONCLUSIONS: Patients with perinatal or infantile hypophosphatasia and vitamin B6-dependent seizures, with or without significant respiratory distress or chest deformities, have high morbidity and mortality in the first 5 years of life. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01419028.
Assuntos
Fosfatase Alcalina/sangue , Causas de Morte , Terapia de Reposição de Enzimas/métodos , Hipofosfatasia/mortalidade , Hipofosfatasia/terapia , Fosfatase Alcalina/uso terapêutico , Estudos de Coortes , Progressão da Doença , Intervalo Livre de Doença , Terapia de Reposição de Enzimas/mortalidade , Feminino , Seguimentos , Humanos , Hipofosfatasia/sangue , Hipofosfatasia/diagnóstico , Lactente , Internacionalidade , Estimativa de Kaplan-Meier , Masculino , Gravidez , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Fatores de TempoRESUMO
OBJECTIVE: To evaluate the impact of prematurity on fracture by age 5, controlling for medications and comorbidities of prematurity. STUDY DESIGN: We performed a retrospective cohort study of infants born in Military Treatment Facilities in 2009-2010 with ≥5 years of follow-up care. Gestational age, low birth weight, comorbidities of prematurity (osteopenia, necrotizing enterocolitis, chronic lung disease, and cholestasis) and fractures were identified by International Classification of Disease, 9th Edition, codes. Pharmaceutical records identified treatment with caffeine, diuretics, postnatal corticosteroids, and antacids. Poisson regression analysis determined fracture rate by 5 years of life. RESULTS: There were 65 938 infants born in 2009-2010 who received care in the military health system for ≥5 years, including 3589 born preterm; 165 born at ≤286/7 weeks of gestation, 380 born at 29-316/7 weeks of gestation, and 3044 born at 32-366/7 weeks of gestation. Preterm birth at any gestational age was not associated with fracture rate in adjusted models. The fracture rate was increased with cholestasis, proton pump inhibitor exposure, and male sex. CONCLUSIONS: Prematurity was not associated with fracture rate. Neonatal cholestasis and proton pump inhibitor treatment were associated with increased fractures by age 5.
Assuntos
Fraturas Ósseas/epidemiologia , Recém-Nascido de Baixo Peso , Doenças do Prematuro/epidemiologia , Recém-Nascido Prematuro , Medição de Risco/métodos , Pré-Escolar , Comorbidade , Feminino , Seguimentos , Idade Gestacional , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Serviços de Saúde Militar/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologiaRESUMO
The past two decades have seen a proliferation in bioarchaeological literature on the identification of scurvy, a disease caused by chronic vitamin C deficiency, in ancient human remains. This condition is one of the few nutritional deficiencies that can result in diagnostic osseous lesions. Scurvy is associated with low dietary diversity and its identification in human skeletal remains can provide important contextual information on subsistence strategy, resource allocation, and human-environmental interactions in past populations. A large and robust methodological body of work on the paleopathology of scurvy exists. However, the diagnostic criteria for this disease employed by bioarchaeologists have not always been uniform. Here we draw from previous research on the skeletal manifestations of scurvy in adult and juvenile human skeletal remains and propose a weighted diagnostic system for its identification that takes into account the pathophysiology of the disease, soft tissue anatomy, and clinical research. Using a sample of individuals from the prehistoric Atacama Desert in Northern Chile, we also provide a practical example of how diagnostic value might be assigned to skeletal lesions of the disease that have not been previously described in the literature.
