Mineral In Patients Research Articles

8131 A Rare Case of Autoimmune Polyendocrine Syndrome; a Menopause Despite Replacement Therapy

Abstract Disclosure: M.E. Chacon Cruz: None. M. Sanchez Cordero: None. R.M. Roman Torres: None. G. Guerra Velazquez: None. Polyendocrinopathy is a heterogeneous group of disorders leading to dysfunction of multiple endocrine glands and other tissues. The syndromes can occur in patients from early infancy to old age and new components of a given syndrome can appear throughout life. APS can be classified into APS type 1 and APS2-4. APS-1 is a rare monogenic autosomal recessive autoimmune disorder consisting of the triad of chronic mucocutaneous candidiasis, hypoparathyroidism and adrenal insufficiency. APS2 require presence of Addison disease, autoimmune thyroid disorder and type 1 diabetes. APS 3 requires presence of Thyroid autoimmune disease associated with other autoimmune diseases. APS4 is a combination of organ specific autoimmune disease non included in a previous group. Autoimmune oophoritis is found in approximately 4 percent of females who presented with spontaneous primary ovarian insufficiency and may occur in type I and II syndromes of polyglandular autoimmune failure. This is the case of 44 year old female patient with history of hypertension, hypoparathyroidism diagnose at the age of 9 year old, vitiligo and premature ovarian failure diagnose at the age of 16 year old. Patient reported that started with multiple episodes of watery non bloody diarrhea and arthralgia. Patient went to her Pediatrician and they found hypocalcemia hyperphospathemia. Patient mineral was replaced with medication and then followed by pediatric endocrinologist. Patient continues with normal life, but menstrual periods had not started even at age 16th. Laboratory work up was done and premature ovarian failure was diagnosed after that, patient started with progesterone and estrogen to induce menstrual periods. Menstrual periods began regularly and monthly. Patient continues taking medication regularly, phoslo, calcitriol, progestin and estradiol without problem until this year that despite regular medication, started with signs and symptoms of menopause with irregular menstrual periods, palpitations hot flashes, sweating, anxiety and sleep problems. Patient met criteria for APS4 due to combination of organ specific autoimmune disease such premature ovarian failure, vitiligo and hypoparathryroidism. This case is extremely important since despite the fact that there is no family history of either endocrinological or autoimmune diseases, our patient debuts throughout her life with several autoimmune diseases, such as premature ovarian failure and vitiligo. Patient had Schedule appointment with gynecologist who increased the dose of progestin and estradiol. This case highlights the importance of being vigilant about new components of a syndrome developing at different times though a patient's life. As described, autoimmune diseases commonly are related to other diseases, but without a good clinical history and physical examination could be misdiagnosed affecting the quality of life of those patients. Presentation: 6/2/2024

The Effect of Vitamins and Minerals on Dental Implants: A Review

Aims: The focus of this review study was to examine and analyze the impact of vitamins and minerals on dental implants. Methods and Material: In order to obtain information on the effects of vitamins and minerals on dental implants, a group of existing articles was thoroughly examined for their findings. This examination process involved the selection of specific articles that met the necessary criteria to be included in the analysis, which were then subjected to an extensive review process. The duration of this review process was over a time span of 11 years, starting from the year 2011 and concluding in the year 2022. Results: A total of 23 articles were included in the study, consisting of 9 clinical studies, 6 animal studies, 1 laboratory study, and 7 reviews. Clinical studies were limited due to uncertain results regarding the impact of vitamins and minerals on DIT, with most focusing on vitamin D levels rather than other nutrients. Conclusions: It has been concluded that vitamins and minerals play an important role in forming bone tissue. The lack of these essential elements may result in several diseases, such as diabetes mellitus and osteoporosis. It is therefore recommended to increase the levels of vitamins and minerals in patients before undergoing dental implant treatment (DIT), even though the quality of the patient's bone can also impact the success of the implant. Consequently, the patient's diet should be modified, and essential supplements and vitamins should be administered to ensure optimal implant success.

