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Cha JH, Kang E, Na JY, Ryu S, Choi YJ, Kim JH. Growth trajectories of children born preterm and full term with low birth weight to preschool ages: A nationwide study. J Clin Endocrinol Metab 2024:dgae208. [PMID: 38563465 DOI: 10.1210/clinem/dgae208] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
CONTEXT Preterm (PT) and full term with low birth weight (FT-LBW) children are at a high-risk of poor growth outcomes. OBJECTIVE To investigate the growth trajectories of PT and FT-LBW children from birth to preschool ages. METHODS This study included 1,150,508 infants (PT, 41,454; FT-LBW, 38,250) who underwent the first three rounds (4-6, 9-12, and 18-24 months) of the National Health Screening Program for Infants and Children (NHSPIC). Growth measurements were obtained from the NHSPIC database and converted into Z-scores. Growth data at 2, 4, and 6 years old were measured as outcome variables. The impact of being born small on poor growth outcomes was investigated using a generalized estimating equation and Cox proportional-hazards regression analysis. RESULTS The median birth weights of the PT, FT-LBW, and full term (FT) groups were 2.3, 2.4, and 3.2 kg, respectively. The incidence of short stature (height Z-score < -2 standard deviation score [SDS]) and failure to thrive (FTT) (body mass index (BMI) Z-score < -2 SDS) was the highest in the FT-LBW group, followed by the PT and FT groups. At 4 years old, the incidence rates were 6.0% vs. 5.2% vs. 1.9% for short stature and 4.6% vs. 3.9% vs. 1.7% for FTT. The β estimate of height outcome was lower in both the PT (-0.326 SDS) and FT-LBW (-0.456 SDS) groups. CONCLUSIONS The FT-LBW group was consistently shorter and lighter throughout the preschool period than the PT group, highlighting the significance of growth monitoring in high-risk populations.
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Affiliation(s)
- Jong Ho Cha
- Department of Pediatrics, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Eungu Kang
- Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae Yoon Na
- Department of Pediatrics, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea
| | - Soorack Ryu
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea
| | - Young-Jin Choi
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Ja Hye Kim
- Department of Pediatrics, Asan Medical Centre Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
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He Q, Lin X, Zhou Z, Shen H, Ma K, Dou Z, Liu Y, Pan H, Li S. Failure to thrive in pediatric patients with congenital heart disease: a cross-sectional study of 13,256 patients. Lancet Reg Health West Pac 2024; 44:101002. [PMID: 38322730 PMCID: PMC10844746 DOI: 10.1016/j.lanwpc.2023.101002] [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] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/09/2023] [Accepted: 12/24/2023] [Indexed: 02/08/2024]
Abstract
Background The prevalence and risk factors for failure to thrive (FTT) in pediatric patients with congenital heart disease (CHD) remain ambiguous. We aimed to investigate the prevalence, growth profiles, risk factors, and vulnerable subtypes of CHD associated with FTT in pediatric patients with CHD. Methods This was a cross-sectional study based on Chinese Database for Congenital Heart Surgery. FTT was defined as either stunting or underweight (height or weight standard deviation score <-2), and they were standardized by references of normal Chinese population. Risk factors was determined with logistic regression model, and growth profiles were delineated in each subgroup. Findings A total of 13,256 CHD patients were included in this study, with 3994 patients of mild CHD, 7195 patients of moderate CHD and 2067 patients of complex CHD. The prevalence of stunting, underweight and FTT was 24%, 29.3% and 36.9%, respectively. Preoperative anaemia, left ventricle systolic dysfunction, younger age, more complex CHD types, lower birth weight and genetic syndrome were found to be the risk factors for FTT in CHD patients. Interrupted aortic arch was revealed to be the most severe group associated with FTT. Interpretation FTT is ubiquitous in patients with CHD and exacerbated in high-risk subgroups. Our findings hinted the necessity of early identification and intervention for FTT in patients with CHD during daily practice of pediatrics, as it has the potential to improve outcomes and enhance their quality of life. Furthermore, we advocate for the initiation of prospective research with longitudinal data to comprehensively investigate the association between FTT and CHD across the lifespan. Funding This study was supported by National High Level Hospital Research Funding (2022-GSP-GG-19), Capital Health Research and Development of Special Fund (2022-1-4032) and National Key R&D Program of China (2022YFC3600202 and 2022YFC3600203).
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Affiliation(s)
- Qiyu He
- Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Xinjie Lin
- Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Zhibo Zhou
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Huayan Shen
- Center of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Kai Ma
- Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Zheng Dou
- Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Yuze Liu
- Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shoujun Li
- Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
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Bharadwaj SK, Mathai SS, Bhargava S, Lewis LES. Chronic diarrhoea due to trichohepatoenteric syndrome (THES) in an infant. BMJ Case Rep 2024; 17:e257746. [PMID: 38383127 PMCID: PMC10882327 DOI: 10.1136/bcr-2023-257746] [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] [Indexed: 02/23/2024] Open
Abstract
An infant was admitted with suspected postinfectious malabsorption with watery diarrhoea, fever and failure to thrive. She had dehydration, acute kidney injury and metabolic acidosis, which were corrected with intravenous fluids and managed with empiric antibiotics and prophylactic antifungals. She also developed Escherichia coli sepsis, meningitis and Candida skin infections during hospitalisation, which were treated according to the culture reports. Intrauterine growth restriction, woolly hair and a broad nasal bridge with chronic refractory diarrhoea prompted genetic testing to rule out syndromic diarrhoea. Whole-exome sequencing revealed a pathogenic compound heterozygous mutation causing trichohepatoenteric syndrome. She succumbed to severe infections at 80 days of life. The condition is rare, and no established guidelines or specific treatments exist; the focus is to promote optimal growth through parenteral nutrition, elemental formula and infection control. Early suspicion and molecular genetic testing can help reduce the time to diagnosis, treatment and genetic counselling.
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Affiliation(s)
| | | | - Smriti Bhargava
- Pediatrics, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Moscoso J, Serôdio M, Prior AR. Acute renal failure as a key to significant neonatal weight loss. BMJ Case Rep 2024; 17:e256947. [PMID: 38355203 PMCID: PMC10868399 DOI: 10.1136/bcr-2023-256947] [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] [Indexed: 02/16/2024] Open
Abstract
We present a case of a male neonate who experienced a 13.5% weight loss at 96 hours of life, despite receiving adequate calorie intake and exhibiting no feeding difficulties. The pregnancy was uneventful, and maternal serological investigation was normal. A routine ultrasound at 34 weeks of gestational age revealed late oligohydramnios. The neonate was delivered at 35 weeks of gestational age by forceps, weighing 2600 g. Physical examination disclosed bilateral cryptorchidism. Laboratory studies unveiled acute kidney injury (AKI) with hyperkalaemia. Renal ultrasound revealed bilateral hydronephrosis and renal dysplasia with pyelocalyceal dilatation. Despite early recognition and treatment, the newborn developed chronic kidney disease (CKD). AKI is an important and under-recognised cause of significant neonatal weight loss.This case underscores the significance of considering AKI as a potential and under-recognised cause of neonatal weight loss. It emphasises the importance of maintaining a high clinical suspicion for early AKI diagnosis to mitigate the risk of progression to CKD.
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Affiliation(s)
- Joana Moscoso
- Pediatrics, Hospital de São Francisco Xavier, Lisboa, Portugal
| | | | - Ana Rita Prior
- Pediatrics, Hospital de São Francisco Xavier, Lisboa, Portugal
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Robyn S, Veronica N, Stephen B, Joanne P. Undernutrition in young children with congenital heart disease undergoing cardiac surgery in a low-income environment. BMC Pediatr 2024; 24:73. [PMID: 38262979 PMCID: PMC10804775 DOI: 10.1186/s12887-023-04508-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Malnutrition (undernutrition) in children with congenital disease (CHD) is a notable concern, with preoperative and persistent growth failure post-cardiac surgery contributing to poorer outcomes. Poor growth in children with CHD in low-income environments is exacerbated by feeding difficulties, poverty, delayed diagnosis, and late corrective surgery. This study describes and compares the growth of young children with CHD undergoing cardiac surgery in central South Africa from before to 6-months after cardiac surgery. METHODS Children 30 months and younger, with their mothers, were included in this prospective observational descriptive study. Weight- height-, and head circumference-for-age z-scores were used to identify children who were underweight, stunted and microcephalic. Z-scores for growth indices were compared from baseline to 3-months and 6-months post-cardiac surgery. Changes in growth over time were calculated using a 95% confidence interval on the difference between means. Linear regression was used to determine the association between growth and development, health-related quality of life and parenting stress respectively. RESULTS Forty mother-child pairs were included at baseline. Most children (n = 30) had moderate disease severity, with eight children having cyanotic defects. A quarter of the children had Down syndrome (DS). Twenty-eight children underwent corrective cardiac surgery at a median age of 7.4 months. Most children (n = 27) were underweight before cardiac surgery [mean z-score - 2.5 (±1.5)], and many (n = 18) were stunted [mean z-score - 2.2 (±2.5)]. A quarter (n = 10) of the children had feeding difficulties. By 6-months post-cardiac surgery there were significant improvements in weight (p = 0.04) and head circumference (p = 0.02), but complete catch-up growth had not yet occurred. Malnutrition (undernutrition) was strongly associated (p = 0.04) with poorer motor development [Mean Bayley-III motor score 79.5 (±17.5)] before cardiac surgery. Growth in children with cyanotic and acyanotic defects, and those with and without DS were comparable. CONCLUSION Malnutrition (undernutrition) is common in children with CHD in central South Africa, a low-income environment, both before and after cardiac surgery, and is associated with poor motor development before cardiac surgery. A diagnosis of CHD warrants regular growth monitoring and assessment of feeding ability. Early referral for nutritional support and speech therapy will improve growth outcomes.
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Affiliation(s)
- Smith Robyn
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- School of Health and Rehabilitation Sciences, University of the Free State, Bloemfontein, South Africa.
| | - Ntsiea Veronica
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Brown Stephen
- Department of Pediatrics and Child Health, University of the Free State, Bloemfontein, South Africa
| | - Potterton Joanne
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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6
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Elswick S, West K, Hirschi M, Durham A, Bowden M, Yaun J. The social work discipline in the management of Failure to thrive in infants and children: an integrated behavioral health approach to pediatric programming. Soc Work Health Care 2024; 63:131-153. [PMID: 37997949 DOI: 10.1080/00981389.2023.2286243] [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] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/07/2023] [Indexed: 11/25/2023]
Abstract
Failure to thrive (FTT) is a DSM-5/ICD-10 diagnosis which describes infants and children who fail to grow within expected norms. The causes for poor growth are multifactorial and often include psychosocial factors. Social workers are important players in an interdisciplinary team approach to this diagnosis. This research and manuscript focus on the use of an integrated infant mental health pediatric model of practice, and outcomes for one case study. The article will review the social worker's role in the treatment of FTT, effective social work services provided in an integrated behavioral health approach, and a review of a cost-benefit analysis of treatment of FTT in a Primary Care Facility verses a hospital setting.