Assuntos
Paleopatologia/métodos , Escorbuto , Adulto , Arqueologia , Osso e Ossos/patologia , Criança , Chile , Diagnóstico Diferencial , Dieta , História Antiga , Humanos , Lactente , Maxila/patologia , Escorbuto/diagnóstico , Escorbuto/história , Escorbuto/patologiaRESUMO
OBJECTIVE: We sought to assess worldwide differences among pediatric patients undergoing hemodialysis. Because practices differ widely regarding nutritional resources, treatment practice, and access to renal replacement therapy, investigators from the Pediatric Investigation and Close Collaboration to examine Ongoing Life Outcomes, the pediatric subset of the MONitoring Dialysis Outcomes Cohort (PICCOLO MONDO) performed this cross-sectional study. We hypothesized that growth would be better in developed countries, possibly at the expense of bone mineral disease. STUDY DESIGN: In this cross-sectional study, we analyzed growth by height z score and recommended age-specific bone mineral metabolism markers from 225 patients <18 years of age maintained on hemodialysis, between the years of 2000 to 2012 from 21 countries in different regions. RESULTS: The patients' median age was 16 (IQR 14-17) years, and 45% were females. A height z score less than the third percentile was noted in 34% of the cohort, whereas >66% of patients reported normal heights, with patients from North America having the greatest proportion (>80%). More than 70% of the entire cohort had greater than the age-recommended levels of phosphorus, particularly in the Asia-Pacific and North America, where we also observed the greatest body mass index z score (0.99 ± 1.6) and parathyroid hormone levels (557.1 [268.4-740.5]). Below-recommended parathyroid hormone levels were noted in 26% and elevated levels in 61% of the entire sample, particularly in the Asia Pacific region. Lower-than-recommended calcium levels were noted in 36% of the entire cohort, particularly in Latin America. CONCLUSIONS: We found regional differences in growth- and age-adjusted bone mineral metabolism markers. Children from North America had the best growth, received the most dialysis, but also had the worst phosphate control and body mass index z scores.
Assuntos
Estatura , Doenças Ósseas Metabólicas/epidemiologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/epidemiologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Diálise Renal/métodos , Adolescente , Antropometria , Biomarcadores/sangue , Índice de Massa Corporal , Doenças Ósseas Metabólicas/diagnóstico , Criança , Pré-Escolar , Distúrbio Mineral e Ósseo na Doença Renal Crônica/diagnóstico , Estudos Transversais , Feminino , Saúde Global , Humanos , Internacionalidade , Falência Renal Crônica/diagnóstico , Masculino , Prognóstico , Medição de Risco , Taxa de SobrevidaRESUMO
Studies of contemporary populations have demonstrated an association between decreased dietary diversity due to resource scarcity or underutilization and an increase in diseases related to poor micronutrient intake. With a reduction of dietary diversity, it is often the women and children in a population who are the first to suffer the effects of poor micronutrient status. Scurvy, a disease of prolonged vitamin C deficiency, is a micronutrient malnutrition disorder associated with resource scarcity, low dietary diversity, and/or dependence on high carbohydrate staple-foods. The aim of this paper is to assess the potential impact of nutritional transition on the prevalence of diseases of nutritional insufficiency in an archaeological sample. Here, we report palaeopathological findings from an Early Formative Period transitional site located in coastal Northern Chile (Quiani-7). The subadult cohort from this site is composed of four perinates who exhibit a number of non-specific skeletal changes suggestive of a systemic pathological condition. One of these is associated with an adult female exhibiting diagnostic skeletal lesions of scurvy. We argue that the lesions exhibited by these perinates may represent maternal transmission of vitamin C deficiency but acknowledge that there are difficulties in applying current diagnostic criteria for scurvy to individuals this young.
