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Castelbón Fernández FJ, Barreda Sánchez M, Arranz Canales E, Hernández Contreras ME, Solares I, Morales Conejo M, Muñoz Cuadrado Á, Casado Gómez A, Yébenes Cortés M, Guillén Navarro E. The burden of disease and quality of life in patients with acute hepatic porphyria: COPHASE study. Med Clin (Barc) 2024; 162:103-111. [PMID: 37838536 DOI: 10.1016/j.medcli.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Acute hepatic porphyria (AHP) comprises a group of rare genetic diseases characterized by neurovisceral crises that are manifested by abdominal pain and neurological and/or psychological symptoms that interfere with the ability to lead a normal life. Our objective was to determine the burden of the disease in one year and the health-related quality of life (HRQoL) in patients with AHP. RESULTS 28 patients were analyzed. The mean age was 36.6±10.2 years, 89.3% were women, and the average number of crises was 1.9±1.5. The average annual cost per patient was €38,255.40. 80.2% of the costs was direct medical costs, 17.5% was associated with loss of productivity and 2.3% was direct non-medical costs. 85.9% of the total cost corresponded to the crises. The intercrisis period accounted for the remaining 14.1%. The global index of the EQ-5D-5L (HRQoL) was 0.75±0.24. The dimensions of pain/discomfort, anxiety/depression and daily activities were the most affected. Leisure, travel/vacations and household activities were the most affected daily activities. 53.6% of patients required a caregiver due to AHP. 92.9% did not present overload and 7.1% presented extreme overload. CONCLUSIONS Patients with AHP are associated with a high economic impact and an affected HRQoL in the pain/discomfort dimension, with a negative impact on the performance of daily activities and a risk of psychiatric diseases.
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Affiliation(s)
- Francisco Javier Castelbón Fernández
- Consulta de Porfirias, CSUR de errores congénitos del metabolismo, Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - María Barreda Sánchez
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Elena Arranz Canales
- Consulta de Porfirias, CSUR de errores congénitos del metabolismo, Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Isabel Solares
- Consulta de Porfirias, CSUR de errores congénitos del metabolismo, Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Montserrat Morales Conejo
- Consulta de Porfirias, CSUR de errores congénitos del metabolismo, Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Encarna Guillén Navarro
- Sección Genética Médica, Hospital Clínico Universitario Virgen de la Arrixaca/Universidad de Murcia/IMIB-Arrixaca, Murcia, Spain
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Sánchez Soler MJ, López-González V, Ballesta-Martínez MJ, Gálvez-Pradillo J, Nicolás-Arnao M, Gómez-Sánchez E, Pérez-Fernández V, Guillén Navarro E. Risk of mayor and minor birth defects in children conceived by assisted reproductive technology (IVF/ICSI): A prospective controlled cohort study. An Pediatr (Barc) 2021; 95:448-458. [PMID: 34857501 DOI: 10.1016/j.anpede.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION About 0.2-6.1% of newborns in the developed world have been conceived by assisted reproductive techniques (ART). Higher rate of major and minor malformations have been described in this population, but the multiple possible confounders associated make it difficult to establish a direct causal relationship and the specific factors involved. MATERIAL AND METHODS To determine the risk of these malformations in our population, a collaborative prospective controlled cohort study was designed. We collected the specific ART-data related to the clinical gestation of women treated in a period of 2 years in the Reproduction Unit from a Spanish public tertiary-level hospital. 231 out of 267 newborns of these gestation (88%) participated in the study and were assessed by a pediatrician with expertise in Clinical Genetics and Dysmorphology at 12-20 and 26-40 months of age. At the same time a controlled group of children naturally conceived (NC) was selected according to the following criteria: the next NC newborn belonging to the same group of maternal and gestational age, and type of gestation (single or multiple). 230 controls were chosen and 208 participated in the study (90%). RESULTS Major malformations were presented in 7.8% of the ART-children and 7.2% of the controls, without founding statistically differences between groups. However, differences were found in the risk of some minor malformations such as capillary malformations and pigmentary lesions, higher in the ART-group. A recurrent pattern of craneofacial anomalies was also unexpectedly detected. CONCLUSIONS In spite of the high rate of major congenital malformations detected, there were no differences between groups. Thus, our results suggest that ART may affect the normal embryonic development but in a milder way than other confounding factors do. The facial phenotype identified has not previously been described, either the higher risk of capillary malformations and pigmentary lesions. More studies are needed to confirm this association.
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Affiliation(s)
- María José Sánchez Soler
- Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain.
| | - Vanesa López-González
- Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | | | - Jorge Gálvez-Pradillo
- Unidad de Reproducción, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | | | - Encarna Guillén Navarro
- Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
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Sánchez Soler MJ, López-González V, Ballesta-Martínez MJ, Gálvez-Pradillo J, Nicolás-Arnao M, Gómez-Sánchez E, Pérez-Fernández V, Guillén Navarro E. [Risk of mayor and minor birth defects in children conceived by assisted reproductive technology (IVF/ICSI): A prospective controlled cohort study]. An Pediatr (Barc) 2021; 95:S1695-4033(21)00220-4. [PMID: 34315688 DOI: 10.1016/j.anpedi.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/03/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION About 0.2-6.1% of newborns in the developed world have been conceived by assisted reproductive techniques (ART). Higher rate of major and minor malformations have been described in this population, but the multiple possible confounders associated, make it difficult to establish a direct causal relationship, and the specific factors involved. MATERIAL AND METHODS To determine the risk of these malformations in our population, a collaborative prospective controlled cohort study was designed. We collected the specific ART-data related to the clinical gestation of women treated in a period of 2 years in the Reproduction Unit from a Spanish public tertiary-level hospital. 231 out of 267 newborns of these gestation (88%) were exhausted assessed by a Clinical Geneticist expertise in Dysmorphology at 12-20 and 26-40 months of age. At the same time a controlled group of children naturally conceived (NC) was selected according to the following criteria: the next NC newborn belonging to the same group of maternal and gestational age, and type of gestation (single or multiple). 230 controls were chosen and 208 participated in the study (90%). RESULTS Major malformations were presented in 7.8% of the ART-children and 7.2% of the controls, without founding statistically differences between groups. However, differences were found in the risk of some minor malformations such as capillary malformations and pigmentary lesions, higher in the ART-group. A recurrent pattern of craneofacial anomalies was also unexpectedly detected. CONCLUSIONS In spite of the high rate of major congenital malformations detected, there were no differences between groups. Thus, our results suggest that ART may affect the normal embryonic development but in a milder way than other confounding factors do. The facial phenotype identified has not previously, either the higher risk of capillary malformations and pigmentary lesions. More studies are needed to confirm this association.