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Affiliation(s)
- Susan Elswick
- School of Social Work, University of Memphis, Memphis, USA
| | - Kayla West
- School of Social Work, University of Memphis, Memphis, USA
| | | | - Abigail Durham
- School of Social Work, University of Memphis, Memphis, USA
| | - Michelle Bowden
- Methodist LeBonheur, Outpatient Pediatric Clinic, Memphis, USA
| | - Jason Yaun
- Methodist LeBonheur, Outpatient Pediatric Clinic, Memphis, USA
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Kamali F, Jamee M, Sayer JA, Sadeghi-Bojd S, Golchehre Z, Dehghanzad R, Keramatipour M, Mohkam M. Intestinal hypomagnesemia in an Iranian patient with a novel TRPM6 variant: a case report and review of the literature. CEN Case Rep 2023; 12:413-418. [PMID: 36967423 PMCID: PMC10620355 DOI: 10.1007/s13730-023-00785-8] [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: 09/24/2022] [Accepted: 03/13/2023] [Indexed: 03/28/2023] Open
Abstract
TRPM6 is predominantly expressed in the kidney and colon and encodes a protein containing an ion channel domain and a protein kinase domain. It is crucial for magnesium homeostasis and plays important roles in epithelial magnesium transport and the active magnesium absorption. In this study, we present a 70-day-old Iranian female patient from consanguineous parents with hypomagnesemia and secondary hypocalcemia. She presented with seizures 19 days after birth and refractory watery non-bloody diarrhea. She consequently had failure to thrive. Other features included hypotonia, wide anterior fontanel, ventriculomegaly, and pseudotumor cerebri following administration of nalidixic acid. She had severe hypomagnesemia and hypocalcemia which were treated with magnesium and calcium supplementation. Despite initial unstable response to supplemental magnesium, she eventually improved and the diarrhea discontinued. The patient was discharged by magnesium and calcium therapy. At the last follow-up at age 2.5 years, the patient remained well without any recurrence or complication. Genetic testing by whole-exome sequencing revealed a novel homozygous frameshift insertion-deletion (indel) variant in exon 26 of the TRPM6 gene, c.3693-3699del GCAAGAG ins CTGCTGTTGACATCTGCT, p.L1231Ffs*36. Segregation analysis revealed the TRPM6 heterozygous variant in both parents. Patients with biallelic TRPM6 pathogenic variants typically exhibit hypomagnesemia with secondary hypocalcemia and present with neurologic manifestations including seizures. In some patients, this is also complicated by chronic diarrhea and failure to thrive. Long-term complications are rare and most of the patients show a good prognosis with supplemental magnesium therapy.
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Affiliation(s)
- Farnaz Kamali
- Pediatric Nephrology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahnaz Jamee
- Pediatric Nephrology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - John A Sayer
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Central Parkway, Newcastle Upon Tyne, NE1 3BZ, UK
- Renal Services, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle Upon Tyne, NE45PL, Tyne and Wear, UK
| | - Simin Sadeghi-Bojd
- Genetics of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zahra Golchehre
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Dehghanzad
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Keramatipour
- Watson Genetic Laboratory, North Kargar Street, Tehran, Iran.
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Masoumeh Mohkam
- Pediatric Nephrology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Han X, Lu S, Gu C, Bian Z, Xie X, Qiao X. Clinical features, epidemiology, and treatment of Shwachman-Diamond syndrome: a systematic review. BMC Pediatr 2023; 23:503. [PMID: 37803383 PMCID: PMC10557232 DOI: 10.1186/s12887-023-04324-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Shwachman-Diamond syndrome (SDS) is an autosomal recessive disease which results in inherited bone marrow failure (IBMF) and is characterized by exocrine pancreatic dysfunction and diverse clinical phenotypes. In the present study, we reviewed the internationally published reports on SDS patients, in order to summarize the clinical features, epidemiology, and treatment of SDS. METHODS We searched the WangFang and China National Knowledge Infrastructure databases with the keywords "Shwachman-Diamond syndrome," "SDS," "SBDS gene" and "inherited bone marrow failure" for relevant articles published from January 2002 to October 2022. In addition, studies published from January 2002 to October 2022 were searched from the Web of Science, PubMed, and MEDLINE databases, using "Shwachman-diamond syndrome" as the keyword. Finally, one child with SDS treated in Tongji Hospital was also included. RESULTS The clinical features of 156 patients with SDS were summarized. The three major clinical features of SDS were found to be peripheral blood cytopenia (96.8%), exocrine pancreatic dysfunction (83.3%), and failure to thrive (83.3%). The detection rate of SDS mutations was 94.6% (125/132). Mutations in SBDS, DNAJC21, SRP54, ELF6, and ELF1 have been reported. The male-to-female ratio was approximately 1.3/1. The median age of onset was 0.16 years, but the diagnostic age lagged by a median age of 1.3 years. CONCLUSIONS Pancreatic exocrine insufficiency and growth failure were common initial symptoms. SDS onset occurred early in childhood, and individual differences were obvious. Comprehensive collection and analysis of case-related data can help clinicians understand the clinical characteristics of SDS, which may improve early diagnosis and promote effective clinical intervention.
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Affiliation(s)
- Xue Han
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China
| | - Shuanglong Lu
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China
| | - Changjuan Gu
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China
| | - Zhuli Bian
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China
| | - Xiaotian Xie
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China
| | - Xiaohong Qiao
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China.
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Sethi SK, Mohan N, Rana A, Bagoria G, Soni K, Sharma V, Nair A, Savita S, Bansal SB, Raina R. A child with chronic kidney disease and hepatic dysfunction: Questions. Pediatr Nephrol 2023; 38:3275-3276. [PMID: 37405490 DOI: 10.1007/s00467-023-05924-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Sidharth Kumar Sethi
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India, 122001.
| | - Neelam Mohan
- Pediatric Gastroenterology & Hepatology, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | - Alka Rana
- Department of Pathology, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | - Gaurav Bagoria
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | - Kritika Soni
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | - Vivek Sharma
- Department of Radiology, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | - Aishwarya Nair
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | - Savita Savita
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | | | - Rupesh Raina
- Pediatric Nephrology, Akron Children's Hospital, Akron, Cleveland, OH, USA
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Sethi SK, Mohan N, Rana A, Bagoria G, Soni K, Sharma V, Nair A, Savita S, Bansal SB, Raina R. A child with chronic kidney disease and hepatic dysfunction: Answers. Pediatr Nephrol 2023; 38:3277-3279. [PMID: 37405491 DOI: 10.1007/s00467-023-05949-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Sidharth Kumar Sethi
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India, 122001.
| | - Neelam Mohan
- Pediatric Gastroenterology & Hepatology, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | - Alka Rana
- Department of Pathology, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | - Gaurav Bagoria
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | - Kritika Soni
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | - Vivek Sharma
- Department of Radiology, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | - Aishwarya Nair
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | - Savita Savita
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | | | - Rupesh Raina
- Pediatric Nephrology, Akron Children's Hospital, Akron, Cleveland, OH, USA
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Sabljak J, Heath O, Halligan R, Cheng DR. Histologically atypical case of Gaucher disease type 1. BMJ Case Rep 2023; 16:e256368. [PMID: 37775277 PMCID: PMC10546139 DOI: 10.1136/bcr-2023-256368] [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] [Indexed: 10/01/2023] Open
Abstract
This report presents a case of childhood Gaucher disease type 1, a rare inherited metabolic disorder. Although the clinical symptoms were classical, the histological findings in this case were atypical and initially led to diagnostic uncertainty. The pathognomonic histological finding on bone marrow is Gaucher cells, which are lipid-engorged phagocytes secondary to the accumulation of glucosylceramide. These cells typically demonstrate diffuse and avid iron staining using a Prussian blue iron stain. In this case, although the histiocytes seen on bone marrow were abnormal, the absence of iron staining on bone marrow led to a large range of other diagnoses being considered. In retrospect, this anomaly was likely in the setting of prolonged iron deficiency and anaemia as a result of the insidious nature of this presentation. The prognosis of type 1 Gaucher disease is favourable, with current treatments significantly improving duration and quality of life. We explore the utility of a collaborative multidisciplinary approach in addressing diagnostic uncertainty and the importance in making a diagnosis for Gaucher disease type 1 in order to provide appropriate and targeted treatment.
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Affiliation(s)
- Jessica Sabljak
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Oliver Heath
- Department of Metabolic Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Rebecca Halligan
- Department of Metabolic Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Daryl R Cheng
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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Vardhan A, Singh D, Tripathi S, Kumar M, Singhai A. Congenital myopathy presenting as recurrent pneumonia with lung collapse and pulmonary artery hypertension. BMJ Case Rep 2023; 16:e255502. [PMID: 37739444 PMCID: PMC10533661 DOI: 10.1136/bcr-2023-255502] [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] [Indexed: 09/24/2023] Open
Abstract
A boy presented with cough, breathlessness for 1 month, fever for 1 week with similar previous episodes without hospitalisation. He had generalised muscle wasting, acute chronic malnutrition and required immediate ventilation. Provisional diagnosis of recurrent pneumonia with failure to thrive was made. As serial chest X-rays showed recurrent lung collapse, congenital lung anomalies were ruled out. 2D-echocardiography showed pulmonary arterial hypertension. Workup for congenital immunodeficiency and cystic fibrosis was negative. There was no improvement in muscle mass despite total parenteral nutrition. He was noticed to have myopathic facies. History was reviewed when the mother reported reduced fetal movements in this pregnancy. The patient had low voice amplitude. Creatine kinase levels were normal. Muscle biopsy followed by whole exome sequencing identified frameshift duplication NM_020451.3(SELENON):c.249_250dupGG (p.Asp84Glyfs*17), thus, confirming diagnosis of SEPN1-related congenital myopathy (CM) with fibre-type disproportion. Respiratory system involvement was distracter, emphasising consideration of CM while evaluating persistent lung collapse with muscle wasting.
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Affiliation(s)
- Anand Vardhan
- Pediatrics, King George Medical College, Lucknow, Uttar Pradesh, India
| | - Devina Singh
- Pediatrics, King George Medical College, Lucknow, Uttar Pradesh, India
| | - Shalini Tripathi
- Pediatrics, King George Medical College, Lucknow, Uttar Pradesh, India
| | - Mala Kumar
- Pediatrics, King George Medical College, Lucknow, Uttar Pradesh, India
| | - Atin Singhai
- Pathology, King George Medical College, Lucknow, Uttar Pradesh, India
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Sharma A, Swarnkar B, Sethuraman G. Hutchinson-Gilford progeria. BMJ Case Rep 2023; 16:e256203. [PMID: 37723091 PMCID: PMC10510932 DOI: 10.1136/bcr-2023-256203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Affiliation(s)
- Ananya Sharma
- Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavya Swarnkar
- Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Gomathy Sethuraman
- Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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14
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Bagga N, Panigrahi N, Germain A, Namazova I, Rahman MM, Saugstad OD, Maheshwari A. Extrauterine Growth Restriction: Need for an Accurate Definition. Newborn (Clarksville) 2023; 2:198-202. [PMID: 37974930 PMCID: PMC10653204 DOI: 10.5005/jp-journals-11002-0072] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Neonates show considerable variation in growth that can be recognized through serial measurements of basic variables such as weight, length, and head circumference. If possible, measurement of subcutaneous and total body fat mass can also be useful. These biometric measurements at birth may be influenced by demographics, maternal and paternal anthropometrics, maternal metabolism, preconceptional nutritional status, and placental health. Subsequent growth may depend on optimal feeding, total caloric intake, total metabolic activity, genetic makeup, postnatal morbidities, medications, and environmental conditions. For premature infants, these factors become even more important; poor in utero growth can be an important reason for spontaneous or induced preterm delivery. Later, many infants who have had intrauterine growth restriction (IUGR) and are born small for gestational age (SGA) continue to show suboptimal growth below the 10th percentile, a condition that has been defined as extrauterine growth restriction (EUGR) or postnatal growth restriction (PNGR). More importantly, a subset of these growth-restricted infants may also be at high risk of abnormal neurodevelopmental outcomes. There is a need for well-defined criteria to recognize EUGR/PNGR, so that correctional steps can be instituted in a timely fashion.