Plasma levels and dietary intake of minerals in patients with type 2 diabetes and chronic kidney disease: A case-control study

Background and aimDiabetic kidney disease (DKD) is the primary cause of chronic kidney disease (CKD) worldwide. Altered mineral levels leading to adverse outcomes are widely reported in diabetes but limited in DKD, in the Indian scenario, hence this study was taken up to address this issue. MethodsA hospital-based case-control study was taken up with 54 healthy controls (C) and 140 subjects with type 2 diabetes wherein 74 subjects with diabetes and CKD formed the DKD group, and 66 subjects with diabetes but no CKD formed the diabetic no-chronic kidney disease (DNCKD) group. High-resolution inductively coupled plasma mass spectrometry was used to evaluate the blood levels of minerals (calcium (Ca), vanadium (V), chromium (Cr), manganese (Mn), iron (Fe), cobalt (Co), copper (Cu), zinc (Zn), and selenium (Se)), and a raw food-based food frequency questionnaire for dietary intakes. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (mL/min/1.73 m2) and albuminuria. Spearman’s rank correlation was used to evaluate the relationship between the categorical variables. ResultsThe median values of plasma Ca in the DKD group were significantly lower compared with the DNCKD and C groups (10.5 mg/dL vs. 11.0 mg/dL and 11.7 mg/dL, p<0.001). Furthermore, plasma Ca levels lowered with declining kidney function, as evidenced by the eGFR and albuminuria segregation. Dietary intake of minerals did not correlate with the corresponding plasma levels. However, in the DKD group, eGFR correlated positively with the plasma levels of Ca (r= 0.422, p=0.001), Cr (r= 0.351, p=0.008), Mn (r= 0.338, p=0.011), Fe (r= 0.403, p=0.002), Cu (r= 0.274, p=0.041) and negatively with Se (r= −0.486, p<0.001). ConclusionPlasma Ca levels are lower in the DKD group with a strong positive association with eGFR, indicating its role in predicting the onset and progression of kidney function decline.

Estimation of Serum Minerals, Total Protein and Liver Enzymes in HIV Patients Receiving Haart in Federal Medical Centre, Keffi, Nasarawa State, Nigeria

Aims: This study was aimed to estimate serum minerals level (calcium, zinc, phosphorus), total protein and liver enzymes (ALT and AST) in patients taking HAART at Federal Medical Centre Keffi, Nasarawa state. Nigeria.&#x0D; Study design: This study engaged a cross-sectional study design to investigate the liver enzyme alterations and the level of serum minerals in patients taking HAART when compare with treatment naïve (Pre-HAART) controls.&#x0D; Place and duration of the study: The study was conducted in Federal Medical Center Keffi, Nasarawa State-Nigeria. Data collection spanned a specific duration from December, 2022 to March, 2023.&#x0D; Method: A total of 143 subjects were involved in the study of which were 59 HIV positive patients on HAART, 34 Pre-HAART patients and 50 healthy subjects served as controls. 5ml venous blood sample was collected after taking aseptic precaution from the study subjects into plain vacuum tubes; sample was left for 30 minutes at room temperature and centrifuged at 3000 rpm for 4 minutes. Sero-negativity of the control (healthy patients) was confirmed by HIV TRI-DOT test. Serum total calcium, serum phosphorus, serum zinc. Total proteins were estimated using spectrophotometer while AST and ALT were estimated by colorimetric method.&#x0D; Result: The study indicated that both pre-HAART and HAART patients showed significantly higher (P&lt;.05) AST and ALT activities compared to sero-negative patients. Pre-HAART patients had lower Zinc (11.22±4.86) and TP (43.18±22.52) levels than sero-negative patients, with Zinc (16.58±4.20) and TP (65.47±12.79). In contrast, HAART patients experienced a significant increase (P&lt;.005) in Zinc (14.29±3.41) and TP (61.56±18.87) levels compared to pre-HAART patients (11.22±4.86) and (43.18±2.52). No significant difference in serum calcium level in all groups. Patients on HAART and sero-negative patients displayed normal Phosphorus level which is significantly higher in pre-HAART patients.&#x0D; Conclusion: This study concluded that the serum level of ALT and AST were increased in HIV positive patients on HAART and pre-HAART patients. HAART improved level of serum zinc and total protein.