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Deficiência de Ácido Ascórbico/história , Efeitos Tardios da Exposição Pré-Natal/história , Escorbuto/história , Deficiência de Ácido Ascórbico/epidemiologia , Chile , Feminino , História Antiga , Humanos , Recém-Nascido , Estado Nutricional , Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Prevalência , Escorbuto/epidemiologiaAssuntos
Anormalidades Múltiplas/tratamento farmacológico , Fosfatase Alcalina/deficiência , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Predisposição Genética para Doença , Hipofosfatasia/diagnóstico , Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/genética , Fosfatase Alcalina/genética , Doenças do Desenvolvimento Ósseo/tratamento farmacológico , Cesárea/métodos , Terapia de Reposição de Enzimas/métodos , Seguimentos , Humanos , Hipofosfatasia/complicações , Recém-Nascido , Masculino , Diagnóstico Pré-Natal/métodos , Doenças Raras , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Resultado do TratamentoRESUMO
Introducción: La enfermedad metabólica ósea (EMO) del recién nacido prematuro (RNPT) es una complicación de origen multifactorial, que ha ido en aumento, consecuencia de la disminución progresiva de la mortalidad. El objetivo del estudio fue analizar los factores de riesgo (FR) pre y postnatales relacionados con la EMO severa y sus marcadores analíticos. Pacientes y Métodos: Estudio retrospectivo observacional, descriptivo y analítico, que incluyó RNPT nacidos con menos de 32 semanas y/o peso menor de 1.500 g entre enero de 2012 y diciembre de 2014. Se analizó la muestra en función del desarrollo de EMO severa. Resultados: 139 pacientes, con 25(OH)D3 media de 70,68 ± 25,20 nmol/l, mayor en los nacidos en primavera-verano que en otoño-invierno (80,94 ± 25,33 vs 61,13±21,07; p = 0,000). Los pacientes con EMO severa presentaron valores de 25(OH)D3 similares al resto de pacientes (65,61 ± 26,49 vs 72,07 ± 24,89; p = 0,283), y superiores de fosfatasa alcalina (FA) (1314,19 ± 506,67 vs 476,56 ± 188,85; p = 0,000). Mediante curva ROC se calculó un punto de corte de FA de 796,5 IU/l (S 95,2%, E 92,4%). Los FR más asociados al desarrollo de EMO severa fueron el crecimiento intrauterino restringido, el peso al nacimiento y la duración de ventiloterapia y nutrición parenteral. Conclusiones: Las cifras de FA son las que mejor se relacionan con el desarrollo de EMO severa. El riesgo de ésta aumenta a mayor número de factores de riesgo y menores cifras de vitamina D3. Niveles de 25(OH)D3 por encima de 70 nmol/l parecen proteger del desarrollo de EMO, incluso en pacientes con múltiples factores de riesgo.
Background: Metabolic bone disease (MBD) of prematurity is a complication of multifactorial aetiology, which has been increasing, due to progressive decrease in mortality of preterm newborns. The aim of the study was to analyze risk factors of severe MBD and its analytical markers. Patients and Method: Retrospective study involving preterm infants less than 32 weeks gestational age and/or weight less tan 1,500 g born between january 2012 and december 2014. Comparison was made according to the presence of severe MBD. Results: 139 patients were recruited. Mean value of 25(OH)D3 was 70.68 ± 25.20 nmol/L, being higher in patients born in spring-summer than in autumn-winter (80.94 ± 25.33 vs 61.13 ± 21.07; p = 0.000). Levels of 25(OH)D3 were similar in patients with severe MBD compared with the rest of patients (65.61 ± 26.49 vs 72.07 ± 24.89, P = 0.283). Higher levels of alkaline phosphatase (AP, IU/L ) (1314.19 ± 506.67 vs 476.56 ± 188.85; p = 0.000) were found in these patients. Cutoff point of AP 796.5 IU/L (S 95.2%, specificity 92.4%) was calculated by ROC curve. The risk factors most associated to severe EMO were restricted fetal growth, birth weight, duration of ventilation therapy and parenteral nutrition. Conclusions: AP levels were the best marker of severe MBD development. EMO risk increases with the number of risk factors and lower levels of 25(OH)D3. Levels of 25(OH)D3 higher than 70nmol/L appear to protect from the development of severe MBD, even in patients with multiple risk factors.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/etiologia , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/etiologia , Doenças Ósseas Metabólicas/metabolismo , Recém-Nascido Prematuro , Biomarcadores/metabolismo , Estudos Retrospectivos , Fatores de Risco , Doenças do Prematuro/metabolismoRESUMO