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Affiliation(s)
- Nitasha Bagga
- Department of Neonatology, Rainbow Children’s Hospital, Hyderabad, Telangana, India; Global Newborn Society, Maryland, United States of America
| | - Nalinikanta Panigrahi
- Department of Neonatology, Rainbow Children’s Hospital, Hyderabad, Telangana, India; Global Newborn Society, Maryland, United States of America
| | - Aaron Germain
- Department of Neonatology, Johns Hopkins All Children’s Maternal, Fetal, and Neonatal Institute, St. Petersburg, Florida, United States of America
| | - Ilhama Namazova
- Department of Pediatrics, Azərbaycan Tibb Universiteti, Baku, Azerbaijan; Global Newborn Society, Maryland, United States of America
| | - Md Mozibur Rahman
- Department of Neonatology, Institute of Child and Mother Health, Dhaka, Bangladesh
| | | | - Akhil Maheshwari
- Department of Neonatology and Pediatrics, Louisiana State University Health Sciences Center – Shreveport, Louisiana, United States of America
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15
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Tavares LS, Pinho RS, Aragão MM, Cappellano AM, Dastoli PA, Cavalheiro S, da Silva NS. Diencephalic syndrome-like presentation of brainstem tumor: a series case-based review. Childs Nerv Syst 2023. [PMID: 36752912 DOI: 10.1007/s00381-023-05869-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/28/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE Russel described a rare clinical entity known as diencephalic syndrome (DS) in 1951, which was traditionally caused by a neoplasm in the hypothalamic-optic chiasmatic region. DS is characterized by severe emaciation despite adequate or slightly reduced caloric intake, locomotor hyperactivity, euphoria and other minor features. Current evidence suggests that a rare population of children with a similar phenotype may have their tumor located in the posterior fossa instead, defining the DS-like presentation, a rare entity with few cases reported in the literature. METHODS A thorough search of three databases (PubMed, Ovid Medline, and Ovid Embase) was conducted to identify relevant papers reporting children with DS associated with brainstem tumors. To our knowledge, only seven cases have been documented in the literature. Moreover, we present four of our own cases, focusing on the unusual clinical presentation, the diagnosis process, and the lag time between the initial symptoms and the definitive diagnosis. RESULTS In this review, the mean lag time between the onset of symptoms and diagnosis was 20.9 months (median: 16 months; range: 1.5-72 months), whereas in our series of cases, the time was 32.5 months (median: 33 months; range: 7-57 months). CONCLUSION Despite recent significant advances in neuro-oncology diagnostic tools, this mean lag time did not improve when compared with the previous literature review from 1976. Throughout these data, we aim to raise awareness in the hopes of detecting intracranial neoplasms earlier in cases of children with profound emaciation of unknown cause.
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Votto M, Lenti MV, De Silvestri A, Bertaina F, Bertozzi M, Caimmi S, Cereda E, De Filippo M, Di Sabatino A, Klersy C, Raffaele A, Riccipetitoni G, Marseglia GL, Licari A, Brambilla I. Evaluation of diagnostic time in pediatric patients with eosinophilic gastrointestinal disorders according to their clinical features. Ital J Pediatr 2023; 49:9. [PMID: 36647148 PMCID: PMC9841131 DOI: 10.1186/s13052-023-01410-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Eosinophilic gastrointestinal disorders (EGIDs) are chronic/remittent inflammatory diseases associated with a substantial diagnostic delay, often attributable to misdiagnosis and variable clinical presentation in adults. In the pediatric population, few studies have been conducted worldwide reporting EGID diagnostic delay and its consequences on patients. This study aims to analyze and identify potential clinical factors and complications associated with a longer diagnostic time. We performed a retrospective analysis of pediatric patients with EGIDs followed at the Center for Pediatric EGIDs in Pavia, Italy. A total of 60 patients with EGIDs were enrolled. Thirty-nine (65%) patients had EoE, and 21 (35%) non-esophageal EGIDs. EGID diagnosis was achieved about 2 years after the symptom onset, and the median diagnostic time was 12 months (IQR 12-24 months). Diagnostic time was 12 months (IQR 12-69) in non-esophageal EGIDs and 12 months (IQR 4-24 months) in EoE patients. EoE patients presenting with FTT and feeding issues experienced a longer diagnostic time (p = 0.02 and p = 0.05, respectively) than children without growth and feeding impairments.In this study, symptoms appeared about 2 years before the definitive EGID diagnosis was reached, and this diagnostic time was shorter than the delay observed in other published studies. Especially in EoE children, the diagnostic time is significantly associated with impaired child growth, highlighting the importance of an early diagnosis to prevent esophageal stenosis and failure to thrive.
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Affiliation(s)
- Martina Votto
- grid.8982.b0000 0004 1762 5736Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Marco Vincenzo Lenti
- grid.8982.b0000 0004 1762 5736First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Annalisa De Silvestri
- grid.419425.f0000 0004 1760 3027Scientific Direction, Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Bertaina
- grid.8982.b0000 0004 1762 5736Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mirko Bertozzi
- grid.8982.b0000 0004 1762 5736Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy ,grid.419425.f0000 0004 1760 3027Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS-Policlinico San Matteo, Pavia, Italy
| | - Silvia Caimmi
- grid.419425.f0000 0004 1760 3027Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuele Cereda
- grid.419425.f0000 0004 1760 3027Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Maria De Filippo
- grid.8982.b0000 0004 1762 5736Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy ,grid.419425.f0000 0004 1760 3027Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Di Sabatino
- grid.8982.b0000 0004 1762 5736First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- grid.419425.f0000 0004 1760 3027Scientific Direction, Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Raffaele
- grid.419425.f0000 0004 1760 3027Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS-Policlinico San Matteo, Pavia, Italy
| | - Giovanna Riccipetitoni
- grid.8982.b0000 0004 1762 5736Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy ,grid.419425.f0000 0004 1760 3027Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS-Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- grid.8982.b0000 0004 1762 5736Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy ,grid.419425.f0000 0004 1760 3027Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amelia Licari
- grid.8982.b0000 0004 1762 5736Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy ,grid.419425.f0000 0004 1760 3027Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Brambilla
- grid.8982.b0000 0004 1762 5736Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy ,grid.419425.f0000 0004 1760 3027Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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17
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Ledger ML, Kaare M, Mailo JA, Jain-Ghai S. Phenotype expansion and neurological manifestations of neurobehavioural disease caused by a variant in RFX7. Eur J Med Genet 2023; 66:104657. [PMID: 36334883 DOI: 10.1016/j.ejmg.2022.104657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/14/2022] [Revised: 09/20/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
The RFX7 gene is one of eight genes within the regulatory factor X family. RFX7 is highly expressed in the brain and plays an important role in cell maturation and differentiation. It has only recently been implicated in disease in humans. Reports from 15 individuals have described RFX-associated phenotype as a neurobehavioural disease, manifesting primarily with global developmental delay and intellectual disability. Autism spectrum disorder and attention deficit hyperactivity disorder have also been described in some children. Here we report a case of a 19-month-old with a de novo missense variant in RFX7 resulting in severe global developmental delay including significant speech delay, microcephaly, dyskinetic movements, and failure to thrive. This is the first association between variants in RFX7 and failure to thrive, expanding the phenotype of this newly described gene. In this report we will also show RFX7 associated progressive central nervous system involvement through serial brain imaging.
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Affiliation(s)
- Marissa L Ledger
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Milja Kaare
- Blueprint Genetics, A Quest Diagnostics Company, Espoo, Finland
| | - Janette A Mailo
- Department of Pediatrics, Division of Pediatric Neurology, University of Alberta, Edmonton, AB, Canada
| | - Shailly Jain-Ghai
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
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18
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Bahraini A, Purcell LN, Cole K, Koonce R, Richardson L, Trembath A, deJong N, Sutton A, Hayes AA, Phillips MR. Failure to thrive, oral intake, and inpatient status prior to gastrostomy tube placement in the first year of life is associated with persistent use 1-year later. J Pediatr Surg 2022; 57:723-727. [PMID: 35400490 DOI: 10.1016/j.jpedsurg.2022.03.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gastrostomy tube (GT) placement is a common procedure in infants (≤1-year-old). There is variation in patient selection and a paucity of studies examining which patients require long term enteral access. The objective of this study was to assess demographic and clinical factors associated with persistent GT use (PGU) at 1-year after placement. METHODS We performed a single-institution retrospective review of patients ≤1-year-old who underwent GT placement from January 31, 2014, and January 31, 2020, using institutional NSQIP-P data supplemented with chart review. Multivariable logistic regression analysis was performed to identify factors associated with PGU. Clinical predictors were selected a priori, and a p-value less than 0.05 was used to detect a significant association. RESULTS 140 patients were included, and 118 had a 1-year follow-up. At 1-year following GT placement, 38 patients had weaned from their GT (32.2%). Failure to thrive (FTT), and inpatient admission prior to surgery are associated with increased odds of PGU at 1-year after surgery, OR: 5.19 and 6.02, respectively. There is an inverse association between the percentage of feeds taken by mouth at the time of surgery and the odds of PGU at 1-year (OR: 0.03). CONCLUSION Patients who have FTT (documented prior to surgery) or an inpatient admission prior to GT had a higher odds of PGU at 1-year post-op. Additionally, the amount taken by mouth at the time of GT placement was inversely related to PGU. These factors are important in determining the need for a surgical gastrostomy tube. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Anoosh Bahraini
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Laura N Purcell
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Kristen Cole
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Robin Koonce
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Lisa Richardson
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Andrea Trembath
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Neal deJong
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Ashley Sutton
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Andrea A Hayes
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Michael R Phillips
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA.