Features of hemostasis in patients after severe Covid-19 at discharge from the hospital (original study)

Since 2020, the world has been living in the COVID-19 pandemic caused by the SARS-CoV-2 virus. This situation is due to the high virulence and prevalence of the virus, which has reached epidemic proportions in recent years. Hemostasis disorders are the main marker and prognosis of the severe course of the disease. The virus in the body of a patient with COVID-19 triggers a pathophysiological chain reaction, which, in turn, will lead to the development of a cytokine storm, a disorder in the hemostasis system, and the development of multiple organ disorders. The purpose of the study: to determine and study the influence of various factors on the characteristics of hemostasis in patients with moderate and severe COVID-19. The object of the study were patients with moderate and severe forms of the disease. The following methods were used in the study: standard laboratory diagnostics and hair mineralogram. Results. Moderate and severe courses have clear laboratory markers, with a high probability of developing thrombotic complications, especially in conditions of deficiency of such minerals as zinc, selenium, iron, copper, bismuth, and aluminum, which have immunoregulatory, antioxidant, antiviral, and hemostatic properties, as well as reduce the risk of secondary infection. Conclusions. The results of the study suggest the importance of using minerals and emphasize the significance of using minerals in patients at the very beginning of the disease in order to strengthen the main physiological systems in case of laboratory-confirmed deficiency.

Bone Tissue Evaluation Indicates Abnormal Mineralization in Patients with Autoimmune Polyendocrine Syndrome Type I: Report on Three Cases

Autoimmune polyendocrine syndrome type-1 (APS1) is characterized by autoimmune manifestations affecting different organs from early childhood on. Immunological abnormalities, the resulting endocrinopathies, and their treatments may compromise bone health. For the first time in APS1, we analyzed transiliac bone biopsy samples by bone histomorphometry and quantitative backscattered electron imaging in three adult patients (female P1, 38 years; male P2, 47 years; male P3, 25 years). All had biallelic mutations in the autoimmune regulator gene and in addition to endocrinopathies, also significant bone fragility. Histomorphometry showed bone volume in the lower normal range for P1 (BV/TV, − 0.98 SD) and P3 (− 1.34 SD), mainly due to reduced trabecular thickness (TbTh, − 3.63 and − 2.87 SD). In P1, osteoid surface was low (OS/BS, − 0.96 SD); active osteoblasts and double labeling were seen only on cortical bone. P3 showed a largely increased bone turnover rate (BFR/BV, + 4.53 SD) and increased mineralization lag time (Mlt, + 3.40 SD). Increased osteoid surface (OS/BS, + 2.03 and + 4.71 SD for P2 and P3) together with a large proportion of lowly mineralized bone area (Trab CaLow, + 2.22 and + 9.81 SD for P2 and P3) and focal mineralization defects were consistent with abnormal mineralization. In all patients, the density and area of osteocyte lacunae in cortical and trabecular bone were similar to healthy adults. The bone tissue characteristics were variable and included decreased trabecular thickness, increased amount of osteoid, and abnormal mineralization which are likely to contribute to bone fragility in patients with APS1.

Agmatine, telomerase and trace minerals levels in patients with obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is a disease characterized by repetitive, partially or complete upper airway obstructions resulting in hypoxia and bioelectrical wakefulness reactions along with sleep. There is a limited and different information on the biochemical pathways that may determine harmful effects in OSAS patients with different disease severity. Hence, we aimed to estimate the plasma levels of polyamine agmatine, which has many effects on the central nervous system, telomerase and trace minerals in patients with OSAS. The study included 90 volunteer patients diagnosed with OSAS and divided into three groups of 30 people each according to the apnea-hypopnea index (AHI) score: mild, moderate and severe. Nocturnal blood oxygen saturation percentage (SpO2) and body mass index (BMI) were measured. Plasma agmatine level was defined by ultra-high-pressure liquid chromatography (UHPLC), plasma trace elements (Cu, Co, Mg, Mo, Zn, Se) level by inductively coupled plasma mass spectrometer (ICP-MS) and serum telomerase level by enzyme-linked immunosorbent assay (ELISA) method. It was found that SpO2 value decreased as the disease progressed and showed a negative correlation with BMI, Co and Se plasma levels. The levels of agmatine and telomerase were shown to lower in patients with severe OSAS group compared to other groups. Keywords: agmatine, sleep apnea syndrome, SpO2, telomerase, trace minerals