The objective of this study was to evaluate the microarchitecture and trabecular bone strength at the distal region of the femur, and its biomechanical properties with simvastatin administration with two different doses in ovariectomized (OVX) rats. Ninety rats were divided into six groups to evaluate treatment with the simvastatin drug (n = 15): SH (Sham surgery), SH-5 (5 mg simvastatin), SH-20 (20 mg simvastatin), OVX, OVX-5, and OVX-20. Euthanasia was performed at three different times, five animals per period: 7, 14, and 28 days. The effectiveness of the treatments was evaluated by mechanical testing and histomorphometric analysis of the femurs. The results of analysis by the linear model of mixed effects showed 20 mg of simvastatin results in increased trabecular bone after 14 days (P = 0.039) of ingestion in ovariectomized animals. However, ingestion of 5 mg of simvastatin is able to sensitize the trabecular bone only at 28 days (P = 0.005) of ingestion. In the mechanical tests stiffness improves within 28 days (P = 0.003). Regarding maximum strength, no statistical differences were observed. According to these results, it can be concluded that for a decrease in oral intake, longer treatment times are required. Microsc. Res. Tech. 79:684-690, 2016. © 2016 Wiley Periodicals, Inc.
Assuntos
Cabeça do Fêmur/efeitos dos fármacos , Cabeça do Fêmur/ultraestrutura , Osteoporose/patologia , Sinvastatina/farmacologia , Animais , Modelos Animais de Doenças , Cabeça do Fêmur/patologia , Ovariectomia , Fotomicrografia , Ratos , Ratos WistarRESUMO
BACKGROUND: Aluminum contamination from intravenous solutions still represents an unsolved clinical and biochemical problem. Increased aluminum intake constitutes a risk factor for the development to metabolic bone disease, anemia, cholestasis, and neurocognitive alterations. Low-birth-weight preterm infants (LBWPIs) are one of the most exposed populations for aluminum toxicity. METHODS: To determine the presence of aluminum in components employed in the preparation of parenteral nutrition (PN) admixtures in Mexico and compare with the maximal aluminum recommended intake from the Food and Drug Administration. RESULTS: Cysteine, trace elements, levocarnitine, phosphate, and calcium salts tested positive for aluminum contamination. All components analyzed were contained in glass vials. Total aluminum intake for 2 sample PN admixtures were calculated in basis to cover nutrition requirements of 2 hypothetical LBWPIs. Aluminum contents, stratified in micrograms per kilogram of weight, exceeded maximal aluminum recommendations, particularly for the very LBWPIs. Substituting sodium phosphate for potassium phosphate salts reduced aluminum intake by 52.7%. Calcium gluconate was the leading aluminum contamination source and confers the greatest risk for aluminum overdose, even with the salt substitution of potassium phosphate by sodium phosphate salts. Adding cysteine and trace elements might increase aluminum content in PN admixtures. CONCLUSION: Cysteine, trace elements, phosphate, and gluconate salts are the main sources of aluminum in PN prepared in Mexico. Substituting sodium phosphate for potassium phosphate salts reduces aluminum intake but does not resolve aluminum contamination risk. Mineral salts contained in plastic vials should be explored as an additional measure to reduce aluminum contamination.