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19
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Kim R, Ye X, Sanchez-Lara PA, Puliyanda D, Kumar S, Pizzo H. Failure to thrive in an 8-month-old female: Questions. Pediatr Nephrol 2022:10.1007/s00467-022-05778-w. [PMID: 36315272 DOI: 10.1007/s00467-022-05778-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 07/13/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Romina Kim
- Pediatric Hospital Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste 4221, Los Angeles, CA, 90048, USA.
| | - XinYi Ye
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | | | - Dechu Puliyanda
- Pediatric Nephrology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Sanjeev Kumar
- Nephrology Cedars-Sinai Medical Center, Los Angeles, USA
| | - Helen Pizzo
- Pediatric Nephrology, Cedars-Sinai Medical Center, Los Angeles, USA
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20
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Ju Y, Liu P, Li L, Zhou L, Liu X, He J. Diencephalic syndrome in a female child due to intracranial germinoma: a case report. Childs Nerv Syst 2022; 38:2033-2035. [PMID: 35507081 DOI: 10.1007/s00381-022-05528-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/11/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Diencephalic syndrome (DS) is a rare syndrome with failure to thrive (FTT) as the primary manifestation, which is often associated with astrocytoma or glioma and rarely caused by germinoma. To our knowledge, there are no reports of female patients presenting with DS secondary to germinoma. CASE REPORT we report a case (an 11-year-old girl) of diencephalic syndrome presenting with FTT. She was diagnosed with severe malnutrition in the local hospital two years before admission and still did not show normal development after long-term nutritional support. Finally, after ruling out increased metabolism, inadequate caloric intake, and nutrient absorption, intracranial MRI showed a space-occupying lesion in the suprasellar cisterna-hypothalamus area. After excluding other causes of FTT, a biopsy was performed for pathological examination and demonstrated a germinoma. An excellent therapeutic effect was achieved during the three-month follow-up after radiotherapy. CONCLUSION This case reminds us that intracranial tumors should be considered an indispensable etiology for patients with suspicious FTT, and early diagnosis and intervention may achieve a good prognosis.
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Affiliation(s)
- Yan Ju
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Peng Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Li Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Liangxue Zhou
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaoyin Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jiaojiang He
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China.
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Trapani S, Bortone B, Bianconi M, Rubino C, Sardi I, Lionetti P, Indolfi G. Diencephalic syndrome in childhood, a challenging cause of failure to thrive: miniseries and literature review. Ital J Pediatr 2022; 48:147. [PMID: 35978327 PMCID: PMC9387003 DOI: 10.1186/s13052-022-01316-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/04/2022] [Indexed: 11/15/2022] Open
Abstract
The aim of our study was to better define the clinical pattern of diencephalic syndrome, a rare but potentially lethal cause of failure to thrive in infancy. Poor weight gain or weight loss, the characteristic presenting feature, often firstly attributed to gastrointestinal or endocrinological or genetic diseases, is secondary to a malfunctioning hypothalamus, caused by a diencephalic tumor. Due to its unexpected clinical onset, diagnostic delay and misdiagnosis are common. We described a case series of 3 children with diencephalic syndrome admitted at our Hospital, over a 5-year period. Furthermore, a narrative review on all pediatric cases published in the last seventy years was performed. Clinical pattern, timing to diagnosis, neuroimaging, management, and outcome were analyzed. Our three cases are singularly described in all clinical and diagnostic findings. Overall, 100 children were selected; all these cases as well as our children presented with failure to thrive: 96% had body mass index or weight-length/height ratio lower than 5th percentile. Vomiting and hyperactivity are reported in 35 and 26% of cases, respectively. The neurological features, mainly nystagmus reported in 43%, may occur late in the disease course. In conclusion, the diagnostic delay is the hallmark of diencephalic syndrome, confirming the lack of knowledge by clinicians. The poor weight gain/loss despite adequate length growth and food intake, especially in children with hyperactivity and good psychomotor development, should alert pediatricians towards this condition, before neurological signs/symptoms occurrence.
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Affiliation(s)
- Sandra Trapani
- Department of Health Sciences, Pediatric Unit, Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy.
| | - Barbara Bortone
- Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Martina Bianconi
- Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Chiara Rubino
- Pediatric Unit, Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Iacopo Sardi
- Neuro-Oncology Unit, Department of Pediatric Medicine, Meyer Children's Hospital, Florence, Italy
| | - Paolo Lionetti
- NEUROFARBA Department, Gastroenterology and Nutrition Unit, University of Florence, Meyer Children's Hospital, Viale Pieraccini, 24, 50139, Florence, Italy
| | - Giuseppe Indolfi
- NEUROFARBA Department, Pediatric Unit, Meyer Children's Hospital, University of Florence, Viale Pieraccini 24, 50139, Florence, Italy
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22
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Landolfo F, De Rose DU, Columbo C, Valfrè L, Massolo AC, Braguglia A, Capolupo I, Bagolan P, Dotta A, Morini F. Growth and morbidity in infants with Congenital Diaphragmatic Hernia according to initial lung volume: A pilot study. J Pediatr Surg 2022; 57:643-648. [PMID: 34281708 DOI: 10.1016/j.jpedsurg.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/25/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 11/28/2022]
Abstract
Background In congenital diaphragmatic hernia (CDH) survivors, failure to thrive is a well-known complication, ascribed to several factors. The impact of lung volume on growth of CDH survivors is poorly explored. Our aim was to evaluate if, in CDH survivors, lung volume (LV) after extubation correlates with growth at 12 and 24 months of life. Methods LV (measured as functional residual capacity-FRC) was evaluated by multibreath washout traces with an ultrasonic flowmeter and helium gas dilution technique, shortly after extubation. All CDH survivors are enrolled in a dedicated follow-up program. For the purpose of this study, we analyzed the correlation between FRC obtained shortly after extubation and anthropometric measurements at 12 and 24 months of age. We also compared growth between infants with normal lungs and those with hypoplasic lungs according to FRC values. A p < 0.05 was considered as statistically significant. Results We included in the study 22 CDH survivors who had FRC analyzed after extubation and auxological follow-up at 12 and 24 months of age. We found a significant correlation between FRC and weight Z-score at 12 months, weight Z-score at 24 months and height Z-score at 24 months. We also demonstrated that CDH infants with hypoplasic lungs had a significantly lower weight at 12 months and at 24 months and a significantly lower height at 24 months, when compared to infants with normal lungs. Conclusion We analyzed the predictive value of bedside measured lung volumes in a homogeneous cohort of CDH infants and demonstrated a significant correlation between FRC and growth at 12 and 24 months of age. An earlier identification of patients that will require an aggressive nutritional support (such as those with pulmonary hypoplasia) may help reducing the burden of failure to thrive.
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Affiliation(s)
- Francesca Landolfo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy.
| | - Claudia Columbo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Laura Valfrè
- Neonatal Surgery Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Anna Claudia Massolo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Annabella Braguglia
- Neonatal Intermediate Care Unit and Follow-up, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Irma Capolupo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Pietro Bagolan
- Neonatal Surgery Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Francesco Morini
- Neonatal Surgery Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
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Schneider AL, Köhler H, Röthlisberger B, Grobholz R, McLin VA. Sodium taurocholate co-transporting polypeptide deficiency. Clin Res Hepatol Gastroenterol 2022; 46:101824. [PMID: 34757153 DOI: 10.1016/j.clinre.2021.101824] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/25/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Little is known about bile acid transporter defects on the basolateral side of hepatocytes. In 2015 Vaz et al. published a first case of SLC10A1 mutation causing Na-taurocholate Co-transporting Polypeptide deficiency with hypercholanemia and normal bilirubin and Autotaxin levels. The index patient presented with failure to thrive, but without pruritus or jaundice. Several new cases have been published since, but the full spectrum of clinical presentation of mutations in SLC10A is not known. The primary aim of this review is to report a patient with a novel homozygous mutation and discuss the findings in the light of all other reported cases to date. MATERIAL AND METHODS We describe the findings of a patient with a previously unreported homozygous mutation and review all published cases to date in English on PubMed. RESULTS Our female patient born in 2002 presented with a feeding disorder and failure to thrive akin to the first description by Vaz. Workup suggested underlying liver disease although she did not complain of pruritus. Serum levels of aminotransferases, alkaline phosphatase, gamma-glutamyl transferase and bilirubin were normal. Plasma bile acids were chronically elevated, up to 150-fold. A first liver biopsy performed at 2 years of age showed unspecific findings with focal steatosis. Ursodeoxycholic acid treatment was introduced and the liver panel monitored regularly. At age 14, a second biopsy was performed, and histology was within normal limits. At this time, serum Autotaxin levels were found to be in normal range. Finally, genetic analysis revealed a homozygous 5 bp deletion in the gene SLC10A1 resulting in a premature stop codon predicted to lead to a complete NTCP loss of function. Most other reported cases to date carry the c.800C>T (p.Ser267Phe) mutation and are asymptomatic. DISCUSSION NTCP deficiency appears to have a benign course as most patients are asymptomatic. Many patients seem to present with transient neonatal jaundice. Large variations in total plasma bile acid levels are observed between patients; they may be linked to the underlying genetic mutation or to yet uncharacterized compensatory mechanisms. Longer follow-up is needed to evaluate the long-term consequences of this newly identified inherited disease of bile acid transport.
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Affiliation(s)
- A L Schneider
- Swiss Pediatric Liver Center, Division of Pediatric Specialties, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.
| | - H Köhler
- Department of Pediatrics, Hospital of Aarau, Switzerland
| | - B Röthlisberger
- Laboratory for human genetic testing and genetic counselling, Zurich
| | - R Grobholz
- Department of Pathology, Hospital of Aarau, Switzerland
| | - V A McLin
- Swiss Pediatric Liver Center, Division of Pediatric Specialties, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
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Jat NK, Bhagwani D, Bhutani N, Sharma U, Sharma R, Gupta R. Assessment of the prevalence of congenital heart disease in children with pneumonia in tertiary care hospital: A cross-sectional study. Ann Med Surg (Lond) 2022; 73:103111. [PMID: 34976377 PMCID: PMC8683668 DOI: 10.1016/j.amsu.2021.103111] [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] [Received: 08/19/2021] [Revised: 11/21/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pneumonia is the most common cause of death in children under five years of age. Epidemiological factors and the disease burden differ in developing and industrialized countries. The present study is a cross sectional observational study, carried out from August 2018 to August 2020 in Hindu Rao Hospital, to assess the prevalence of congenital heart disease (CHD) in patients with pneumonia in children up to 5 years. The main objectives of the study were to study the prevalence of congestive cardiac failure (CCF) in pneumonia with and without congenital heart disease. MATERIAL AND METHODS Patients under 5 years of age, presenting with pneumonia during August 2018 to July 2020 were enrolled for study. The bio-data of each patient was documented each patient was clinically evaluated thoroughly and findings noted. Pneumonia was diagnosed on typical history, physical findings, blood investigations and chest radiographic finding of pneumonia infiltrates in either one or both lung fields. All the cases of pneumonia underwent transthoracic 2 Dimensional (2D) and Doppler echocardiography, done by the cardiologist. Any congenital heart disease so found was noted. The type and size of the defects was documented. The ventricular septal defects were classified based on the site and size. The size of the patient ductus arteriosus was also determined. These measurements were taken to evaluate the impact of defect size on pneumonia. CCF was diagnosed when the patient fulfilled the clinical diagnostic criteria of heart failure. All the cases of pneumonia underwent transthoracic 2 Dimensional (2D) and Doppler echocardiography for diagnosis of any congenital heart disease. RESULTS Mean age of the children with pneumonia was 9.94 months with 77.5% of the cases below 1 year of age. Male predominance was seen with 56.3% males to 43.8% females. Prevalence of congenital heart disease among cases of pneumonia was 12.5% while that of congestive heart failure was 27.5%. Most common CHD observed was VSD (14 cases; 8.8%) followed by PDA, ASD and TGA (4; 2.5% and 3; 1.9% and 1; 0.6% cases respectively). A significant association was observed between presence of congenital heart disease and development of CCF. CONCLUSION Our study demonstrates that most patients with pneumonia or recurrent pneumonia are likely to have an underlying illness at the time of pneumonia. Recurrent ALRTI often occurred in children with history of congenital heart diseases (CHD) and is also associated with Congestive Cardiac Failure. Children with CHD are more vulnerable to recurrent respiratory tract infection.