Impact of hydrocortisone replacement on bone mineral density and bone turnover markers in patients with primary adrenal insufficiency.

A cross-sectional study was conducted in 37 PAI patients treated with HC. BMD and selected bone turnover markers (β-crosslaps and osteocalcin) were measured. A stepwise binary logistic regression model was applied to determine the independent variables associated with low BMD. Osteoporosis was noted in 14.3% and osteopenia in 34.3% of cases. These patients were older (p=0.01) and received higher daily HC dose compared to patients with normal BMD (p=0.01). BMD values in the lumbar spine and the femoral neck were negatively correlated with daily HC dose (r=-0.36, p=0.03 and r=-0.34, p=0.05, respectively). Plasma osteocalcin was negatively correlated with disease duration (r=-0.38, p=0.02) and cumulative HC dose (r=-0.43, p<0.01). In multivariate analysis, a daily HC dose ≥12 mg/m2/day was independently associated with a higher risk of osteopenia/osteoporosis [OR (95% CI), 9.0 (1.1-74.6); p=0.04]. Impaired bone mineralization in patients with PAI is correlated with HC dose. A daily HC dose ≥12 mg/m2/day was associated with an increased risk of osteopenia and osteoporosis in these patients.

Evaluation of MDA and serum minerals in patients with overt and subclinical hypothyroidism

Hypothyroidism is a common disorder of the thyroid gland in which the gland cannot compete with the body requirement of the thyroid hormones, triiodothyronine (T3) and thyroxine (T4). Hypothyroidism is classified into overt (OH) and subclinical (SbH), in which the first comprises the cases that have elevated levels of thyroid- stimulating hormone (TSH) and reduced levels of T4 while the second comprises the cases with elevated TSH but normal T4 levels. The goal of the present study is to investigate the level of malondialdehyde (MDA) and some minerals (calcium, magnesium, and phosphorus) in patients with SbH and OH. For this purpose, 80 patients from Al-Yarmook Teaching Hospital were enrolled in the study half of them were diagnosed with OH and the other half were diagnosed with SbH. The study has been controlled with 40 healthy people of comparable age and all of the three groups were contained 50% males and females. The anthropometric examination of subjects has revealed that the body mass index (BMI) and waist to hip ratio (WHpR) were significantly (p&lt;0.05) altered among control, OH, and SbH subjects.

Evaluation of the effect of electron beam therapy on oxidative stress and some minerals in patients with type 2 diabetes mellitus

