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Fröhlich-Reiterer E, Elbarbary NS, Simmons K, Buckingham B, Humayun KN, Johannsen J, Holl RW, Betz S, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes 2022; 23:1451-1467. [PMID: 36537532 DOI: 10.1111/pedi.13445] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | - Kimber Simmons
- Barbara Davis Center for Diabetes, University of Colorado, Denver, Colorado, USA
| | - Bruce Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University Medical Center, Stanford, California, USA
| | - Khadija N Humayun
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jesper Johannsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Herlev and Steno Diabetes Center Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Shana Betz
- Parent/Advocate for people with diabetes, Markham, Canada
| | - Farid H Mahmud
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Memon F, Arif M, Kirmani S, Humayun KN. Wolcott-Rallison syndrome: a case series of three patients. Pediatr Endocrinol Diabetes Metab 2022; 28:238-240. [PMID: 36106422 PMCID: PMC10214929 DOI: 10.5114/pedm.2022.118325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/28/2022] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Neonatal diabetes is a rare disease with incidence estimated at 1 in 300,000 to 1 in 400,000 live births. Walcott-Rallison syndrome has been identified as the most common cause of permanent neonatal diabetes in consanguineous families caused by mutations in eukaryotic translation initiation factor 2-α kinase 3 (EIF2AK3), characterized by permanent neonatal diabetes associated with liver dysfunction, multiple epiphyseal dysplasia, and developmental delay. We herein report 3 cases of genetically proven Wolcott-Rallison syndrome with variable phenotype presentation. CASE SERIES All cases presented with high glucose levels and were treated with insulin. EIF2AK3 homozygous mutation was identified in all 3 on genetic analysis. Initial screening testing for associated comorbidities was normal, including X-ray examination, which did not show any signs of epiphyseal dysplasia in all cases. Case 2 and case 3 were both lost to follow-up and were later found to have expired at the ages of 18 months and 2 years, respectively, due to liver failure associated with intercurrent respiratory illness in hospitals in their native towns. Case one is now 2 years old on regular follow-up in paediatric Endocrine and neurology clinics and doing well so far. CONCLUSIONS Morbidity, as well as mortality, is high among children with WRS neonatal diabetes. It is crucial to screen for gene mutation in patients with diabetes diagnosed before 6 months. Close therapeutic monitoring is recommended in WRS because of the risk of acute episodes of hypoglycaemia and ketoacidosis.
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Affiliation(s)
- Fozia Memon
- Fozia Memon Pediatric and Child Health Section of Pediatric Endocrinology Aga Khan University Pakistan e-mail:
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Campisi SC, Humayun KN, Wasan Y, Soofi SB, Islam M, Hussain A, Shakeel A, Vandermorris A, Söder O, Bhutta ZA. The relationship between pubertal timing and under-nutrition in rural Pakistan. J Adolesc 2021; 88:58-66. [PMID: 33618265 DOI: 10.1016/j.adolescence.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/22/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Sexual development in females and males are routinely measured according to the Tanner Stages. Sparse data exist on the timing of pubertal milestones in Pakistan. To fill this gap, the age of attainment of pubertal milestones and their relationship with nutritional status was explored among children and adolescents living in the rural district of Matiari, Pakistan. METHODS Anthropometry, nutrition biomarkers and Tanner Stage were assessed among girls aged 9.0-14.9 years (n = 723) and boys aged 10.0-15.9 years (n = 662) who were free from known disease in the rural District of Matiari, Pakistan. Median age was calculated for all Tanner Stages and menarche. Multivariable linear regressions were undertaken to determine covariates associated with the timing (age) of pubertal milestones. RESULTS Among participants living in this rural community, the median age of puberty onset for girls was 11.9 years (95%CI:10.9; 12.5) and boys was 12.3 years (95%CI:11.5; 12.9). Age at first menarche was 12.9 years (95%CI:12.1; 13.3). Undernutrition was widespread among adolescents in this community. Thirty-seven percent of females and 27.0% of males were stunted while 20.5% of females and 31.3% of males were thin. Only 8% (n = 58) of females and 12% (n = 78) of males were free from any nutrient deficiency with most adolescents having two or three nutrient deficiencies. CONCLUSIONS Undernutrition (stunting or thinness) was associated with relatively older ages for early puberty stages but not puberty completion. This may decrease the duration of the pubertal growth spurt and curtail potential catch-up growth that may occur during puberty. Efforts to decrease nutrient deficiencies, stunting and thinness beyond childhood should be made in rural Pakistan.