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Abstract
Approximately 5% of children experience difficulty with the complex coordination of sucking, swallowing and breathing required for feeding. Infants with craniofacial malformations may have anatomic and neurologic contributions to feeding problems. Examples include cleft lip and/or palate, micrognathia, maxillary hypoplasia, and pharyngeal dysfunction. Interventions may facilitate weight gain and avoid failure-to-thrive in these infants. An interdisciplinary approach to address feeding challenges in children with craniofacial differences is necessary. Positional changes, latching maneuvers, specialized feeder nipples, squeezable bottles, and cup feeding can be implemented early. Surgical intervention, including gastrostomy tube placement, tongue lip adhesion, mandibular distraction osteogenesis and tracheostomy, may be required in more severe cases.
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Affiliation(s)
- Mark A Green
- Instructor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine and Harvard Medical School, Oral and Maxillofacial Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Cory M Resnick
- Harvard School of Dental Medicine and Harvard Medical School, Oral and Maxillofacial Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.
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Aggarwal N, Dwarakanathan V, Singh A, Agarwal A, Khuttan A, Ahmed A, Rajput MS, Chauhan A, Banyal V, Verma AK, Gupta V, Lodha R, Ahuja V, Makharia GK. Spectrum of height in patients with celiac disease. Indian J Gastroenterol 2021; 40:604-12. [PMID: 34921660 DOI: 10.1007/s12664-021-01173-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/11/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Growth retardation is an important feature of celiac disease (CeD) that can lead to the failure of attainment of potential adult height. There is lack of data on the spectrum of height in treatment-naïve patients with CeD, with normal expected height at one end and short stature at the other. METHODS We performed a retrospective analysis of a prospectively maintained database at our center, including a total of 583 treatment-naïve patients with CeD: 419 adults (183 [43.7%] males) and 164 adolescents (12-18 years) (72 [43.9%] males). The details extracted from the database included demographic details, height, weight, body mass index, clinical symptoms, biochemical parameters, anti-tissue transglutaminase antibody anti-tTG Ab) titer, and the severity of villous abnormalities (as per modified Marsh grade). The data from Indian National Family Health Survey-4 were used as comparators. RESULTS Overall, 19.6% of adults and 57.9% of adolescents with CeD had short stature. While mean height of men with CeD was similar, women were taller than population controls. While a higher proportion of men with CeD had short stature as compared to the controls (32.2% vs. 20%, p<0.001), a lower proportion of women with CeD had short stature (9.7% vs. 18.9%, p<0.001). Higher proportion of adolescents with CeD had short stature compared to adults (57.9% vs. 19.6%, p<0.001). On multivariate analysis, adulthood was found to be associated with a lower prevalence of short stature. CONCLUSIONS Overall, 19.6% of adults and 57.9% of adolescents with CeD had short stature. While the mean height of adult men with CeD was not significantly different from the population controls, women were taller. Adolescents with CeD were significantly shorter than their peers.
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Chen WY, Niu DM, Chen LZ, Yang CF. Congenital hypopituitarism due to novel compound heterozygous POU1F1 gene mutation: A case report and review of the literature. Mol Genet Metab Rep 2021; 29:100819. [PMID: 34815942 PMCID: PMC8593650 DOI: 10.1016/j.ymgmr.2021.100819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 09/07/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 01/15/2023] Open
Abstract
Failure to thrive is one of the most common complaints in the endocrinology and genetics clinic. An 8-month-old girl with presentation of motor developmental delay, failure to thrive, and midline facial defects, with history of hypoglycemia at birth and central congenital hypothyroidism (CCH), was brought to our genetic clinic. Hormone test demonstrated combined pituitary hormone deficiency with growth hormone deficiency (GHD), central hypothyroidism, and hypoprolactinemia. Brain magnetic resonance imaging (MRI) showed anterior pituitary hypoplasia (APH), abnormal pituitary stalk, and preserved posterior pituitary lobe. Whole exome sequence (WES) identified a compound heterozygous mutation of the POU1F1 gene: c.649C>T (p.Arg217Ter) and c.662T>C (p.Ile221Thr), which are de novo mutation and inherited from mother, respectively. The patient's phenotype was consistent clinically with congenital hypopituitarism due to the POU1F1 gene mutation. Based on our literature review, this is the first report of the c.662T>C mutation, to the best of our knowledge. Our study demonstrates the power of WES for early diagnosis of congenital hypopituitarism with its relative phenotype for improving prognosis and preventing irreversible deficit.
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Affiliation(s)
- Wei-Yu Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Dau-Ming Niu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Zhen Chen
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Feng Yang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
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Doya LJ, Mohammad L, Omran R, Ibrahim AA, Yousef N, Ibrahim A, Houreih MA. Chylomicron retention disease caused by a new pathogenic variant in sar1b protein: a rare case report from Syria. BMC Pediatr 2021; 21:449. [PMID: 34629076 DOI: 10.1186/s12887-021-02897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Chylomicron retention disease (Anderson disease) is a result for variant of the SAR1B gene. It is a rare autosomal recessive hereditary disorder with most incidence in infant. It is characterized by lipid malabsorption syndrome with fatty, chronic diarrhea, and growth retardation. Case presentation We report a case of a 19-month Syrian boy who presented with vomiting, growth failure, and chronic, fatty diarrhea. Upper gastrointestinal endoscopy showed whitish appearing duodenal mucosa and small intestinal biopsies revealed steatosis of enterocytes. Genetic testing confirmed chylomicron retention disease with the first description of variant located in the fourth helix of sar1b protein. The patient is treated with nutritional supplements and fat-soluble vitamin supplementation resulting in significant improvement. Conclusion Early endoscopy is recommended in infants with persistent vomiting and failure to thrive due to high suspicion for a disorder of hypocholesterolemia. Early diagnosis and treatment are essential to avoid serious clinical complications, especially neurological impairment.
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Darougar S, Shirzani A, Mansouri M, Mohkam M. A Report of Two Patients with Food Protein-induced Enterocolitis Mimicking Bartter Syndrome. Iran J Allergy Asthma Immunol 2021; 20:641-646. [PMID: 34664823 DOI: 10.18502/ijaai.v20i5.7415] [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] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/15/2021] [Indexed: 11/24/2022]
Abstract
Food protein-induced enterocolitis syndrome (FPIES), is a non-IgE mediated food allergy presenting in infants younger than 12 months. Diagnostic delay may occur due to overlapping clinical symptoms with several conditions. Here, we present two cases of FPIES, mistakenly diagnosed and treated as Bartter syndrome. This study aims to emphasize the several features of this syndrome that may mimic other diagnoses and sometimes leading to near-death events due to delay in the diagnosis and improper treatment. The first patient was a 30-month-old boy with multiple episodes of profuse vomiting and diarrhea within 1 hour after breastfeeding, beginning from the first month of life progressing to hypokalemia and metabolic alkalosis at the age of 5 months leading to the diagnosis of Bartter syndrome. The second patient had a history of unremitting diarrhea which had been started soon after his first breastfeeding followed by biliary vomiting on the 7th day of life. He was treated in another hospital for neonatal sepsis, however, without an appropriate response to treatment. To conclude, despite the current belief on the rarity of FPIES, it is a more prevalent disease than expected with various non-specific manifestations imitating other conditions which may result in diagnostic delay and sometimes fatalities. To shed light on the importance of the physicians' awareness of this syndrome, these two cases are presented here as examples of FPIES imitating other disorders.
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Affiliation(s)
- Sepideh Darougar
- Department of Pediatrics, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran.
| | - Arezoo Shirzani
- Department of Pediatrics, Mofid's Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mahboubeh Mansouri
- Department of Allergy and Clinical Immunology, Mofid's Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Masoumeh Mohkam
- Pediatric Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Brndiarova M, Mraz M, Kolkova Z, Cisarik F, Banovcin P. Sensenbrenner Syndrome Presenting with Severe Anorexia, Failure to Thrive, Chronic Kidney Disease and Angel-Shaped Middle Phalanges in Two Siblings. Mol Syndromol 2021; 12:263-267. [PMID: 34421506 DOI: 10.1159/000515645] [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: 08/17/2020] [Accepted: 03/02/2021] [Indexed: 01/03/2023] Open
Abstract
Sensenbrenner syndrome is a very rare autosomal recessive disorder caused by variants in genes involved in the functional development of primary cilia. Typical clinical manifestations include craniofacial and skeletal abnormalities, hence the alternative name cranioectodermal dysplasia. Chronic kidney disease due to progressive tubulointerstitial nephritis (nephronophthisis) has been described in these patients. The authors present 2siblings with severe anorexia, failure to thrive, chronic kidney disease, and angel-shaped middle phalanges. Two previously described variants p.(Leu641*) and p.(Asp841Val) were identified in the WDR35 gene which is most commonly affected in this condition. Analysis of all coding exons of the GDF5 gene was normal. This is the first report of Sensenbrenner syndrome presenting with severe anorexia and failure to thrive at early age. Angel-shaped middle phalanges in the absence of the GDF5 variant may represent an overlapping phenotypic manifestation of ciliopathy.