Background: The study on the control and treatment of type 2 diabetes mellitus, as a growing metabolic disease in the world, is important. Oxidative stress and reactive oxygen species in uncontrolled diabetes can play a role in the consequences of diabetes such as neuropathy and nephropathy. The presence of minerals as bioactive compounds in the diet and their role in antioxidant enzymes can play a role in reducing the oxidative effects of diabetes. Electron beam therapy as an adjunct method can be effective in reducing free radicals and oxidative stress. Objective: The main purpose of this study was to investigate the effect of electron beam therapy on glucose, oxidative markers and some minerals, as bioactive compound, in people with type 2 diabetes mellitus. Methods: The study was performed on 30 volunteers with type 2 diabetes mellitus and 30 healthy volunteers as a control group. Serum samples from diabetic and control groups were assayed for glucose, hydrogen peroxide, reactive oxygen species and minerals such as iron, zinc, copper, magnesium and selenium binding protein before and after electron beam irradiation. ATP levels and NAD/NADH ratio were also evaluated. The mentioned parameters were measured by ELISA and calorimetric methods according to the relevant kit protocol. Electron beam therapy was performed using a linear accelerator. The used amount of energy was 9 MeV. The depth of treatment was 1.5 cm.Results: The results of electron beam therapy showed that the concentrations of glucose, reactive oxygen species, hydrogen peroxide, copper and iron were significantly (P value &lt; 0.05) reduced in diabetics. Zinc levels in this group increased significantly (P value &lt; 0.05). In control group, ATP levels were significantly (P value &lt; 0.05) increased by electron beam therapy.Conclusion: According to the obtained results, electron beam therapy can be effective in reduction of oxidation indexes and thus reducing oxidative stress. Electron beam therapy can be effective in reducing the consequences of diabetes mellitus. Keywords: Electron beam therapy, Oxidative stress, Mineral, Type 2 diabetes mellitus

Decreased plasma levels and dietary intake of minerals in women with migraine

ABSTRACT It has been suggested that an imbalance in mineral levels is involved in the pathophysiology of migraine. However, only a few studies have investigated the circulating levels of mineral in patients with migraine during the pain-free period (i.e. interictal). This study aimed to investigate whether the interictal plasma levels of minerals of women with migraine differ from those of women without migraine (controls). This is a cross-sectional study involving 67 women, of which 38 were diagnosed with migraine and 29 were controls. The groups were similar in age and body mass index. Plasma levels of magnesium (Mg), copper (Cu), calcium (Ca), zinc (Zn), iron (Fe), and selenium (Se) were measured. Dietary intake was assessed using a 24-hour food recall, and migraine impact was evaluated using the Headache Impact Test, version 6 (HIT-6). The association between migraine disability, and plasma levels and dietary intake of minerals was assessed through correlation and logistic regression analyses. Women with migraine had significantly lower plasma levels of Mg, Ca, Cu, and Zn than controls. In parallel, dietary intake of Mg, Cu, and Fe was significantly lower in patients with migraine. Migraine impact was not associated with plasma levels or dietary intake of minerals. The results suggest that patients with migraine have lower plasma levels of minerals, and dietary intervention to ensure adequate mineral intake should be considered as a therapeutic strategy for migraine.

Bone tissue evaluation indicates abnormal mineralization in patients with autoimmune polyendocrine syndrome type I

Bone tissue evaluation indicates abnormal mineralization in patients with autoimmune polyendocrine syndrome type I

Supplementation of minerals in effective management of refractory major depressive disorders

In the past two decades, rapid urbanization and globalization have adversely changed our lifestyle and diet habits. Our traditional healthy food habits have been replaced by processed foods with low nutritive value. These measures also saw a high prevalence of depression and other psychiatric disorders not only in western, urbanized countries but also in other developing countries as well. Long-term undernutrition due to deficiency of micronutrients such as iodine and iron can lead to increased chances of physical and mental disabilities. Undernourished children have less energy, decreased curiosity, and less interest in physical activities as well as they lack communication skills. These factors impair their physical, mental, and cognition. The aim of this article was to find the association of micronutrients especially minerals in patients with major depressive disorders. An adequate supply of nutrients is essential to regulate microbiome health and to improve the efficacy of other psychotherapeutic and psychopharmacological interventions. Lifestyle interventions in the form of dietary coaching could be used as promising, cost-effective, and practical intervention in depressed individuals. Nutritional interventions should be integrated in the multifactorial and treatment-resistant psychiatry patients.

Altered Thyroid Function Tests Observed in Hypophosphatasia Patients Treated with Asfotase Alfa.

