Discussion
enlargement, TNFα, hemorrhage, tonsillar hypertrophy, human tonsillar T, avascular
INFILTRATION, CHRONIC INFECTION, ENLARGEMENT, DISEASES, DISEASE, DEGENERATIVE CHANGE, INFECTIONS, DYSFUNCTION, NA DEFICIENCY, CHRONIC TONSILLITIS, HEMORRHAGE, VITAMIN D DEFICIENCY, TONSILLAR HYPERTROPHY, SECONDARY, ULCERATION, PATHOGENESIS
The main findings of the present study revealed a significantly lower serum level of 25(OH)D in the Placebo group versus the Vitamin D group. Vitamin D deficiency was significantly more detected in children with chronic tonsillitis compared to children treated with vitamin D. This hypovitaminosis D increased the risk for chronic tonsillitis (As regards the histological examination of tonsils in the Placebo group before vitamin D supplementation, we found thinning of the covering epithelium with multiple areas of hemorrhage or surface epithelium erosions (ulceration). The apparent decrease in the number of lymphatic follicles, some of them had areas of hemorrhage. Sometimes, follicular expansion (enlargement) and irregularity could be seen. This follicular enlargement is consistent with Mogoanta et al.Marked mononuclear cellular infiltration could be seen within tonsillar tissue. Also, there was a significant increase in collagen fibers deposition in the subepithelial region and around the lymphatic follicles.Palatine tonsil, just like the entire Waldeyer lymphatic circle, contains an increased immunologic reactivity tissue, thus building a barrier against the pathogenic agents’ penetration into the respiratory and digestive tractsA common histological characteristic of chronic tonsillitis and tonsillar hypertrophy is immunological parameters, genetic susceptibility, and local lymphocyte dysfunction. The endoplasmic reticulum (ER) is an organelle that has a very important function in the balanced functioning of cells, in which the accumulation of a cellular protein called ER stress occurs in case of cellular dysfunction. ER stress influences the pathogenesis of many diseases and immune system functions. In a study by Onal, Merih, et al.The palatine tonsils are covered with stratified squamous nonkeratinized epithelium. This epithelium is avascular and only a very few nonepithelial cells are found in a normal healthy person. In chronic infection as chronic tonsillitis, the circulation of blood is poor because of degenerative changes causing parenchymal fibrosisThis study researches the association between vitamin D levels and inflammatory cytokines in children with chronic tonsillitis. Rendering to our results vitamin D had a significant association with pro-inflammatory cytokines (TNFα and IL-2) and a non-significant association with anti-inflammatory cytokines (IL-4 and IL-10). The correlation between vitamin D administration and serum levels of inflammatory markers such as cytokines has been investigated previously by Sun and colleaguesImmunostaining with CD68 revealed the presence of macrophages. In this study, subepithelial and intraepithelial disposed of macrophages were found in the Placebo group. Mogoanta et al., 2008The results of the current study proved the potential effects of vitamin D in patients with chronic tonsillitis. The tonsillar sections restored their histological structure in the Vitamin D group. Vitamin D has an important role in maintaining immunity. Vitamin D has numerous effects on different cell types of the immune system such as dendritic cells, B lymphocytes, T lymphocytes, and NK cellsVitamin D receptors are found in T cells, B cells, antigen-presenting cells, macrophages, and dendritic cells. Vitamin D immunomodulates both innate and adaptive immune responsesIn terms of the effects of vitamin D on the adenoids and tonsils, a deficiency may increase recurrent infections. In addition, vitamin D regulates human tonsillar T cells, and a deficiency may trigger tonsillar hypertrophyChildren with COVID-19 who have secondary lymphoid tissue such as tonsils may have a milder course of the disease