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Affiliation(s)
- Miroslava Brndiarova
- Department of Paediatrics, Jessenius Faculty of Medicine of Comenius University in Bratislava, Martin University Hospital, Martin, Slovakia
| | - Martin Mraz
- Department of Paediatric and Adolescent Medicine, Children's University Hospital, Kosice, Slovakia
| | - Zuzana Kolkova
- Biomedical Center, Jessenius Faculty of Medicine of Comenius University in Bratislava, Bratislava, Slovakia
| | - Frantisek Cisarik
- Department of Genetics, University Hospital in Zilina, Zilina, Slovakia
| | - Peter Banovcin
- Department of Paediatrics, Jessenius Faculty of Medicine of Comenius University in Bratislava, Martin University Hospital, Martin, Slovakia
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Zenteno-Salazar E, Sifuentes-Vela C, Contreras-Capetillo S, López-Cabrera M, Núñez-Enríquez JC. Manejo multidisciplinario con terapia de electroestimulación en un paciente con síndrome de Goldenhar, trastorno de la deglución y falla para crecer. Bol Med Hosp Infant Mex 2021; 78:362-369. [PMID: 34351893 DOI: 10.24875/bmhim.20000222] [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] [Indexed: 11/17/2022] Open
Abstract
INTRODUCCIÓN El síndrome de Goldenhar es un trastorno heterogéneo, esporádico en su mayoría o por patrón de herencia autosómico dominante o recesivo, de la morfogénesis craneofacial asociada al primero y segundo arcos faríngeos, y forma parte del espectro oculoauriculovertebral. La incidencia es de 1 por cada 3500-45,000 recién nacidos vivos, con una razón de sexo masculino/femenino de 3:2. CASO CLÍNICO Se presenta el caso de un recién nacido con fenotipo de síndrome oculoauriculovertebral. Se abordó con radiografía de tórax, ecografía abdominal y tamizaje metabólico y auditivo, que reportaron hemivértebra torácica, fusión costal, quiste renal e hipoacusia bilateral profunda, respectivamente. Fue alimentado con lactancia mixta desde el nacimiento, sin lograr una succión adecuada y con pérdida de peso. A los 3 meses de edad recibió terapia de rehabilitación oral con electroestimulación en conjunto de 10 sesiones con 10 mA de intensidad, al igual que a los 23, 24, 25, 27, 30 y 32 meses de edad. A los 4 meses, espesamiento de fórmula con cereal; a los 7 meses, sonda de gastrostomía; a los 20 meses, cirugía de paladar y macrostomía. Mostró mejoría en intensidad de babeo en las primeras 10 sesiones y mejoría en la deglución a las 30 sesiones. A los 3 años de edad consume el 100% de los alimentos por vía oral. CONCLUSIONES Con la escasa evidencia científica que este caso aislado aporta, el tratamiento con la terapia de rehabilitación en conjunto con la terapia convencional y la corrección anatómica dio resultados positivos para el trastorno de la deglución. BACKGROUND Goldenhar syndrome is a heterogeneous disorder, mostly sporadic or due to a dominant autosomal or recessive pattern of inheritance, that exhibits craniofacial morphogenesis associated with the first and second pharyngeal arches and is part of the oculoauriculovertebral spectrum. Its incidence is of 1 in 3,500-45,000 live newborns, with a male to female ratio of 3:2. CASE REPORT We describe the case of a male newborn with oculoauriculovertebral syndrome phenotype. It was approached with chest X-ray, abdominal ultrasound, metabolic and hearing screening, which reported thoracic hemivertebra, costal fusion, renal cyst, and profound bilateral hypoacusis, respectively. Although the newborn was fed with mixed lactation from birth, adequate suction and with weight loss were not achieved. At 3 months of age, as well as at 23, 24, 25, 27, 30 and 32 months of age, the infant received oral rehabilitation therapy with electrostimulation in a set of 10 sessions with 10 mA intensity. At 4 months, thickening of formula with cereal; at 7 months, gastrostomy tube; at 20 months, palate surgery and macrostomy. Improvement in drooling intensity was observed during the first 10 sessions, and improvement in swallowing after 30 sessions. At 3 years of age, the patient consumes 100% of food orally. CONCLUSIONS According to limited scientific evidence that this isolated case provides, rehabilitation therapy together with conventional therapy coupled with anatomical correction gave positive results for swallowing disorder.
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Affiliation(s)
| | - Claudia Sifuentes-Vela
- Escuela de Ciencias de la Salud, Universidad Marista de Mérida, Mérida, Yucatán. México.,Gastroenterología y Nutrición Pediátrica, Hospitales Star Médica, Mérida, Yucatán. México
| | - Silvina Contreras-Capetillo
- Laboratorio de Genética y Salud Reproductiva, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Yucatán. México
| | - Marisol López-Cabrera
- Foniatría y Trastornos de Deglución, Voz y Habla, Clínica de Mérida, Mérida, Yucatán. México
| | - Juan C Núñez-Enríquez
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad Hospital de Pediatría Dr. Silvestre Frenk Freund, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México. México
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Selcuk SZ, Elmas AT, Yildirim IO, Sigirci A, Sozeri B, Tabel Y. A hypertensive girl with failure to thrive accompanied by gastrointestinal symptoms: Questions. Pediatr Nephrol 2021; 36:2123-4. [PMID: 33646394 DOI: 10.1007/s00467-021-04991-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
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Selcuk SZ, Elmas AT, Yildirim IO, Sigirci A, Sozeri B, Tabel Y. A hypertensive girl with failure to thrive accompanied by gastrointestinal symptoms: Answers. Pediatr Nephrol 2021; 36:2125-8. [PMID: 33646393 DOI: 10.1007/s00467-021-05004-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
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Conversano E, Romano S, Taddio A, Faletra F, Zanon D, Barbi E, Pennesi M. When salt is needed to grow: Answers. Pediatr Nephrol 2021; 36:1131-1132. [PMID: 32778955 DOI: 10.1007/s00467-020-04647-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Ester Conversano
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Sara Romano
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy.
| | - Andrea Taddio
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
- Paediatric Department, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Flavio Faletra
- Genetic Department, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Davide Zanon
- Pharmacy and Clinical Pharmacology Department, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
- Paediatric Department, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marco Pennesi
- Paediatric Department, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
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Franceschi R, Rizzardi C, Maines E, Liguori A, Soffiati M, Tornese G. Failure to thrive in infant and toddlers: a practical flowchart-based approach in a hospital setting. Ital J Pediatr 2021; 47:62. [PMID: 33691756 PMCID: PMC7945305 DOI: 10.1186/s13052-021-01017-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/02/2021] [Indexed: 12/05/2022] Open
Abstract
Background Failure to thrive is a common reason for referral to paediatric services. Malnutrition or inadequate caloric intake is the most common cause, while organic form is unlikely in children who are asymptomatic and healthy on examination. By this study we evaluate the application of a cost-effective flow chart that helps the clinician in a hospital setting discern accurately organic and non-organic failure to thrive. Methods Conduct a prospective single-center study in children up to 2 years of age with growth faltering. The pediatricians used a practical flow chart, took the medical history, created a growth chart, performed clinical examinations, and requested blood test and consultations in a step by step approach. Results Among the 74 subjects included in the study, the diagnosis of organic failure to thrive was reached by 42%. Gastrointestinal and genetic diagnoses were the most frequent. Patients with organic failure to thrive had significantly lower gestational age and birth weight. Age at diagnosis and Z-score weight were lower in organic than in non-organic forms. Most patients with non-organic forms (88%) did not undergo in-depth blood test or specialist advice. Conclusion The flow chart we presented was accurate for diagnosing children with failure to thrive in a hospital setting and distinct organic and non-organic forms. It was cost-effective to avoid unnecessary blood test or consultations in most non-organic diagnoses.
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Affiliation(s)
- Roberto Franceschi
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy.
| | - Caterina Rizzardi
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Evelina Maines
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Alice Liguori
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Massimo Soffiati
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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Mousavi S, Amiri B, Beigi S, Farzaneh M. The value of a simple method to decrease diagnostic errors in Turner syndrome: a case report. J Med Case Rep 2021; 15:79. [PMID: 33596986 PMCID: PMC7890814 DOI: 10.1186/s13256-021-02673-0] [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] [Received: 07/28/2020] [Accepted: 01/08/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Turner syndrome is a genetic disorder in females and is the result of complete or partial loss of an X chromosome during fertilization. The missing X chromosome is originally either from the mother's ovum or the father's sperm cell. Approximately 45% of patients have the 45,X karyotype and the rest have other variants of Turner syndrome, which are either mosaicism patterns or structural abnormalities of the X chromosome. Here, we report a case of Turner syndrome that is the fifth case of Turner syndrome with balanced Robertsonian translocation of (13;14)(q10;q10), and the sixth case with 44,X chromosomes, reported in the literature thus far. Case presentation A 10.3-year-old Persian girl was brought to our clinic by her parents, with the complaint of failure to thrive and short height. She had been examined and investigated by endocrinologists since the age of 4 years, but no definite diagnosis was made. At the time of presentation, she had been through three provocative growth hormone tests and had been on no medications for about a year. Her physical examination revealed mild retrognathia and micrognathia. Initially, she was started on somatropin treatment which, after 12 months, did not appropriately improve her height velocity. Therefore, a more thorough physical examination was performed, in which high arched palate and low posterior hairline were observed. There was also a difference between target height and patient height standard deviation scores. Karyotype study was requested, and Turner syndrome was confirmed. Conclusion The diagnosis of this case was not straightforward, both because the somatic presentations were not obvious, and because the physicians had not looked for them when performing the physical examinations. This case report introduces a rare 44,X chromosome karyotype of Turner syndrome and highlights the value in using the difference between target height and patient height standard deviation scores as a simple and inexpensive tool for diagnosis of this syndrome.
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Affiliation(s)
- Seyedetahere Mousavi
- Pediatric Endocrinology, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Batool Amiri
- Clinical Research Development Center, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Saidee Beigi
- Royal Australian College of General Practitioners, The Melanoma Centre, Brisbane, Australia
| | - Mohammadreza Farzaneh
- Molecular Pathology and Cytogenetic, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
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Affiliation(s)
- Ester Conversano
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Sara Romano
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy.
| | - Andrea Taddio
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy ,Paediatric Department, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Flavio Faletra
- Genetic Department, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Davide Zanon
- Pharmacy and Clinical Pharmacology Department, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy ,Paediatric Department, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Marco Pennesi
- Paediatric Department, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
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38
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Saneifard H, Sheikhy A, Karbasian F, Eslamian G, Shakiba M, Babaie D. Non-celiac gluten sensitivity as a rare cause of growth retardation in children: a case series study. Gastroenterol Hepatol Bed Bench 2021; 14:362-366. [PMID: 34659665 PMCID: PMC8514215] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/29/2021] [Indexed: 11/03/2022]
Abstract
AIM Herein, we present five children and adolescents with a final diagnosis of non-celiac gluten sensitivity (NCGS). BACKGROUND Non-celiac gluten sensitivity (NCGS) is a condition characterized by gastrointestinal and extra-intestinal symptoms triggered by ingestion of gluten-containing compounds, e.g., wheat, rye, and barley, in subjects without celiac disease or wheat allergy. METHODS Demographic characteristics, clinical manifestations, serum biomarkers and skin prick test were evaluated. Patient data was also recorded after they followed a gluten-free diet (GFD). Height and weight were measured, and all patients were examined 6 months after following the suggested GFD. RESULTS All patients had failure to thrive and abdominal pain. Clinical symptoms were reduced, and significant weight and height gains were detected after 1 month of following a gluten-free diet. CONCLUSION The relationship between failure to thrive (FTT) and NCGS is still unknown; hence, NCGS may be one of the main causes of FTT which can be prevented by gluten-free diets.
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Affiliation(s)
- Hedyeh Saneifard
- Department of Pediatric Endocrinology and Metabolism, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Sheikhy
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Karbasian
- Department of Pediatric Emergency, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golnaz Eslamian
- Department of Allergy and Clinical Immunology, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marjan Shakiba
- Department of Pediatric Endocrinology and Metabolism, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Delara Babaie
- Department of Allergy and Clinical Immunology, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nilay M, Phadke SR. Pearson Syndrome: Spontaneously Recovering Anemia and Hypoparathyroidism. Indian J Pediatr 2020; 87:1070-1072. [PMID: 32537709 DOI: 10.1007/s12098-020-03333-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/30/2020] [Indexed: 11/25/2022]
Abstract
Pearson syndrome is a genetic disorder caused by mutations in the mitochondrial genome, characterized by failure to thrive with hematological and gastrointestinal abnormalities. Individuals with Pearson syndrome may develop the symptoms and signs of Kearns-Sayre syndrome with multisystem involvement. Spontaneous recovery of hematological problems is reported as is the situation in the present case. The child reported here was born out of in-vitro fertilization. She was maintaining normal hemoglobin level for more than three and a half years but had been detected to have hypoparathyroidism. The diagnosis of Pearson syndrome was confirmed by presence of deletion in mitochondrial genome. Awareness about this rare disorder will help clinicians to broaden their differentials when dealing with common presentations like failure to thrive and anemia.
