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Kapoor S, Gupta AK, Thelma BK. Charting the Course: Towards a Comprehensive Newborn Screening Program in India. Int J Neonatal Screen 2024; 10:43. [PMID: 39051399 PMCID: PMC11270161 DOI: 10.3390/ijns10030043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/21/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024] Open
Abstract
Integrating health interventions in a growing economy like India, with a birth cohort of 27 million/year, one-fifth of all childbirths, and approximately one-third of neonatal deaths globally, is a challenge. While mortality statistics are vital, intact survival and early preventive healthcare, such as newborn screening (NBS), are paramount. The appalling lack of information about the precise burden of metabolic errors at the state/national level or a mandated program encouraged a feasibility study of NBS in a prospective newborn cohort recruited in Delhi State (November 2014-April 2017) using a public-private partnership mode. The major determinants for effective implementation of universal NBS at the national level and limitations encountered are discussed in this report. Data to generate the 'core' panel for screening, sustained training of healthcare personnel, dissemination of the power of NBS to ensure neonatal/societal health to the public, and a 'national policy' emerge as priorities in a developing country.
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Affiliation(s)
- Seema Kapoor
- Genetic & Metabolic Lab, Division of Genetics, Department of Pediatrics, Lok Nayak Hospital & Maulana Azad Medical College, New Delhi 110002, India;
| | - Amit Kumar Gupta
- Genetic & Metabolic Lab, Division of Genetics, Department of Pediatrics, Lok Nayak Hospital & Maulana Azad Medical College, New Delhi 110002, India;
| | - B. K. Thelma
- Department of Genetics, University of Delhi South Campus, New Delhi 110021, India
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Panchbudhe SA, Shivkar RR, Banerjee A, Deshmukh P, Maji BK, Kadam CY. Improving newborn screening in India: Disease gaps and quality control. Clin Chim Acta 2024; 557:117881. [PMID: 38521163 DOI: 10.1016/j.cca.2024.117881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 03/25/2024]
Abstract
In India, newborn screening (NBS) is essential for detecting health problems in infants. Despite significant progress, significant gaps and challenges persist. India has made great strides in genomics dueto the existence of the National Institute of Biomedical Genomics in West Bengal. The work emphasizes the challenges NBS programs confront with technology, budgetary constraints, insufficient counseling, inequality in illness panels, and a lack of awareness. Advancements in technology, such as genetic testing and next-generation sequencing, are expected to significantly transform the process. The integration of analytical tools, artificial intelligence, and machine learning algorithms could improve the efficiency of newborn screening programs, offering a personalized healthcare approach. It is critical to address gaps in information, inequities in illness incidence, budgetary restrictions, and inadequate counseling. Strengthening national NBS programs requires increased public awareness and coordinated efforts between state and central agencies. Quality control procedures must be used at every level for implementation to be successful. Additional studies endeavor to enhance NBS in India through public education, illness screening expansion, enhanced quality control, government incentive implementation, partnership promotion, and expert training. Improved neonatal health outcomes and the viability of the program across the country will depend heavily on new technology and counseling techniques.
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Affiliation(s)
- Sanjyoti A Panchbudhe
- Shrimati Kashibai Navale Medical College and General Hospital, Narhe, Pune 411041, Maharashtra, India
| | - Rajni R Shivkar
- Shrimati Kashibai Navale Medical College and General Hospital, Narhe, Pune 411041, Maharashtra, India
| | - Arnab Banerjee
- Department of Physiology (UG & PG), Serampore College, 9 William Carey Road, Serampore, Hooghly 712201, West Bengal, India
| | - Paulami Deshmukh
- Shrimati Kashibai Navale Medical College and General Hospital, Narhe, Pune 411041, Maharashtra, India
| | - Bithin Kumar Maji
- Department of Physiology (UG & PG), Serampore College, 9 William Carey Road, Serampore, Hooghly 712201, West Bengal, India
| | - Charushila Y Kadam
- Department of Biochemistry, Sukh Sagar Medical College and Hospital, Jabalpur 482003, Madhya Pradesh, India.
