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1.
Revista Digital de Postgrado ; 9(2): 214, ago. 2020.
Article in Spanish | LILACS (Americas), LIVECS | ID: biblio-1103446

ABSTRACT

El término Origen Temprano de las Enfermedades del Adulto explica la aparición temprana de las condiciones anormales cardiovasculares y metabólicas en la vida adulta, mayor riesgo de morbilidad y muerte asociados a factores ambientales, especialmente nutricionales, que actúan en las primeras etapas de la vida. Estas respuestas programadas dependen de la naturaleza del estímulo o noxa, del tiempo de exposición y del momento de ocurrencia de la noxa, pudiendo un solo genotipo original varios fenotipos y estarían condicionadas por criterios críticos en los cuales se desarrollarían cambios a largo plazo pudiendo ser reversibles o no. La Programación Fetal explica que respuestas adaptativas embrionarias y fetales en un ambiente subóptimo genera consecuencias adversas permanentes. La desnutrición, así como la sobrenutrición fetal aumenta el riesgo de desarrollar alteraciones en el peso y composición corporal fetal, y posteriormente obesidad, síndrome metabólico, incremento en la adiposidad, alteración en el metabolismo de la glucosa y / o insulina, alteración del metabolismo lipídico, alteraciones hepáticas y de las cifras tensionales. La impronta genómica es esencial para el desarrollo y defectos en la misma puede originar alteraciones de la identidad parental transmisibles a las siguientes generaciones. Esta programación fetal puede ser explicada por la epigenética, definida como la serie de alteraciones hereditarias de la expresión genética a través de modificaciones del ADN y las histonas centrales sin cambios en la secuencia de ADN. Estas modificaciones epigenéticas alteran la estructura y condensación de la cromatina, afectando la expresión del genotipo y fenotipo. Este artículo desarrolla los aspectos involucrados en la Programación Fetal y los posibles mecanismos sobre la misma(AU)


The term Early Origin of Adult Diseases explains the early onset of abnormal cardiovascular and metabolic conditions in adult life, increased risk of morbidity and death associated with environmental factors, especially nutritional factors, that act in the early stages of life. These programmed responses depend on the nature of the stimulus or noxa, the time of exposure and the moment of occurrence of the noxa, with a single original genotype being able to have several phenotypes and would be conditioned by critical criteria in which long-term changes could develop, reversibles or not. Fetal Programming explains that embryonic and fetal adaptive responses in a suboptimal environment generate permanent adverse consequences. Fetal malnutrition as overnutrition increases the risk of developing alterations in fetal body weight and composition, and subsequently obesity, metabolic syndrome, increased adiposity, impaired glucose and / or insulin metabolism, impaired lipid metabolism, liver disorders and altered blood pressure. The genomic imprint is essential for development and defects in it can cause alterations of the parental identity and are transmitted to the following generations. This fetal programming can be explained by epigenetics, defined as the series of inherited alterations of genetic expression through modifications of DNA and central histones without changes in the DNA sequence. These epigenetic modifications alter the structure and condensation of chromatin, affecting the expression of the genotype and phenotype. This article develops the aspects involved in Fetal Programming and the possible mechanisms on it(AU)


Subject(s)
Humans , Fetal Nutrition Disorders , Fetal Development , Noxae , Nutritional and Metabolic Diseases , Body Composition , Hypothalamus/anatomy & histology , Metabolism, Inborn Errors
2.
Revista Digital de Postgrado ; 9(2): 205, ago. 2020. tab
Article in Spanish | LILACS (Americas), LIVECS | ID: biblio-1102879