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Affiliation(s)
- Mayank Nilay
- Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Shubha R Phadke
- Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.
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40
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Xu L, Gu W, Luo Y, Lou J, Chen J. DGAT1 mutations leading to delayed chronic diarrhoea: a case report. BMC Med Genet 2020; 21:239. [PMID: 33261563 PMCID: PMC7708908 DOI: 10.1186/s12881-020-01164-1] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/04/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Early-onset chronic diarrhoea often indicates a congenital disorder. Mutation in diacylglycerol o-acyltransferase 1 (DGAT1) has recently been linked to early-onset chronic diarrhoea. To date, only a few cases of DGAT1 deficiency have been reported. Diarrhoea in those cases was severe and developed in the neonatal period or within 2 months after birth. CASE PRESENTATION Here, we report a female patient with DGAT1 mutations with delayed-onset chronic diarrhoea. The patient had vomiting, hypoalbuminemia, hypertriglyceridemia, and failure to thrive at early infancy. Her intractable chronic diarrhoea occurred until she was 8 months of age. A compound heterozygous DGAT1 mutation was found in the patient, which was first found in the Chinese population. Her symptoms and nutrition status improved after nutritional therapy, including a fat restriction diet. CONCLUSIONS This case expanded our knowledge of the clinical features of patients with DGAT1 mutations. Intractable diarrhoea with delayed onset could also be a congenital disorder.
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Affiliation(s)
- Luojia Xu
- Present Address: Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No.3333, Binsheng Road, Hangzhou, Zhejiang Province, PR China
| | - Weizhong Gu
- Present Address: Department of Pathology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No.3333, Binsheng Road, Hangzhou, Zhejiang Province, PR China
| | - Youyou Luo
- Present Address: Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No.3333, Binsheng Road, Hangzhou, Zhejiang Province, PR China
| | - Jingan Lou
- Present Address: Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No.3333, Binsheng Road, Hangzhou, Zhejiang Province, PR China
| | - Jie Chen
- Present Address: Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No.3333, Binsheng Road, Hangzhou, Zhejiang Province, PR China.
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Dontaine P, Kottos E, Dassonville M, Balasel O, Catros V, Soblet J, Perlot P, Vilain C. Digestive involvement in a severe form of Snyder-Robinson syndrome: Possible expansion of the phenotype. Eur J Med Genet 2020; 64:104097. [PMID: 33186760 DOI: 10.1016/j.ejmg.2020.104097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/22/2020] [Revised: 10/23/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
Snyder-Robinson syndrome (OMIM #309583) is a rare X-linked condition, caused by mutation in the SMS gene (MIM *300105), characterized by a wide spectrum of clinical signs including developmental delay, epilepsy, asthenic habitus, dysmorphism, osteopenia, and renal or genital anomalies. Here we describe two maternal half-brothers who both presented with severe neurodevelopmental delay, seizures, hearing loss, facial dysmorphism, renal and ophthalmologic anomalies, failure to thrive and premature death. A novel p.(Gly203Asp) variant was found at the hemizygous state in the two boys, and an elevated Spermidine/Spermine ratio confirmed the diagnosis of Snyder-Robinson syndrome. One of the brothers presented with gastrointestinal symptoms, with jejunal stenosis, enteral feeding intolerance, failure to thrive due to a dysfunctional gastrointestinal system, cholestasis and exocrine pancreatic insufficiency. Although more studies will be needed to understand its mechanisms, this observation lends further support to the possibility of severe digestive involvement in Snyder Robinson syndrome.
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Affiliation(s)
- Pauline Dontaine
- Department of Genetics, Hôpital Universitaire des Enfants Reine Fabiola, ULB Center of Human Genetics, Universite Libre de Bruxelles, Brussels, Belgium
| | - Elisa Kottos
- Department of Genetics, Hôpital Universitaire des Enfants Reine Fabiola, ULB Center of Human Genetics, Universite Libre de Bruxelles, Brussels, Belgium
| | - Martine Dassonville
- Department of Pediatric Surgery, Hôpital Universitaire des Enfants Reine Fabiola, Universite Libre de Bruxelles, Brussels, Belgium
| | - Ovidiu Balasel
- Department of Neonatalogy, Hôpital Universitaire des Enfants Reine Fabiola, Universite Libre de Bruxelles, Brussels, Belgium
| | - Véronique Catros
- Univ Rennes, Inserm, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), CRB Santé Rennes, F-35000, Rennes, France
| | - Julie Soblet
- Department of Genetics, Hôpital Universitaire des Enfants Reine Fabiola, ULB Center of Human Genetics, Universite Libre de Bruxelles, Brussels, Belgium; Department of Genetics, Hôpital Erasme, ULB Center of Human Genetics, Universite Libre de Bruxelles, Brussels, Belgium; Interuniversity Institute of Bioinformatics in Brussels, Universite Libre de Bruxelles, Brussels, Belgium
| | - Pascale Perlot
- Department of Pediatrics, Hôpital Universitaire des Enfants Reine Fabiola, Universite Libre de Bruxelles, Brussels, Belgium
| | - Catheline Vilain
- Department of Genetics, Hôpital Universitaire des Enfants Reine Fabiola, ULB Center of Human Genetics, Universite Libre de Bruxelles, Brussels, Belgium; Department of Genetics, Hôpital Erasme, ULB Center of Human Genetics, Universite Libre de Bruxelles, Brussels, Belgium; Interuniversity Institute of Bioinformatics in Brussels, Universite Libre de Bruxelles, Brussels, Belgium.
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42
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Cohen O, Picard E, Joseph L, Schwartz Y, Sichel JY, Attal P. Supraglottoplasty for severe laryngomalacia. Can we predict success? Int J Pediatr Otorhinolaryngol 2020; 138:110333. [PMID: 32891942 DOI: 10.1016/j.ijporl.2020.110333] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/05/2020] [Accepted: 08/23/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Laryngomalacia is the dynamic collapse of supraglottic structures during inspiration, leading to a variable degree of airway obstruction. Clinical symptoms appear in the first months of life and are usually mild and resolve by the age of 12-18 months. In severe cases, surgical intervention may be considered. The goal of the study was to review the clinical outcome of pediatric patients who underwent supraglottoplasty for laryngomalacia. MATERIAL AND METHODS Clinical and demographic data were retrieved from medical records of children diagnosed with laryngomalacia by laryngo-bronchoscopy between 2013 and 2019. Indications, outcome and long-term follow-up were collected from children undergoing surgery. RESULTS During the study period, 115 children were diagnosed with laryngomalacia. The median age at diagnosis was 3 months. Synchronous airway lesions were diagnosed in 20% of patients. Ten (8.7%) children underwent surgical treatment because of significant respiratory symptoms and/or failure to thrive. Three of them had comorbidities. All otherwise healthy children had significant respiratory and nutritional improvement after surgery while those with comorbidities had less successful outcomes. CONCLUSION We conclude that in severe cases of laryngomalacia, supraglottoplasty has an important role to play in management. In children with comorbidities, the surgical results may be less successful. Therefore, we recommend that the decision to operate should be individualized, ensuring full disclosure to the family regarding the probable benefit along with the limitations of surgery.
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Affiliation(s)
- Ohad Cohen
- Otolaryngology Head and Neck Surgery Department, Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Elie Picard
- Pediatric Pulmonary Institute, Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel.
| | - Leon Joseph
- Pediatric Pulmonary Institute, Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Yehuda Schwartz
- Otolaryngology Head and Neck Surgery Department, Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Jean-Yves Sichel
- Otolaryngology Head and Neck Surgery Department, Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Pierre Attal
- Otolaryngology Head and Neck Surgery Department, Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
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43
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Wineland AM. Surgical management of an infantile elliptical cricoid: Endoscopic posterior laryngotracheoplasty utilizing a resorbable plate. Int J Pediatr Otorhinolaryngol 2020; 138:110285. [PMID: 32795728 DOI: 10.1016/j.ijporl.2020.110285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/13/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
The cricoid is a circular "ring" of cartilage in the airway. When the lateral walls of the cricoid approximate, it takes the shape of an ellipse. In severe cases, this also reduces the glottic aperture and causes respiratory distress, stridor, and failure to thrive. The elliptical cricoid has limited surgical options outside of open laryngotracheal procedures and tracheostomy. Recently, alternatives to autologous grafts have been utilized in airway reconstruction to reduce harvest site morbidity and increase operating room efficiency. Herein a case is presented that demonstrates the successful use of a resorbable plate in augmenting the posterior larynx in an infant with a severely elliptical cricoid to avoid a tracheostomy.
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Affiliation(s)
- Andre' M Wineland
- University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 1 Children's Way, Slot 836, Little Rock, AR, 72202, USA.
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44
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Zhou YQ, Wu GS, Kong YM, Zhang XY, Wang CL. New mutation in EPCAM for congenital tufting enteropathy: A case report. World J Clin Cases 2020; 8:4975-4980. [PMID: 33195669 PMCID: PMC7642537 DOI: 10.12998/wjcc.v8.i20.4975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Congenital tufting enteropathy (CTE) is a rare cause of diarrhea in children. However, it can result in early-onset of chronic diarrhea and failure to thrive. Children with this disease have to depend on total parenteral nutrition (TPN), and eventually small intestine transplantation. The epithelial cell adhesion molecule (EPCAM) gene was identified to be associated with CTE. Here, we present a case of an infant with CTE due to a mutation not reported in the literature before.
CASE SUMMARY A 1-year and 7-mo infant boy exhibited intractable watery diarrhea and mushy stool within 1 wk after birth, for which he had required medical treatment and hospitalization several times. His sister presented similar symptoms and died at the age of two. On admission, his body weight was 5700 g (-4.8SDS) and measured 66 cm (-5.4SDS) in height. Meanwhile, he cannot speak or climb. He exhibited mild anemia, hypocalcemia, hypomagnesemia, and an infection in the upper respiratory tract. Microvilli sparse and vacuolar degeneration of epithelial cells were reported by small intestine biopsy. Whole-exome sequencing showed a novel homozygous splice mutation (c.657+1[IVS6] G>A) in the EPCAM gene. He was treated with TPN and recombinant human growth hormone. After 2 mo, his body weight was up to 8500 g and he has been waiting for small bowel transplantation.
CONCLUSION CTE is rare but fatal. Patients with CTE require rapid diagnosis and therapy to improve their survival.