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Affiliation(s)
- Susan C Campisi
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4, Canada; Department of Nutritional Sciences, University of Toronto, 1 King's Circle College, Toronto, Ontario, M5S 1A8, Canada.
| | - Khadija N Humayun
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Yaqub Wasan
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Sajid B Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Muhammad Islam
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4, Canada.
| | - Amjad Hussain
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Agha Shakeel
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Ashley Vandermorris
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4, Canada; Hospital for Sick Children, Division of Adolescent Medicine, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
| | - Olle Söder
- Pediatric Endocrinology Division, Department of Women's and Children's Health, Tomtebodavägen 17A, Karolinska Institutet, SE-17176, Stockholm, Sweden.
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4, Canada; Department of Nutritional Sciences, University of Toronto, 1 King's Circle College, Toronto, Ontario, M5S 1A8, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan; Dalla Lana School of Public Health University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.
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Campisi SC, Humayun KN, Wasan Y, Soofi S, Islam M, Lou W, Vandermorris A, Söder O, Bhutta ZA. Self-assessed puberty is reliable in a low-income setting in rural Pakistan. J Pediatr Endocrinol Metab 2020; 33:1191-1196. [PMID: 32817583 DOI: 10.1515/jpem-2020-0246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/29/2020] [Indexed: 11/15/2022]
Abstract
Objectives Staging sexual maturation is an integral component of adolescent research. The Pubertal Development Scale (PDS) is commonly used as a puberty self-assessment tool because it avoids the use of images. Among the youth living in rural Pakistan, we determined the accuracy of self-reported pubertal assessments using a modified PDS compared to the 'gold standard' of physically assessed Tanner stages by a physician. Methods The strength of agreement between self-assessed puberty using a modified PDS and the 'gold' standard of physician-assessed Tanner stages was reported using weighted kappa (κ w) for girls (n = 723) of 9.0-14.9 years of age or boys (n = 662) of 10.0-15.9 years of age living in the rural District of Matiari. Results Agreement between the gold standard and self-assessment for puberty was substantial, with a κ w of 0.73 (95% confidence interval [CI]: 0.67; 0.79) for girls and a κ w of 0.61 (95% CI: 0.55; 0.66) for boys. Substantial agreement was observed for both boys and girls classified as thinness but only for girls with a normal body mass index. Those who were classified as severely thin had moderate agreement. The prevalence of overestimation was 18.5% (95% CI: 15.9-21.5) for girls and 2.7% (95% CI: 1.7-4.3) for boys, while the prevalence of underestimation estimation was 8.0% (95% CI: 6.2-10.2) for girls and 29.0% (95% CI: 25.8-32.6) for boys. Conclusions Most girls and boys assessed their pubertal development with substantial agreement with physician assessment. Girls were better able to assess their puberty, but they were more likely to overestimate. Agreement for boys was also substantial, but they were more likely to underestimate their pubertal development. In this rural Pakistan population, the PDS seems to be a promising tool for self-assessed puberty.