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Saini AG, Singanamalla B, Gunasekaran PK, Didwal G, Attri SV. Knowledge and experiences of healthcare workers in managing children with neurometabolic disorders in a developing country: a cross-sectional study. J Trop Pediatr 2023; 69:fmad023. [PMID: 37616068 DOI: 10.1093/tropej/fmad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To evaluate the knowledge and experiences of healthcare workers in the management of neurometabolic disorders. METHODS A cross-sectional study was carried out among the 132 participants of a continued medical education program conducted in the Department of Pediatrics at a tertiary-care teaching hospital. A questionnaire-based feedback form was circulated among the participants, and their responses were analyzed. RESULTS Ninety-three responses were analyzed. The most common pediatric illnesses identified were infections (91%), nutritional (91%), birth-related injuries (44.4%) and metabolic disorders (44.4%). Consanguinity (81.5%) and genetic heterogeneity (42.4%) were recognized as most important causes of neurometabolic disorders. Important steps identified for prevention were prenatal testing (65.6%) and newborn screening at birth (61%); while for improving the diagnosis were routine availability of metabolic investigations (65.3%) and screening at birth (46.6%). Most respondents (58.7%) expressed discomfort in managing a case with inherited metabolic defect due to a lack of knowledge (46.8%) and diagnostic facilities (44.6%). Despite access to testing in the majority, a high cost of testing was noticed for biochemical and genetic investigations. The majority of participants (73%) considered some of the inherited metabolic disorders as treatable. Dietary substitution (89.3%), enzyme replacement (69%), cofactor replacement (53.6%), gene therapy (35.7%) and regular dialysis (16.7%) were considered the treatment options. CONCLUSION In spite of growing awareness of inherited metabolic disorders, there are still gaps in knowledge among healthcare workers. It is challenging to diagnose and manage these disorders. Cost-reduction of diagnostic tests, routine newborn screening and increased educational activities are key challenges to be addressed.
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Affiliation(s)
- Arushi Gahlot Saini
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | | | | | - Gunjan Didwal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Savita Verma Attri
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Ahuja N, Rane SR, Pai SA. Lacunae in Laboratory Medicine Services and in Pathology Education in Medical Schools in India. Arch Pathol Lab Med 2023; 147:236-243. [PMID: 35738003 DOI: 10.5858/arpa.2021-0545-ep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Laboratories of many medical college hospitals in India do not offer important diagnostic tests, most of which are routine in the West. This detracts from the service as well as the educational function of the college. OBJECTIVES.— To provide the background to pathology and laboratory medicine services and education in India, and to create a questionnaire that will put the lack of tertiary care laboratory services in perspective. This article will help illustrate the lacunae in laboratory medicine services and in the education of students. For this, we present information on the health services and pathology education facilities in India. We propose a questionnaire comprising 30 questions in various disciplines in pathology and laboratory medicine. These questions will help administrators and bureaucrats evaluate the status of the laboratories with respect to the services provided. DATA SOURCES.— Sources include Web sites of the government of India, including that of the National Accreditation Board for Testing and Calibration Laboratories; indexed medical journal articles; and standard books and white papers on health care in India. We also used our personal experiences and interpretations of the laboratory and medical education sector in India. CONCLUSIONS.— Medical colleges in India need to offer specialized diagnostic services if they are to achieve the targets of universal health care as well as turning out competent doctors. The agencies responsible for health care in India should use the questionnaire as a first step toward improving laboratory services. Other low- and middle-income countries should also adopt this method.
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Affiliation(s)
- Nishtha Ahuja
- From the Department of Histopathology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India (Ahuja)
| | - Sharada R Rane
- From the Department of Pathology, Government Medical College, Baramati, India (Rane)
| | - Sanjay A Pai
- From the Department of Pathology and Laboratory Medicine, Manipal Hospital-Yeshwanthpur, Bangalore, India (Pai)
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5
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Hematopoietic Stem Cell Transplantation for Children With Inborn Errors of Metabolism: Single Center Experience Over Two Decades. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2597-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cani I, Pondrelli F, Licchetta L, Minardi R, Giangregorio T, Mostacci B, Muccioli L, Di Vito L, Fetta A, Barba C, Castioni CA, Bordugo A, Tinuper P, Bisulli F. Epilepsy and inborn errors of metabolism in adults: The diagnostic odyssey of a young woman with medium-chain acyl-coenzyme A dehydrogenase deficiency. Epilepsia Open 2022; 7:810-816. [PMID: 35869793 PMCID: PMC9712474 DOI: 10.1002/epi4.12630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/18/2022] [Indexed: 12/30/2022] Open
Abstract
We describe a case of epileptic encephalopathy in a young woman with undiagnosed medium-chain acyl-coenzyme A dehydrogenase deficiency (MCADD), who presented with an early-onset focal motor status epilepticus (SE) then followed by permanent left hemiplegia and drug-resistant epilepsy with neurodevelopmental delay. Throughout her clinical history, recurrent episodes of lethargy, feeding difficulties, and clustering seizures occurred, progressing into a super refractory SE and death at the age of 25 years. Although epilepsy is not a distinctive feature of MCADD, we advise considering this metabolic disease as a possible etiology of epileptic encephalopathy and hemiconvulsion-hemiplegia-epilepsy syndrome of unknown origin, on the chance to provide a timely and targeted treatment preventing development delay and evolution to SE. Adult patients with epilepsy of unknown etiology not screened at birth for inborn errors of metabolism, such as MCADD, should be promptly investigated for these treatable conditions.