Background Asfotase alfa is the only approved treatment that can normalize mineralization in patients with hypophosphatasia (HPP). Its interference in alkaline phosphatase (ALP) dependent immunoassays has been reported. Objective To describe thyroid function tests interfered with by asfotase alfa and elucidate the underlying mechanism. Patients and Methods. Three patients with HPP treated with asfotase alfa were included. Thyroid hormone levels measured using five different immunoassays with or without ALP as a labeling enzyme during asfotase alfa treatment were evaluated. Results After the initiation of asfotase alfa, three HPP patients showed low free triiodothyronine (FT3) and free thyroxine (FT4) measured with AIA-2000 (Tosoh, Tokyo, Japan), an enzyme immunoassay system that uses ALP as a labeling enzyme, but their thyroid-stimulating hormone (TSH) levels were within the normal range. The other CLEIA system using ALP as a label, AIA-CL2400 (Tosoh, Tokyo, Japan), and ALP-independent immunoassay systems demonstrated normal FT3 and FT4 levels. These data suggested that although the thyroid function of these three patients was normal, asfotase alfa interfered with the thyroid hormone measurements made with AIA-2000. AIA-2000 and AIA-CL2400 adopted one-step and delayed one-step measurements, respectively, and the same antibody was used for both immunoassays. However, asfotase alfa may be absorbed on the magnetic beads used in the AIA reagent with the AIA-2000 system but not absorbed on the microparticles used in AIA-CL2400. Conclusion Clinicians should be aware of the possible interference in thyroid function measurements by adopting specific types of immunoassays in asfotase alfa-treated HPP patients.

Manifestation and Mechanisms of Abnormal Mineralization in Teeth.

Tooth biomineralization is a dynamic and complicated process influenced by local and systemic factors. Abnormal mineralization in teeth occurs when factors related to physiologic mineralization are altered during tooth formation and after tooth maturation, resulting in microscopic and macroscopic manifestations. The present Review provides timely information on the mechanisms and structural alterations of different forms of pathological tooth mineralization. A comprehensive study of these alterations benefits diagnosis and biomimetic treatment of abnormal mineralization in patients.

Correlation between different methods of assessing bone maturation

&lt;p&gt;&lt;strong&gt;Introduction&lt;/strong&gt;: the skeletal maturity of na individual can be evaluated through different methods and it is an important tool to the&lt;br /&gt;diagnostic and treatment in othodontics. &lt;strong&gt;Objective&lt;/strong&gt;: to verify the correlation between different methods of assessing bone maturation:&lt;br /&gt;Carpal Maturation Index (CMI), Cervical Vertebrae Maturation Stages (CVM) and Dental Mineralization Stages (DM). &lt;strong&gt;Methodology&lt;/strong&gt;:&lt;br /&gt;the sample consisted of digitalized images of cephalometric, panoramic and hand and wrist radiographs of 73 patients. 50 were&lt;br /&gt;selected for analysis. Two examiners were properly calibrated, through images analysis from another database. Inter and intraexaminer&lt;br /&gt;reliability was measured by Kappa coefficient. The images were assessed according to Fishman (1982), Baccetti, Franchi and&lt;br /&gt;McNamara Junior (2002) and Nolla (1960) methods. All images were coded and data of all analyzes was transferred to spreadsheets.&lt;br /&gt;The data was processed in Matlab program for Windows, version 7.10.0, and analyzed using descriptive and inferential statistics.&lt;br /&gt;&lt;strong&gt;Results&lt;/strong&gt;: the results demonstrated a positive correlation among bone maturity methods (CMI, CVM and DM), as well as between those&lt;br /&gt;methods and chronological age. Females showed precocity in reaching the stages of skeletal maturation indicators and CVM compared&lt;br /&gt;to males. It was observed that there was a correspondence between maturation methods for both genders. &lt;strong&gt;Conclusion&lt;/strong&gt;: there was&lt;br /&gt;a correlation between skeletal maturation assessment methods and dental mineralization in patients. Significant differences were&lt;br /&gt;observed between genders for skeletal maturity assessment methods. There was a relation between the methods used for skeletal&lt;br /&gt;maturation and dental mineralization, as well as chronological age.&lt;/p&gt;

Analysis of Mineral Density of Calcified Tissues in Children with X-Linked Hypophosphatemic Rickets and Hypophosphatasia Using Cone Beam Computed Tomography Data