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Affiliation(s)
- Susan C Campisi
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), Toronto, ON, Canada.,Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Khadija N Humayun
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Yaqub Wasan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Islam
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health University of Toronto Health Sciences Building, Toronto, ON, Canada
| | - Ashley Vandermorris
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), Toronto, ON, Canada.,Division of Adolescent Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Olle Söder
- Pediatric Endocrinology Division, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), Toronto, ON, Canada.,Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.,Dalla Lana School of Public Health University of Toronto Health Sciences Building, Toronto, ON, Canada
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Campisi SC, Humayun KN, Rizvi A, Lou W, Söder O, Bhutta ZA. Later puberty onset among chronically undernourished adolescents living in a Karachi slum, Pakistan. Acta Paediatr 2020; 109:1019-1025. [PMID: 31606907 DOI: 10.1111/apa.15053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/10/2019] [Indexed: 01/01/2023]
Abstract
AIM To assess factors associated with the timing of puberty onset (Tanner Stage Breast 2/Genital 2) among adolescents living in an urban slum in Karachi, Pakistan. METHODS Girls enrolled at 8-10 years (n = 1009) and boys 9-11 years (n = 863) were followed every 6 months from 2006 to 2010. Parametric survival analysis for interval-censored data was used to estimate median age at puberty onset and assess the association between exposures and timing of puberty onset. RESULTS The overall median age at Tanner Stage Breast 2 (AAB2) was 10.1 years (95% CI: 10.1; 10.5), and the median age at Tanner Stage Genital 2 (AAG2) was 10.1 years (95% CI: 10.1; 10.6). Stunting delayed AAB2 1 year and AAG2 about 6 months when compared to non-stunted peers. In the multivariable model, after adjusting for age at enrolment, stunting, thinness and vitamin A deficiency (VAD) were significantly associated with delayed AAB2, while stunting and anaemia were significantly associated with delayed AAG2. CONCLUSION Among adolescents living in the Karachi slum, stunting and highly prevalent anaemia delayed AAG2, while stunting, thinness and VAD delayed AAG2. Parental and household factors were not significantly associated with the timing of puberty onset.
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Affiliation(s)
- Susan C. Campisi
- Department of Nutritional Sciences Faculty of Medicine University of Toronto Toronto ON Canada
- Peter Gilgan Centre for Research and Learning (PGCRL) Center for Global Child Health Hospital for Sick Children Toronto ON Canada
| | - Khadija N. Humayun
- Centre of Excellence in Women and Child Health The Aga Khan University Karachi Pakistan
| | - Arjumand Rizvi
- Centre of Excellence in Women and Child Health The Aga Khan University Karachi Pakistan
| | - Wendy Lou
- Dalla Lana School of Public Health University of Toronto Toronto ON Canada
| | - Olle Söder
- Department of Women's and Children's Health Karolinska Institutet Widerströmska Huset Karolinska University Hospital Solna Stockholm Sweden
| | - Zulfiqar A. Bhutta
- Department of Nutritional Sciences Faculty of Medicine University of Toronto Toronto ON Canada
- Peter Gilgan Centre for Research and Learning (PGCRL) Center for Global Child Health Hospital for Sick Children Toronto ON Canada
- Centre of Excellence in Women and Child Health The Aga Khan University Karachi Pakistan
- Dalla Lana School of Public Health University of Toronto Toronto ON Canada
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Campisi SC, Wasan Y, Soofi S, Monga S, Korczak DJ, Lou W, Soder O, Vandermorris A, Humayun KN, Mian A, Szatmari P, Bhutta ZA. Nash-wo-Numa (childhood growth & development) study protocol: factors that impact linear growth in children 9 to 15 years of age in Matiari, Pakistan. BMJ Open 2019; 9:e028343. [PMID: 31196903 PMCID: PMC6575710 DOI: 10.1136/bmjopen-2018-028343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Adolescence is a time of significant physical and emotional change, and there is emerging concern that adolescents living in low- and middle-income countries (LMIC) may face substantial challenges in relation to linear growth and mental health. Data on the global burden of stunting after 5 years of age are limited, but estimates suggest up to 50 per cent of all adolescents in some LMIC are stunted. Additionally, many LMIC lack robust mental health care delivery systems. Pakistan has one of the world's largest populations of adolescents (10 to 19 years) at approximately 40 million. The Nash-wo-Numa study's primary objective is to assess the prevalence and risk factors for stunting among early adolescents in rural Pakistan. The study also aims to determine the prevalence of poor mental health and identify factors associated with common mental health concerns during the childhood to adulthood transition. METHODS This cross-sectional study will include girls (n= 738) 9.0 to 14.9 years of age and boys (n=687) 10.0 to 15.9 years of age who live in the rural district of Matiari, Pakistan. Participants will be assessed for anthropometrical measures, puberty development, nutritional biomarkers as well as symptoms of depression, anxiety and trauma using validated scales. ETHICS AND DISSEMINATION The proposed study aims to complete the picture of child and adolescent health concerning linear growth and mental health by including puberty indicators. Ethics approval has been granted by the Ethics Review Committee at the Aga Khan University, Karachi, Pakistan, #5251-WCH-ERC-18 and Research Ethics Board at SickKids Hospital, Toronto, Canada, #:1000060684. Study results will be presented at relevant conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03647553; Pre-results.