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Affiliation(s)
- María José Sánchez Soler
- Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca. IMIB-Arrixaca, Murcia, España.
| | - Vanesa López-González
- Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca. IMIB-Arrixaca, Murcia, España
| | | | - Jorge Gálvez-Pradillo
- Unidad de Reproducción, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | | | | | - Encarna Guillén Navarro
- Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca. IMIB-Arrixaca, Murcia, España
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Martínez Jiménez V, Hernández González AN, López Jiménez I, Rodríguez Peña L, Galbis Martínez L, Santa-Olalla González M, Ruiz Merino G, Guillén Navarro E. The importance of the number of antihypertensives in the progression of autosomal dominant polycystic kidney disease. Nefrologia 2021; 41:362-364. [PMID: 36166255 DOI: 10.1016/j.nefroe.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/13/2020] [Indexed: 06/16/2023] Open
Affiliation(s)
- Víctor Martínez Jiménez
- Servicio de Nefrología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
| | | | | | - Lidya Rodríguez Peña
- Unidad de Genética Médica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Liliana Galbis Martínez
- Centro de Bioquímica y Genética Clínica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Guadalupe Ruiz Merino
- Unidad de Metodología, Fundación para la Formación e Investigación Sanitarias de la Región de Murcia, Spain
| | - Encarna Guillén Navarro
- Unidad de Genética Médica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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Martínez Jiménez V, Hernández González AN, López Jiménez I, Rodríguez Peña L, Galbis Martínez L, Santa-Olalla González M, Ruiz Merino G, Guillén Navarro E. [The importance of the number of antihypertensives in the progression of autosomal dominant polycystic kidney disease]. Nefrologia 2020; 41:362-364. [PMID: 32950282 DOI: 10.1016/j.nefro.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/09/2020] [Accepted: 06/13/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Víctor Martínez Jiménez
- Servicio de Nefrología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | | | | | - Lidya Rodríguez Peña
- Unidad de Genética Médica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Liliana Galbis Martínez
- Centro de Bioquímica y Genética Clínica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | - Guadalupe Ruiz Merino
- Unidad de Metodología, Fundación para la Formación e Investigación Sanitarias de la Región de Murcia, España
| | - Encarna Guillén Navarro
- Unidad de Genética Médica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
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Abstract
Niikawa-Kuroki, or Kabuki syndrome (KS), is characterized by distinctive facial features, skeletal anomalies, persisting fingertip pads with dermatoglyphic abnormalities, short stature, and mental retardation. Neurological manifestations and CNS anomalies have been described in some patients with this condition. However, craniosynostosis has been documented in only 4 patients with KS who did not undergo operations. The authors report a case of KS with unicoronal synostosis that constitutes the first documented instance of a patient with this syndrome submitted to surgery. Previous reported instances of craniosynostosis occurring in KS are briefly reviewed. Although rarely documented, craniosynostosis might represent a relatively frequent feature of this syndrome. Kabuki syndrome should be considered at the time of evaluating children with craniosynostosis. The diagnosis of KS can be suspected from the patients' characteristic facial features. Kabuki syndrome appears to be an underdiagnosed condition in the craniosynostosis population. Given that most patients with this syndrome suffer from only mild to moderate mental retardation, surgical correction can be considered in instances of KS with craniosynostosis.
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Affiliation(s)
- Juan F Martínez-Lage
- Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, Murcia, Spain.
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Glóver López G, Guillén Navarro E. Síndrome X frágil. Rev Neurol 2006. [DOI: 10.33588/rn.42s01.2005735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Guillén Navarro E, Glóver López G. Causas monogénicas de retraso mental ligado a X. Rev Neurol 2006. [DOI: 10.33588/rn.42s01.2005707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fernández Barreiro A, Guillén Navarro E, Tortosa Conesa D, Meca Lallana JE. Estado actual de la porfiria aguda intermitente en la región de Murcia. Rev Neurol 2004. [DOI: 10.33588/rn.3809.2003233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
We describe a girl with a previously unreported de novo duplication of chromosome 4q involving segment q21-q28. Clinical manifestations included growth and psychomotor retardation, facial asymmetry, hypotelorism, epicanthic folds, mongoloid slant of palpebral fissures, apparently low-set auricles, high nasal bridge, long philtrum, small mouth, short neck, low-set thumbs, and bilateral club foot. This phenotype is compared with that of previously reported cases of duplication 4q.
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Affiliation(s)
- E G Navarro
- Unidad Técnica de Genética Humana, Centro de Bioquímica y Genética Clínica, Murcia, Spain
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