Assuntos
Alumínio/análise , Contaminação de Medicamentos , Soluções de Nutrição Parenteral/química , Gluconato de Cálcio/química , Carnitina/administração & dosagem , Carnitina/química , Cisteína/administração & dosagem , Cisteína/química , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , México , Necessidades Nutricionais , Soluções de Nutrição Parenteral/administração & dosagem , Fosfatos/administração & dosagem , Fosfatos/química , Compostos de Potássio/administração & dosagem , Compostos de Potássio/química , Estados Unidos , United States Food and Drug AdministrationRESUMO
Objetivo: Los tumores pardos son una manifestación infrecuente del hiperparatiroidismo primario (HPTP). Se presenta la evaluación diagnóstica en una paciente con lesión ósea e imágenes osteolíticas extensas que confunden y orientan a tumor óseo metastásico. Caso clínico: Paciente femenina de 49 años de edad, con dolor lumbosacro irradiado a cresta ilíaca izquierda y limitación para la marcha de dos años de evolución, con episodios de pancreatitis aguda e hipertrigliceridemia; en el último episodio se le realiza TAC abdómino-pélvica, con hallazgo incidental de lesión sacro ilíaca izquierda, que sugiere tumor óseo; se realizan estudios de extensión en pesquisa de metástasis. La biopsia ósea muestra células gigantes con proliferación fibroblástica y formación de hueso reactivo, sugestivo de tumor de células gigantes, el USG tiroideo muestra imagen hipoecoica, hipervascularizada, USG renal con nefrolitiasis renal. Laboratorio: PTH 1250 pg/mL y otra en 986,7 pg/mL. Calcio 9,8 mg/mL, Fosfatasa alcalina 570 U/L, Marcadores tumorales negativos. La Rx de cráneo muestra imágenes líticas en región frontal en sal y pimienta. DXA: osteoporosis cortical, T-score antebrazo izquierdo -3,1. TAC de cadera: lesión osteolítica expansiva con irrupción de la cortical, de 7 x 3.5 cm en cresta ilíaca izquierda y múltiples imágenes osteolíticas sacroilíacas y vertebrales (L4-L5). El CT-PET con áreas múltiples de hipercaptación que sugieren infiltración ósea por enfermedad metastásica, sin captación en cuello. Se realiza Gammagrama 99mTc-MIBI que revela imagen sugestiva de adenoma de paratiroides en el lóbulo izquierdo. Se realiza extirpación del mismo. Conclusiones: Las lesiones óseas múltiples son enfocadas en el contexto metastásico y pueden confundir el diagnóstico de HPTP. Los tumores pardos son causa potencial de falsos positivos con CT/PET en la evaluación de pacientes con tumor primario desconocido o metástasis esqueléticas. Análisis básicos de metabolismo cálcico y gammagrama paratiroideo con 99mTc-MIBI, son herramientas diagnósticas en estos pacientes.
Objective: Brown tumors are an uncommon manifestation of Primary Hyperparathyroisim (PHPT). We provide diagnostic evaluation in a patient with bone lesion and extensive osteolytic images that suggesting metastatic bone tumor. Case report: Female patient 49 years old with lumbosacral pain radiating to the left iliac crest and walking limitation of two years of evolution with episodes of acute pancreatitis and hypertriglyceridemia; in the last episode, abdominal and pelvic CT images were performed, with incidental finding of left sacroiliac bone lesion, that suggests a bone tumor. Extension studies on screening for metastases were performed. Bone biopsy showed giant cells with fibroblastic proliferation and reactive bone formation, suggestive of giant cell tumors; thyroid USG showed hypoechoic image, hypervascularized; renal USG showed nephrolithiasis. Laboratory: PTH 1250 pg/mL and another at 986.7 pg/mL, calcium 9.8 mg/mL, alkaline phosphatase 570 U/L and tumor markers negatives. X ray of skull showed multiple lytic lesions in the frontal region, like salt and pepper. DXA: cortical osteoporosis, with a left forearm T-score of -3.1. Computed tomographic of pelvis showed expansive osteolytic lesion with cortical irruption of 7 cm x 3.5 cm in the left iliac crest and multiple osteolytic vertebral and sacroiliac images (L4-L5). The CT-PET showed multiple areas of increased uptake suggesting infiltration by metastatic bone disease, no neck pickup. A 99mTc-MIBI scintigraphy revealed an image suggestive of parathyroid adenoma in the left lobe, which is excised. Conclusion: Multiple bone lesions are focused as metastasis and may confuse the diagnosis of PHPT. Brown tumors are potential causes of false positives with CT / PET in the evaluation of patients with unknown primary tumor or skeletal metastases. Basic analysis of calcium metabolism and parathyroid scintigraphy 99mTc.MIBI are diagnostic tools in these patients.