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Affiliation(s)
- Susan C Campisi
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Yaqub Wasan
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Soofi
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Suneeta Monga
- Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daphne J Korczak
- Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Olle Soder
- Department of Women's and Children's Health, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Ashley Vandermorris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Ayesha Mian
- Psychiatry, Aga Khan University, Karachi, Pakistan
| | - Peter Szatmari
- Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
- Dalla Lana School of Public Health, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
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Mohsin M, Humayun KN, Atiq M. Clinical Screening for Congenital Heart Disease in Newborns at a Tertiary Care Hospital of a Developing Country. Cureus 2019; 11:e4808. [PMID: 31403007 PMCID: PMC6682379 DOI: 10.7759/cureus.4808] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To screen all newborns admitted to a tertiary care hospital to rule out congenital heart disease before discharge and to find out the utility of pulse oximetry to detect congenital heart disease. Methodology: This prospective study was done at Aga Khan University Hospital from January 2014 to December 2014 in 1,650 newborns over a period of 12 months. Pulse oximetry and clinical examination were done. Persistent oxygen saturation less than 95% was considered as positive pulse oximetry. Newborns who had positive pulse oximetry or abnormal clinical examinations findings were subjected to echocardiography. Results: Pulse oximetry was performed on 1,650 newborns, out of which 25 (1.5%) had congenital heart disease. Positive pulse oximetry cases were 16 (0.97%), out of which 10 had only positive pulse oximetry (negative clinical examination). Positive clinical examination cases were 45 (2.7%), out of which 39 cases had only positive clinical examinations (negative pulse oximetry). Six newborns had both positive pulse oximetry and positive clinical examination. Out of the 25 diagnosed cases of congenital heart disease, ventricular septal defect (VSD) was the most common congenital heart disease, followed by patent ductus arteriosus (PDA). The sensitivity, specificity, positive predictive value, and negative predictive value of pulse oximetry were 32%, 99.5%, 50%, and 98.9% respectively. Conclusion: In the community setting of a developing country, a combination of pulse oximetry screening and clinical examination are better at detecting congenital heart defects than either test alone.
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Affiliation(s)
| | | | - Mehnaz Atiq
- Paediatrics & Child Health, Aga Khan University Hospital, Karachi, PAK
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Gregory LC, Humayun KN, Turton JPG, McCabe MJ, Rhodes SJ, Dattani MT. Novel Lethal Form of Congenital Hypopituitarism Associated With the First Recessive LHX4 Mutation. J Clin Endocrinol Metab 2015; 100:2158-64. [PMID: 25871839 PMCID: PMC4454798 DOI: 10.1210/jc.2014-4484] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND LHX4 encodes a member of the LIM-homeodomain family of transcription factors that is required for normal development of the pituitary gland. To date, only incompletely penetrant heterozygous mutations in LHX4 have been described in patients with variable combined pituitary hormone deficiencies. OBJECTIVE/HYPOTHESIS To report a unique family with a novel recessive variant in LHX4 associated with a lethal form of congenital hypopituitarism that was identified through screening a total of 97 patients. METHOD We screened 97 unrelated patients with combined pituitary hormone deficiency, including 65% with an ectopic posterior pituitary, for variants in the LHX4 gene using Sanger sequencing. Control databases (1000 Genomes, dbSNP, Exome Variant Server, ExAC Browser) were consulted upon identification of variants. RESULTS We identified the first novel homozygous missense variant (c.377C>T, p.T126M) in two deceased male patients of Pakistani origin with severe panhypopituitarism associated with anterior pituitary aplasia and posterior pituitary ectopia. Both were born small for gestational age with a small phallus, undescended testes, and mid-facial hypoplasia. The parents' first-born child was a female with mid-facial hypoplasia (DNA was unavailable). Despite rapid commencement of hydrocortisone and T4 in the brothers, all three children died within the first week of life. The LHX4(p.T126M) variant is located within the LIM2 domain, in a highly conserved location. The absence of homozygosity for the variant in over 65 000 controls suggests that it is likely to be responsible for the phenotype. CONCLUSION We report, for the first time to our knowledge, a novel homozygous mutation in LHX4 associated with a lethal phenotype, implying that recessive mutations in LHX4 may be incompatible with life.