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Affiliation(s)
- Yan-Qiong Zhou
- Department of Pediatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Guo-Sheng Wu
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Yuan-Mei Kong
- Department of Pediatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Xiao-Yuan Zhang
- Department of Pediatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Chun-Lin Wang
- Department of Pediatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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45
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McRae HM, Eccles S, Whitehead L, Alexander WS, Gécz J, Thomas T, Voss AK. Downregulation of the GHRH/GH/IGF1 axis in a mouse model of Börjeson-Forssman-Lehman syndrome. Development 2020; 147:dev.187021. [PMID: 32994169 DOI: 10.1242/dev.187021] [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] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 09/09/2020] [Indexed: 12/28/2022]
Abstract
Börjeson-Forssman-Lehmann syndrome (BFLS) is an intellectual disability and endocrine disorder caused by plant homeodomain finger 6 (PHF6) mutations. Individuals with BFLS present with short stature. We report a mouse model of BFLS, in which deletion of Phf6 causes a proportional reduction in body size compared with control mice. Growth hormone (GH) levels were reduced in the absence of PHF6. Phf6 - /Y animals displayed a reduction in the expression of the genes encoding GH-releasing hormone (GHRH) in the brain, GH in the pituitary gland and insulin-like growth factor 1 (IGF1) in the liver. Phf6 deletion specifically in the nervous system caused a proportional growth defect, indicating a neuroendocrine contribution to the phenotype. Loss of suppressor of cytokine signaling 2 (SOCS2), a negative regulator of growth hormone signaling partially rescued body size, supporting a reversible deficiency in GH signaling. These results demonstrate that PHF6 regulates the GHRH/GH/IGF1 axis.
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Affiliation(s)
- Helen M McRae
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria 3052, Australia.,Department of Medical Biology, The University of Melbourne, Victoria 3052, Australia
| | - Samantha Eccles
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria 3052, Australia
| | - Lachlan Whitehead
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria 3052, Australia.,Department of Medical Biology, The University of Melbourne, Victoria 3052, Australia
| | - Warren S Alexander
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria 3052, Australia.,Department of Medical Biology, The University of Melbourne, Victoria 3052, Australia
| | - Jozef Gécz
- Adelaide Medical School and the Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Tim Thomas
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria 3052, Australia .,Department of Medical Biology, The University of Melbourne, Victoria 3052, Australia
| | - Anne K Voss
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria 3052, Australia .,Department of Medical Biology, The University of Melbourne, Victoria 3052, Australia
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Ashjaei B, Ghamari Khameneh A, Darban Hosseini Amirkhiz G. Abdominal Mass Caused Failure to Thrive in a Young Boy: Mixed-Type Localized Retroperitoneal Castleman Disease. Case Rep Oncol 2020; 13:853-856. [PMID: 32884530 PMCID: PMC7443682 DOI: 10.1159/000508531] [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] [Received: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 11/19/2022] Open
Abstract
Castleman disease is a rare cause of retroperitoneal mass in children. Clinical presentation and laboratory findings are usually nonspecific. Imaging shows features of a hypervascular or soft tissue mass. We present a 12-year-old boy who complained of frequent colds, fatigue, and failure to gain weight for the past 4 years who was referred to our hospital. Anemia and hypergammaglobulinemia were revealed in laboratory tests. Imaging showed a well-delineated retroperitoneal soft tissue mass with intense homogenous enhancement at the midline below the aortic bifurcation. The histopathological features were consistent with mixed type unicentric Castleman disease. Surgical removal was curative. Our patient's hematological abnormalities resolved, and he gained 10 kg in the next 4 weeks after the operation and reached the 25–50th percentile for his age.
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Affiliation(s)
- Bahar Ashjaei
- Department of Pediatric Surgery, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshar Ghamari Khameneh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gisoo Darban Hosseini Amirkhiz
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Stern R, Kuo V, Rogal S, Barron C, Ahmed R, Goldwasser B. A case of failure to thrive secondary to primary hyperoxaluria type 1. Radiol Case Rep 2020; 15:1806-1808. [PMID: 32793322 PMCID: PMC7413989 DOI: 10.1016/j.radcr.2020.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 05/21/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/23/2022] Open
Abstract
Primary hyperoxaluria type 1 is a rare genetic condition characterized by oxalate deposition in the kidneys. We report findings of an 8-month old female presenting with failure to thrive, poor oral intake, and kidney stones resulting in the diagnosis of primary hyperoxaluria type 1. The patient exhibits a unique presentation without renal failure at the time of diagnosis suggesting a previously unreported comorbidity in early stages of disease.
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Affiliation(s)
- Rachel Stern
- Department of Pediatrics, Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY 10461, USA
| | - Vicky Kuo
- Department of Pediatrics, Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY 10461, USA
| | - Sarah Rogal
- Department of Pediatrics, Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY 10461, USA
| | - Carly Barron
- Department of Pediatrics, Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY 10461, USA
- Corresponding author.
| | - Raidour Ahmed
- Department of Pediatrics, Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY 10461, USA
| | - Bernard Goldwasser
- Department of Radiology, Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY 10461, USA
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48
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Mercadante F, Busè M, Salzano E, Fragapane T, Palazzo D, Malacarne M, Piccione M. 12q14.3 microdeletion involving HMGA2 gene cause a Silver-Russell syndrome-like phenotype: a case report and review of the literature. Ital J Pediatr 2020; 46:108. [PMID: 32723361 PMCID: PMC7389890 DOI: 10.1186/s13052-020-00866-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/10/2020] [Indexed: 12/17/2022] Open
Abstract
Background Silver-Russell Syndrome (SRS) is a genetic disorder characterized by intrauterine and postnatal growth restriction and normal head circumference with consequent relative macrocephaly. Addictional findings are protruding forehead in early life, body asymmetry (of upper and lower limbs) and substantial feeding difficulties. Although several genetic mechanisms that cause the syndrome are known, more than 40% of patients with a SRS-like phenotype remain without an etiological diagnosis. In the last few years, different clinical reports have suggested that mutations or deletions of the HMGA2 gene can be responsible for a SRS-like phenotype in patients with negative results of the common diagnostic tests for this syndrome. Case presentation We present a 3-year-old male patient with clinical diagnosis of Silver-Russell Syndrome (SRS) associated with a de novo heterozygous deletion of the long arm of the chromosome 12 (12q14.3) encompassing the HMGA2 gene. Conclusions Our report confirms the etiological role of HMGA2 as a disease gene in the development of a SRS-like phenotype.
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Affiliation(s)
| | - Martina Busè
- U.O.S.D. Medical Genetics, AOOR Villa Sofia-Cervello, Palermo, Italy.
| | - Emanuela Salzano
- U.O.S.D. Medical Genetics, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Tiziana Fragapane
- U.O.S.D. Medical Genetics, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Daniela Palazzo
- U.O.S.D. Medical Genetics, AOOR Villa Sofia-Cervello, Palermo, Italy
| | | | - Maria Piccione
- U.O.S.D. Medical Genetics, AOOR Villa Sofia-Cervello, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
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Gao C, Ehsan L, Jones M, Khan M, Middleton J, Vergales B, Perks P, Syed S. Time to regain birth weight predicts neonatal growth velocity: A single-center experience. Clin Nutr ESPEN 2020; 38:165-171. [PMID: 32690152 DOI: 10.1016/j.clnesp.2020.05.010] [Citation(s) in RCA: 5] [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: 02/12/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Failure to Thrive (FTT) describes the development of an inappropriate pattern of growth, generally secondary to inadequate nutritional intake, and is associated with several negative outcomes. We describe key features among neonates with FTT as well as the variables that predicted their growth after birth at a Neonatal Intensive Care Unit. METHODS A retrospective single center study of 340 patients grouped into FTT (n = 100) and non-FTT (n = 240) was conducted. FTT was defined as having a weight <10th percentile on the Fenton 2013 curve at the time of discharge. For analyzing growth velocity, 204 patients were grouped into 4 quartiles based on their calculated growth velocity (grams/kilograms/day [g/kg/day]; 4th quartile had the highest velocity). Multivariate regression models were used to identify predictors of growth velocity. RESULTS When comparing FTT vs. non-FTT patients, lower birth weights (1897.9 ± 561.4 vs. 2445.9 ± 783.0 g, t(255.1) = -7.2, p < 0.001) and higher growth velocities (9.2 ± 3.9 vs. 8.0 ± 4.1 g/kg/day, t(153.6) = 2.2, p = 0.03) were noted. Among patients with higher growth velocities, birth weights were lower (1st to 4th quartiles: 2474.0 ± 677.0, 2000.0 ± 297.0, 1715.0 ± 285.0, 1533.0 ± 332.0 g, F(3, 200) = 46.5, p < 0.001, adjusted R2 = 0.4). Days to regain birth weight was the most consistent predictor of growth velocity in our overall patient sample (β [SE] = -0.3 [0.03], p < 0.001) and in the lowest growth velocity quartile subgroup (β [SE] = -0.3 [0.04], p < 0.001). CONCLUSIONS Days to regain birth weight was consistently the strongest predictor of neonatal growth velocity along with difference in gender positive predicting growth velocity in the total sample. This highlights the importance of the first week of life in growth pattern establishment.
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Affiliation(s)
- Calvin Gao
- School of Medicine, University of Virginia, Charlottesville, VA, USA; Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Lubaina Ehsan
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Marieke Jones
- Claude Moore Health Sciences Library, University of Virginia, Charlottesville, VA, USA
| | - Marium Khan
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Jeremy Middleton
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Brooke Vergales
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Patti Perks
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Sana Syed
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA.
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Ng A, Galosi S, Salz L, Wong T, Schwager C, Amudhavalli S, Gelineau-Morel R, Chowdhury S, Friedman J. Failure to thrive - an overlooked manifestation of KMT2B-related dystonia: a case presentation. BMC Neurol 2020; 20:246. [PMID: 32546208 PMCID: PMC7296679 DOI: 10.1186/s12883-020-01798-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Received: 02/12/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022] Open
Abstract
Background KMT2B-related dystonia is a recently described form of childhood onset dystonia that may improve with deep brain stimulation. Prior reports have focused on neurologic features including prominent bulbar involvement without detailing general health consequences that may result from orolingual dysfunction. We describe a family with novel KMT2B mutation with several members with failure to thrive to highlight this non-neurologic, but consequential impact of mutation in this gene. Case presentation We present a case of a 15-year old female who was admitted and evaluated for failure to thrive. On exam, she had severe speech dysfluency, limited ability to protrude the tongue, and generalized dystonia involving the oromandibular region, right upper and left lower extremity with left foot inversion contracture. The proband and her parents underwent whole genome sequencing. A previously undescribed variant, c.4960 T > C (p.Cys1654Arg), was identified in the KMT2B gene in the proband and mother, and this variant was subsequently confirmed in two maternal cousins, one with failure to thrive. Literature review identified frequent reports of prominent bulbar involvement but failure to thrive is rarely mentioned. Conclusion Failure to thrive is a common pediatric clinical condition that has consequences for growth and development. In the presence of an abnormal neurologic exam, a search for a specific underlying genetic etiology should be pursued. With this case series, we highlight an unusual potentially treatable cause of failure to thrive, reinforce the importance of precise molecular diagnosis for patients with failure to thrive and an abnormal neurologic exam, and underscore the importance of cascade screening of family members.
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Affiliation(s)
- Andrew Ng
- University of California San Diego, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
| | | | - Lisa Salz
- Rady Children's Institute for Genomic Medicine, San Diego, CA, USA
| | - Terence Wong
- Rady Children's Institute for Genomic Medicine, San Diego, CA, USA
| | | | | | | | - Shimul Chowdhury
- Rady Children's Institute for Genomic Medicine, San Diego, CA, USA
| | | | - Jennifer Friedman
- University of California San Diego, San Diego, CA, USA. .,Rady Children's Hospital, San Diego, CA, USA. .,Rady Children's Institute for Genomic Medicine, San Diego, CA, USA.
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