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Affiliation(s)
- Ilaria Cani
- Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
| | - Federica Pondrelli
- Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
| | - Laura Licchetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCAREBolognaItaly
| | - Raffaella Minardi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCAREBolognaItaly
| | - Tania Giangregorio
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCAREBolognaItaly
| | - Lorenzo Muccioli
- Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
| | - Lidia Di Vito
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCAREBolognaItaly
| | - Anna Fetta
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | - Carmen Barba
- Neuroscience DepartmentMeyer Children's HospitalFirenzeItaly,University of FlorenceFlorenceItaly
| | - Carlo Alberto Castioni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCAREBolognaItaly
| | - Andrea Bordugo
- Inherited Metabolic Diseases Unit and Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine DiseasesAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly,IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCAREBolognaItaly
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly,IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCAREBolognaItaly
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7
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Olety P, Safwan GM, Shenoy RD. Inborn error of metabolism precipitated by COVID-19: challenges in the absence of an expanded newborn screening as state health programmes. BMJ Case Rep 2022; 15:15/6/e248001. [PMID: 35672054 PMCID: PMC9174768 DOI: 10.1136/bcr-2021-248001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Inborn errors of metabolism constitute a differential diagnosis in infants presenting with encephalopathy in developing countries where expanded newborn screening is not a state health programme. Acute neurological presentation with encephalopathy is documented in paediatric COVID-19. The pandemic has also altered parents' healthcare-seeking behaviour, leading to delays in emergency care. We illustrate the challenges faced in diagnosing and managing an 18-month-old child who presented with acute metabolic crisis due to methylmalonic acidaemia on the background of the COVID-19 pandemic. We discuss the current global status of expanded newborn screening services for inborn error of metabolism and the impact of the pandemic on the healthcare of children.
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Affiliation(s)
- Priyanka Olety
- Pediatrics, KS Hegde Medical Academy, Mangalore, Karnataka, India
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8
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Need and Viability of Newborn Screening Programme in India: Report from a Pilot Study. Int J Neonatal Screen 2022; 8:ijns8020026. [PMID: 35466197 PMCID: PMC9036214 DOI: 10.3390/ijns8020026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/05/2022] [Accepted: 03/10/2022] [Indexed: 02/01/2023] Open
Abstract
India, a country with the second largest population in the world, does not have a national newborn screening programme as part of its health policy. With funding support from the Grand Challenges Canada, a pilot newborn screening programme was implemented for the Udupi district of South India to study the need and viability of a national programme in India. Six disorders were selected for the study based on the availability of funding and recommendation from pediatricians in the district. Here, we report the observed incidence during the study. A cost-effectiveness analysis of implementing newborn screening in India was performed. It is evident from our analysis that the financial loss for the nation due to these preventable diseases is much higher than the overall expenditure for screening, diagnosis, and treatment. This cost-effectiveness analysis justifies the need for a national newborn screening programme in India.