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Affiliation(s)
- L C Gregory
- Developmental Endocrinology Research Group (L.C.G., J.P.G.T., M.J.M., M.T.D.), Genetics and Epigenetics in Health and Disease Unit, Genetic and Genomic Medicine Programme, UCL Institute of Child Health, London WC1N 1EH, United Kingdom; Department of Pediatrics and Child Health (K.N.H.), Aga Khan University, Karachi 74800, Pakistan; and Department of Biology (S.J.R.), Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
| | - K N Humayun
- Developmental Endocrinology Research Group (L.C.G., J.P.G.T., M.J.M., M.T.D.), Genetics and Epigenetics in Health and Disease Unit, Genetic and Genomic Medicine Programme, UCL Institute of Child Health, London WC1N 1EH, United Kingdom; Department of Pediatrics and Child Health (K.N.H.), Aga Khan University, Karachi 74800, Pakistan; and Department of Biology (S.J.R.), Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
| | - J P G Turton
- Developmental Endocrinology Research Group (L.C.G., J.P.G.T., M.J.M., M.T.D.), Genetics and Epigenetics in Health and Disease Unit, Genetic and Genomic Medicine Programme, UCL Institute of Child Health, London WC1N 1EH, United Kingdom; Department of Pediatrics and Child Health (K.N.H.), Aga Khan University, Karachi 74800, Pakistan; and Department of Biology (S.J.R.), Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
| | - M J McCabe
- Developmental Endocrinology Research Group (L.C.G., J.P.G.T., M.J.M., M.T.D.), Genetics and Epigenetics in Health and Disease Unit, Genetic and Genomic Medicine Programme, UCL Institute of Child Health, London WC1N 1EH, United Kingdom; Department of Pediatrics and Child Health (K.N.H.), Aga Khan University, Karachi 74800, Pakistan; and Department of Biology (S.J.R.), Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
| | - S J Rhodes
- Developmental Endocrinology Research Group (L.C.G., J.P.G.T., M.J.M., M.T.D.), Genetics and Epigenetics in Health and Disease Unit, Genetic and Genomic Medicine Programme, UCL Institute of Child Health, London WC1N 1EH, United Kingdom; Department of Pediatrics and Child Health (K.N.H.), Aga Khan University, Karachi 74800, Pakistan; and Department of Biology (S.J.R.), Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
| | - M T Dattani
- Developmental Endocrinology Research Group (L.C.G., J.P.G.T., M.J.M., M.T.D.), Genetics and Epigenetics in Health and Disease Unit, Genetic and Genomic Medicine Programme, UCL Institute of Child Health, London WC1N 1EH, United Kingdom; Department of Pediatrics and Child Health (K.N.H.), Aga Khan University, Karachi 74800, Pakistan; and Department of Biology (S.J.R.), Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
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Humayun KN, Atiq M. Clinical profile and outcome of cyanotic congenital heart disease in neonates. J Coll Physicians Surg Pak 2008; 18:290-3. [PMID: 18541084 DOI: 05.2008/jcpsp.290293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Accepted: 03/07/2008] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the clinical profile and assess the outcome of all neonates diagnosed with cyanotic congenital heart disease. STUDY DESIGN A case series. PLACE AND DURATION OF STUDY The Aga Khan University Hospital from January 1998 to December 2000. PATIENTS AND METHODS Neonates admitted with diagnosis of cyanotic congenital heart disease were evaluated for clinical diagnosis, survival and mortality. RESULTS Forty four neonates met the inclusion criteria. Eleven babies (25%) had Tetralogy of Fallot or its variants. Other malformations were d-transposition of great arteries, tricuspid valve anomalies (tricuspid atresia and Ebstein's anomaly), hypoplastic left heart syndrome, truncus arteriosus, total anomalous pulmonary venous return and complex congenital heart disease like single ventricle. Twenty eight (63.6%) neonates survived and 16 (36.4%) expired during hospital stay. Cause of death was surgical in 2 cases and medical problems in 14 babies. CONCLUSION Tetralogy of Fallot or variants was the commonest cyanotic heart disease in neonates with frequency of 27.27%. Majority of neonates with congenital cyanotic heart disease showed survival with appropriate management.
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Affiliation(s)
- Khadija N Humayun
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan.
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