RESUMO
The success of ex situ survival assurance populations as tools for amphibian conservation depends on the health and reproductive success of founder populations. Necropsy examination and histopathology of animals that die in assurance populations are useful for the identification of population-limiting disease problems and can help to direct applied research efforts in areas such as amphibian husbandry and nutrition. This study reviewed postmortem findings in 167 frogs from 13 species that died in a large Panamanian rescue and survival assurance population between 2006 and 2011. Common problems identified in long-term captive animals, especially in Atelopus species, were epithelial squamous metaplasia suggestive of vitamin A deficiency and a polycystic nephropathy resembling lesions seen in laboratory animals with electrolyte imbalances. Metabolic bone disease was a significant contributor to morbidity in captive-bred juvenile frogs of Gastrotheca cornuta, Hemiphractus fasciatus, and Hylomantis lemur. Findings common to multiple species included poor overall nutritional condition that was sometimes attributable to maladaptation to captive husbandry and epidermal hyperplasia and hyperkeratosis possibly reflecting environmental skin irritation. Infectious diseases and endoparasitism were most common in recently captured animals and included chytridiomycosis and Rhabdias sp. lungworms. Applied research efforts to improve sustainability of survival assurance populations should focus on elucidating optimal husbandry practices for diverse species, improving methods for nutritional supplementation of cultured insects and examination of the role of water composition in disease development.
Assuntos
Animais de Zoológico , Anuros , Doenças Ósseas Metabólicas/veterinária , Conservação dos Recursos Naturais/métodos , Metaplasia/veterinária , Mortalidade , Doenças Renais Policísticas/veterinária , Fenômenos Fisiológicos da Nutrição Animal/fisiologia , Animais , Doenças Ósseas Metabólicas/epidemiologia , Doenças Ósseas Metabólicas/patologia , Conservação dos Recursos Naturais/estatística & dados numéricos , Metaplasia/epidemiologia , Metaplasia/patologia , Panamá/epidemiologia , Doenças Renais Policísticas/epidemiologia , Doenças Renais Policísticas/patologia , Especificidade da EspécieRESUMO
Se comunica el caso de una paciente con enfermedad metabólica ósea del prematuro, que nació luego de 26 semanas de gestación y de 62 días de vida extrauterina, que estuvo internada desde su nacimiento en un hospital de 3er nivel en la ciudad de Oruro, donde estuvo conectada a presión positiva nasal (CPAP) por varios días, además de recibir tratamiento antibiótico con varios esquemas de amplio espectro por haber cursado con sepsis neonatal y enterocolitis necrosante (ECN) grado II; además recibió metilxantinas por presentar periodos de apnea y hasta su ingreso a nuestro hospital permanecía dependiente de oxígeno, con muy poca ganancia de peso e hipoactividad. Fue transferida para valoración oftalmológica por sospecha de retinopatía del prematuro. A su ingreso se hizo un examen clínico minucioso y se realizaron varios exámenes de laboratorio y gabinete con los cuales se demostró una osteopenia del prematuro, que respondió en forma favorable al tratamiento.
We describe a 26 weeks old premature baby with metabolic bone disease. She was transferred to our hospital at 62 days of age for ophthalmologic evaluation. She was treated in the primary hospital with CPAP, different antibiotics for sepsis and NEC. She also received methylxanthines for neonatal apnea. When she arrived to our hospital she was oxygen dependent and with little weight increase. During her stay at our neonatal unit we performed a complete physical exam and several diagnostic tests, showing metabolic bone disease which favorable response to specific treatment.