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Passi GR, Wakchaure A, Jaiswal SP. Clinical and Genetic Spectrum of 50 Children with Inborn Errors of Metabolism from Central India. Indian J Pediatr 2022; 89:184-191. [PMID: 34822107 DOI: 10.1007/s12098-021-03958-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022]
Abstract
This is a single-center, retrospective analysis of children confirmed to have an inborn error of metabolism in the pediatric department of a teaching hospital in central India. Patients were categorized as acute encephalopathy, developmental delay/seizures, and neuroregression or organomegaly depending on their predominant phenotype. Of the 50 patients analyzed, the commonest group was lysosomal storage disorders in 13 (26%), followed by organic acidurias - 8 (16%), mitochondrial disorders - 5 (10%), urea cycle disorders, carbohydrate metabolism disorders, and amino acidopathies - 4 (8%) each, fatty acid oxidation defects and neurotransmitter deficiency disorders - 3 (6%) each, and miscellaneous (8%). Genetic variations were identified in 25 (50%). Acylcarnitine profiles and urine organic acids were diagnostic in 62.5% of children presenting as acute encephalopathy, exome sequencing in 55.5% of children with neuroregression, and specific enzyme assay in 83.3% of children with predominant organomegaly (83.3%). Children with developmental delay/seizures needed a wider range of tests.
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Affiliation(s)
- Gouri Rao Passi
- Department of Pediatrics, Choithram Hospital Research Center, Indore, Madhya Pradesh 452014, India.
| | - Akash Wakchaure
- Department of Pediatrics, Choithram Hospital Research Center, Indore, Madhya Pradesh 452014, India
| | - Shree Prakash Jaiswal
- Department of Pathology and Microbiology, Choithram Hospital & Research Center, Indore, Madhya Pradesh, India
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Gupta S, Sharma U. Metabolomics of neurological disorders in India. ANALYTICAL SCIENCE ADVANCES 2021; 2:594-610. [PMID: 38715858 PMCID: PMC10989583 DOI: 10.1002/ansa.202000169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 06/11/2024]
Abstract
Metabolomics is the comprehensive study of the metabolome and its alterations within biological fluids and tissues. Over the years, applications of metabolomics have been explored in several areas, including personalised medicine in diseases, metabolome-wide association studies (MWAS), pharmacometabolomics and in combination with other branches of omics such as proteomics, transcriptomics and genomics. Mass spectrometry (MS) and nuclear magnetic resonance (NMR) spectroscopy are the major analytical techniques widely employed in metabolomics. In addition, MS is coupled with chromatography techniques like gas chromatography (GC) and liquid chromatography (LC) to separate metabolites before analysis. These analytical techniques have made possible identification and quantification of large numbers of metabolites, encompassing characterization of diseases and facilitating a systematic and rational therapeutic strategy based on metabolic patterns. In recent years, the metabolomics approach has been used to obtain a deeper insight into the underlying biochemistry of neurodegenerative disorders and the discovery of biomarkers of clinical implications. The current review mainly focuses on an Indian perspective of metabolomics for the identification of metabolites and metabolic alterations serving as potential diagnostic biomarkers for neurological diseases including acute spinal cord injury, amyotrophic lateral sclerosis, tethered cord syndrome, spina bifida, stroke, Parkinson's disease, glioblastoma and neurological disorders with inborn errors of metabolism.
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Affiliation(s)
- Sangeetha Gupta
- Amity Institute of PharmacyAmity UniversityNoidaUttar PradeshIndia
| | - Uma Sharma
- Department of NMR & MRI FacilityAll India Institute of Medical SciencesNew DelhiIndia
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11
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G G, M R, Narayanasamy S. Efficacy of fermentation parameters on protein quality and microstructural properties of processed finger millet flour. JOURNAL OF FOOD SCIENCE AND TECHNOLOGY 2021; 58:3223-3234. [PMID: 34294985 PMCID: PMC8249654 DOI: 10.1007/s13197-020-04826-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 08/18/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023]
Abstract
The present study aims to explore the outcome of processing methods such as fermentation; treatments using lemon juice (T1), sodium chloride (T2), lemon juice followed by sodium chloride (T3) and fermentation followed by treatment-T3 on the quality characteristics of processed finger millet flour to develop a specialized low protein food supplement for a protein-related inborn error of metabolic disorders. The clean dirt-free finger millet grains were made into slurry subjected to treatment T1 (FMFT1), T2 (FMFT2), T3 (FMFT3), fermentation for 8-36 h with 4 h intervals using yoghurt as starter culture (FFMF) and fermentation (8-36 h) followed by treatment T3 (FFMFT3). The acidity of the finger millet slurry significantly increased with the increase in fermentation time when compared to control. The IVPD was found to be 89% in FFMF (20 h) sample which was significantly higher than the IVPD of control sample flour (27%). However, the crude protein content (%), the protein fractions and the IVPD of FFMFT3 (8-36 h) samples were found to be lesser than the FFMF (8-36 h) samples. The findings were further ensured by the results of scanning electron microscopic images and FT-IR spectra which showed the morphological and chemical modifications caused by the processing methods. The setback and breakdown viscosity of control (945 cP and 664 cP respectively) approximately reduced to two-third in FFMF (20 h) samples and one-third for FFMFT3 samples (303 cP and 286 cP respectively). From the study, it is evident that the processing method of fermentation followed by treatment-T3 could be utilized in the development of low protein food supplements.