The purpose of the present cohort study was a quantitative assessment of the enamel, dentin, and alveolar bone mineral density (BMD) using Cone Beam Computed Tomography (CBCT) scans in patients with X-linked hypophosphatemic rickets (HLHR) and hypophosphatasia (HPP) and a comparison with the data obtained from the control group. Methods and Results: The unrepresentative, non-random sample included 30 CBCT scans of children with genetically and biochemically confirmed XLHR (OMIM #307800) and HPP (OMIM: 146300, 241510, 241500, and 146300). X-ray examination and dental care were carried out in the Radiology Diagnostics Department and Pediatric Dentistry Department at Moscow State University of Medicine and Dentistry named after AI Evdokimov. The mineral density of calcified tissues (enamel, dentin, and alveolar bone) was evaluated using i-CAT Vision TM software options on reconstructed CBCT axial views. The images of all XLHR and HPP patients visualized large pulp chambers with prominent pulp horns extending to the dentin-enamel junction. The present study revealed poor alveolar bone mineralization in patients with HPP and XLHR. Analysis of CBCT scans showed a significant dentine hypodensity in XLHR patients, which may contribute to the emergence of multiple, spontaneous, periapical abscesses spreading rapidly in the jawbone. Conclusion: Data obtained could be used for planning dental treatment of patients with XLHR and HPP.

FGF23-related hypophosphatemic rickets/osteomalacia: diagnosis and new treatment.

FGF23 is a phosphaturic hormone produced by bone. FGF23 reduces serum phosphate by suppressing proximal tubular phosphate reabsorption and intestinal phosphate absorption. After the identification of FGF23, several kinds of hypophosphatemic rickets/osteomalacia such as X-linked hypophosphatemia (XLH) and tumor-induced osteomalacia (TIO) have been shown to be caused by excessive actions of FGF23. Circulatory FGF23 is high in patients with these hypophosphatemic diseases while FGF23 is rather low in those with chronic hypophosphatemia from other causes such as vitamin D deficiency. These results indicate that FGF23 measurement is useful for the differential diagnosis of hypophosphatemia. Chemiluminescent enzyme immunoassay for FGF23 has been approved for clinical use in Japan. The first choice treatment for patients with TIO is complete removal of responsible tumors. However, it is not always possible to find and completely remove responsible tumors. Phosphate and active vitamin D have been used for patients with hypophosphatemic diseases caused by excessive actions of FGF23 including TIO patients with unresectable tumors. However, these medications have limited effects and several adverse events. The inhibition of excessive FGF23 actions has been considered to be a novel therapy for these hypophosphatemic diseases. Human MAB for FGF23, burosumab, has been shown to improve biochemical abnormalities, roentgenological signs of rickets, growth, fracture healing and impaired mineralization in patients with XLH. Burosumab has been approved in several countries including Europe, North America and Japan. Long-term effects of burosumab need to be addressed in future studies.

Level of some essential minerals in patient serum infected with Leishmania tropica/ major in Al-Sharqat district, Salah Al-Din Government/ Iraq

The study was conducted to determine level of some essential minerals (zinc Zn and iron Fe) in patients infected with Leishmania tropica/ major. study was conducted in Sharqat district, during September 2018 till April 2019, included 61 patients with leishmaniasis diagnosed clinically by dermatologist and confirmed by microscopic examination of lesion material. The samples were divided into eight age groups (2 ≤, 3-6, 7-12, 13-22, 23-32, 33-42, 43-52 and 53 ≥ years). Also, 101 healthy people are as a control group. The level of Zn and Fe in serum are measured by using automated spectrophotometer. The study determined a significant decrease P &lt; 0.01 in Zn and Fe level in both genders for all age groups when compared with control groups.

Immune/nutritional evaluation and therapeutic intervention with probiotics, vitamins and minerals in patients with recurrent infections

Immune/nutritional evaluation and therapeutic intervention with probiotics, vitamins and minerals in patients with recurrent infections