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Affiliation(s)
- Gowthamraj G
- Department of Food Science and Technology, Pondicherry University, 605014, Kalapet, Pondicherry India
| | - Raasmika M
- Department of Food Science and Technology, Pondicherry University, 605014, Kalapet, Pondicherry India
| | - Sangeetha Narayanasamy
- Department of Food Science and Technology, Pondicherry University, 605014, Kalapet, Pondicherry India
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Inborn Errors of Metabolism-Approach to Diagnosis and Management in Neonates. Indian J Pediatr 2021; 88:679-689. [PMID: 34097229 DOI: 10.1007/s12098-021-03759-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
Inborn errors of metabolism (IEM), otherwise known as inherited metabolic disorders (IMD), are individually rare, but collectively common. IEM pose a challenge to diagnosis, as neonates present with nonspecific signs. A high index of suspicion is essential. Knowledge on clinical presentation may be life saving, especially for conditions that are treatable. It is important for the first-line physicians not to miss treatable disorders. Simplified classification and algorithmic approach help in the clinical setting. This article describes the classification of IEM into three groups, namely group 1 - intoxication disorders, group 2 - energy defects, and group 3 - storage disorders. Clinical presentations of IEM in the neonatal period, a quick guide to the diagnosis with the help of baseline investigations (glucose, arterial blood gas, lactate, ammonia, and ketone abbreviated as GALAK), a tabulated guide to the diagnosis with the help of tandem mass spectrometry (TMS), and gas chromatography and mass spectrometry (GCMS) are summarized in this article. Four principles of therapy that include substrate reduction, provision of deficient metabolites, disposal of toxic metabolites, and increase in enzyme activity are elaborated with particular stress to the diet management. In addition, a list of medications used in the treatment of different disorders classified according to Society for the Study of IEM (SSIEM) is presented.
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Preserved Blood Spots Aid Antenatal Diagnosis of Citrullinemia Type-1. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-021-00302-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Balakrishnan U, Chandrasekaran A, Amboiram P, Ninan B, Ignatious S. Outcome of Inherited Metabolic Disorders Presenting in the Neonatal Period. Indian J Pediatr 2021; 88:455-462. [PMID: 33051787 DOI: 10.1007/s12098-020-03522-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the outcome of infants who were diagnosed to have Inborn errors of metabolism (IEM) during neonatal period from a single center in South India. METHODS This retrospective cohort study included consecutive neonates diagnosed to have IEM by biochemical testing or those detected using newborn screening (NBS) between November 2014 and July 2018. Disorders were categorized into intoxication and non-intoxication groups. Their presentation and outcome were described. Development at 12 mo was assessed objectively using DASII (Developmental assessment scale for Indian infants). Developmental quotient <70 was considered as delay. Mortality was analyzed using Kaplan Meier survival analysis. RESULTS Among the total of 33 (14 intoxication and 19 non-intoxication groups), 7 died in neonatal period, 3 were lost to follow-up, 9 expired during varying period leaving 14 under regular follow-up. NBS detected 3 of them, others presented symptomatically unwell during neonatal period. Median survival was 18 mo (95% CI 3.7 to 32.2). Kaplan Meier survival analysis revealed a significant difference in mortality in intoxication compared to non-intoxication group. Among 14 survivors, 7 (50%) had developmental delay; 5 (35%) had seizures; 6 (43%) had growth failure. Infants with encephalopathy as initial presentation had poorer prognosis. NBS detection rate was 1 in 1060 live births (3 positives out of 3180 NBS samples). Those detected by NBS remained well. CONCLUSIONS Morbidity and mortality remain high in those diagnosed as IEM during neonatal period. Despite the small sample size, this study calls attention to implement NBS wherever feasible.
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Affiliation(s)
- Umamaheswari Balakrishnan
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India. .,Sri Ramachandra Center of Excellence in Perinatal Health (SCOPE), Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India.
| | - Ashok Chandrasekaran
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India.,Sri Ramachandra Center of Excellence in Perinatal Health (SCOPE), Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India
| | - Prakash Amboiram
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India.,Sri Ramachandra Center of Excellence in Perinatal Health (SCOPE), Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India.,Sri Ramachandra Center of Excellence in Perinatal Health (SCOPE), Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India
| | - Sebatini Ignatious
- Department of Clinical Nutrition, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Sanju S, Tullu MS, Seshadri N, Agrawal M. Glutaric Aciduria Type 1: A Case Report and Review of Literature. J Pediatr Intensive Care 2020; 10:65-70. [PMID: 33585064 DOI: 10.1055/s-0040-1709704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022] Open
Abstract
An 8-month-old male infant patient was referred to our institution (from elsewhere) with a history of fever, convulsions, dystonic posturing, altered sensorium, and loss of motor and mental milestones since past 1 month. Upon admission to our institution, a neuroimaging (magnetic resonance imaging of the brain) revealed frontoparietal atrophy, "bat-wing appearance," and basal ganglia changes. Carnitine and acylcarnitine profile revealed low total carnitine, very low free carnitine, and low free/acylcarnitine ratio, with normal levels of plasma amino acids. Urine gas chromatography mass spectrometry showed an elevated level of ketones (3-hydroxybutyric acid and acetoacetate) and glutaric acid with the presence of 3-hydroxyglutaric acid, suggestive of glutaric aciduria type 1. Diet modification and pharmacotherapy with riboflavin and carnitine arrested the neurological deterioration in the patient.
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Affiliation(s)
- Sidaraddi Sanju
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Milind S Tullu
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Nithya Seshadri
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Mukesh Agrawal
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
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Ganesh R, Abinesh R, Janakiraman L. Clinical Spectrum of Inherited Disorders of Metabolism. Indian J Pediatr 2019; 86:892-896. [PMID: 31222555 DOI: 10.1007/s12098-019-02998-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 05/22/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the clinical profile and outcome of children with Inborn errors of metabolism. METHODS Thirty one newly diagnosed children with Inborn errors of metabolism over a 1 y period were studied for their relevant clinical, biochemical, diagnosis, treatment and follow-up details. RESULTS Inborn errors of metabolism accounted for 2% of hospital admissions. Sixty five percent were born to parents of consanguineous marriage. Of the 31 children with Inborn errors of metabolism, 16 (51%) had lysosomal storage disorders, 8 (26%) had disorders of amino acid metabolism, 2 (6%) each had disorders of carbohydrate and bile acid metabolism, 1 (3%) each had disorders of fatty acid oxidation, mitochondrial and peroxisome metabolism. Acrodermatitis dysmetabolica, as a complication was observed in one child and the overall mortality rate in this series was 10%. CONCLUSIONS Lysosomal storage disorders constituted the majority of Inborn errors of metabolism in this series and amino acidopathies/organic acidemias were successfully treated with special formulas.
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Affiliation(s)
- Ramaswamy Ganesh
- Kanchi Kamakoti CHILDS Trust Hospital and The CHILDS Trust Medical Research Foundation, 12-A, Nageswara road, Nungambakkam, Chennai, Tamil Nadu, 600034, India.
| | - R Abinesh
- Kanchi Kamakoti CHILDS Trust Hospital and The CHILDS Trust Medical Research Foundation, 12-A, Nageswara road, Nungambakkam, Chennai, Tamil Nadu, 600034, India
| | - Lalitha Janakiraman
- Kanchi Kamakoti CHILDS Trust Hospital and The CHILDS Trust Medical Research Foundation, 12-A, Nageswara road, Nungambakkam, Chennai, Tamil Nadu, 600034, India
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Wasim M, Khan HN, Ayesha H, Goorden SMI, Vaz FM, van Karnebeek CDM, Awan FR. Biochemical Screening of Intellectually Disabled Patients: A Stepping Stone to Initiate a Newborn Screening Program in Pakistan. Front Neurol 2019; 10:762. [PMID: 31379716 PMCID: PMC6650569 DOI: 10.3389/fneur.2019.00762] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/01/2019] [Indexed: 12/30/2022] Open
Abstract
Inborn errors of metabolism (IEMs) are rare group of genetic disorders comprising of more than 1,000 different types. Around 200 of IEMs are potentially treatable through diet, pharmacological and other therapies, if diagnosed earlier in life. IEMs can be diagnosed early through newborn screening (NBS) programs, which are in place in most of the developed countries. However, establishing a NBS in a developing country is a challenging task due to scarcity of disease related data, large population size, poor economy, and burden of other common disorders. Since, not enough data is available for the prevalence of IEMs in Pakistan; therefore, in this study, we set out to find the prevalence of various treatable IEMs in a cohort of intellectually disabled patients suspected for IEMs, which will help us to initiate a NBS program for the most frequent IEMs in Pakistan. Therefore, a total of 429 intellectually disabled (IQ <70) patient samples were collected from Pakistan. A subset of 113 patient samples was selected based on the clinical information for the detailed biochemical screening. Advance analytical techniques like, Amino Acid Analyzer, GC-MS, UHPLC-MS, and MS/MS were used to screen for different treatable IEMs like aminoacidopathies, fatty acid β-oxidation disorders and mucopolysaccharidoses (MPS) etc. A total of 14 patients were diagnosed with an IEM i.e., 9 with homocystinuria, 2 with MPS, 2 with Guanidinoacetate methyltransferase (GAMT) deficiency and 1 with sitosterolemia. These IEMs are found frequent in the collected patient samples from Pakistan. Thus, present study can help to take an initiative step to start a NBS program in Pakistan, especially for the homocystinuria having highest incidence among aminoacidopathies in the studied patients, and which is amenable to treatment. This endeavor will pave the way for a healthier life of affected patients and will lessen the burden on their families and society.
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Affiliation(s)
- Muhammad Wasim
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan.,Pakistan Institute of Engineering and Applied Sciences, Islamabad, Pakistan
| | - Haq Nawaz Khan
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan.,Pakistan Institute of Engineering and Applied Sciences, Islamabad, Pakistan
| | - Hina Ayesha
- Department of Pediatrics, DHQ and Allied Hospitals, Faisalabad Medical University (FMU/PMC), Faisalabad, Pakistan
| | - Susanna M I Goorden
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Frederic M Vaz
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Clara D M van Karnebeek
- Departments of Pediatrics and Clinical Genetics, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Fazli Rabbi Awan
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan.,Pakistan Institute of Engineering and Applied Sciences, Islamabad, Pakistan
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Newborn Screening for Selected Disorders in Nepal: A Pilot Study. Int J Neonatal Screen 2019; 5:18. [PMID: 33072977 PMCID: PMC7510202 DOI: 10.3390/ijns5020018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 04/08/2019] [Indexed: 11/16/2022] Open
Abstract
The prevalence of metabolic disorders in Nepal is yet unknown, although many case reports occur in literature. Heel-prick blood samples from newborns were collected on Dried Blood Spot (DBS) collection cards and tested through Tandem Mass Spectroscopy and fluorescence assays for disorders included in the Swiss neonatal screening program; two cases of hypothyroidism and one case of cystic fibrosis were identified. Thyroid stimulating hormone (TSH), immuoreactive trypsinogen (IRT), hydroxyprogesterone (OHP), tyrosine (Tyr), and octanoylcarnitine (C8) showed significant differences with gestation age. Most of the parameters were positively correlated with each other except galactose, galactose 1 phosphate uridyl transferase (GALT), and biotinidase. First and ninety-ninth percentiles in the Nepalese newborns were found to be different when compared with the Swiss newborns. Congenital hypothyroidism and cystic fibrosis are candidates to be considered for a newborn screening program in Nepal. Differences between the Nepalese and Swiss newborns in parametric values that change with gestation age can be attributed to a higher survival rate of pre-term babies in Switzerland. Others could be explained in part by early and exclusive breastfeeding in Nepalese newborns.
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The Journey of Newborn Screening: Inception to Conclusion. Indian J Pediatr 2018; 85:933-934. [PMID: 29546660 DOI: 10.1007/s12098-017-2544-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 11/15/2017] [Indexed: 11/28/2022]
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