ABSTRACT

La Parálisis Cerebral (PC) es un conjunto de alteraciones motrices no progresivas en la población infantojuvenil, ocasionadas por lesión ­a nivel cerebral- de neuronas o fibras de esa vía, de sus aferencias o de las que la modulan; para su diagnóstico deben conocerse otras patologías también frecuentes y que pueden incidir simultánea o causalmente en la motricidad del paciente; la resultante sería disfunción motora tanto voluntaria como involuntaria, refleja o con propósito, de la postura y/o del tono muscular. Objetivo: detectar errores innatos metabólicos (EIM) que causan o se asocian con PC en una serie significativa. Métodos: Estudio descriptivo-interpretativo, se revisaron los expedientes clínicos del Centro de Parálisis Cerebral de Caracas, en cuyos diagnósticos se presentaron ambas alteraciones, entre los años 1988 y 2018. Resultados: De las 2.000 historias clínicas revisadas, el exámen clínico y las pruebas de laboratorio permitieron seleccionar 174 casos de EIM. Conclusiones: Se tipificaron los errores innatos metabólicos en diez formas clínicas distintas, se evidenciaron en pacientes con PC atendidos en un centro público de Caracas, es posible que la casuística sea varias veces mayor en Venezuela dado que ya no se aplica la pesquisa en los centros de atención pública(AU)


Cerebral Palsy (CP) is a set of non-progressive motor alterations in the child and youth population, caused by injury - at the brain level - of neurons or fibers of that pathway, their afferences or those that modulate it; for its diagnosis, other pathologies that are also frequent and that can simultaneously or causally affect the motor skills of the same patient must be known; The result would be both voluntary and involuntary motor dysfunction, reflected or with purpose, of posture and / or muscle tone. Objective: to detect inborn metabolic errors (EIM) that cause or are associated with CP in a significant series. Methods: Descriptive-interpretive study, we reviewed the clinical records of the Cerebral Palsy Center of Caracas, in whose diagnoses both alterations were presented, between the years 1988 and 2018. Results: Of the 2,000 clinical histories reviewed, the clinical examination and tests Laboratory tests allowed the selection of 174 cases of IMD. Conclusions: Inborn metabolic errors were typified in ten different clinical forms, they were evidenced in patients with CP treated in a public center in Caracas, it is possible that the casuistry is several times greater in Venezuela since the investigation is no longer applied in the centers of public attention(AU)


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Cerebral Palsy/pathology , Metabolism, Inborn Errors , Neurons/metabolism , Pediatrics , Nervous System Diseases
3.
Rev. MED ; 27(2): 21-33, jul.-dic. 2019. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-1115226

ABSTRACT

Resumen: El tamizaje neonatal expandido permite la detección temprana de diversos errores innatos del metabolismo. En Colombia, las condiciones para llevar adelante un programa nacional de alto impacto en salud pública están dadas. A través de una búsqueda bibliográfica sobre el tema en diferentes países, se realizó una disertación sobre la implementación de un programa nacional de tamizaje neonatal. Esto con el fin de plantear una propuesta de tamizaje neonatal expandido por espectrometría de masas en tándem en Colombia, completo, conciso, detallado y acorde con la legislación colombiana, las necesidades y las características de la población. Implementar un programa nacional de este tipo supone un gran impacto en la salud pública y debe ser liderado por el Estado, con la participación y apoyo de profesionales de salud, academia, asociaciones de pacientes e industria farmacéutica.


Abstract: Expanded neonatal screening allows early detection of various inborn errors of metabolism. In Colombia, the conditions to carry out a national program with a high impact on public health are in place. Through a review of the international literature on the subject, this reflection on the implementation of a national neonatal screening program brings forward a complete, concise, detailed proposal for tandem mass spectrometry-expanded neonatal screening in Colombia that conforms to the legislation and the needs and characteristics of the population. Implementing such a national program has a great impact on public health and must be led by the State, with the participation and support of health professionals, academia, patient associations, and the pharmaceutical industry.


Resumo: A triagem neonatal ampliada permite que vários erros inatos do metabolismo sejam identificados precocemente. Na Colômbia, as condições para a realização de um programa nacional com alto impacto na saúde pública estão disponíveis. Por meio de uma pesquisa bibliográfica sobre o assunto em diferentes países, foi realizada uma dissertação sobre a implementação de um programa nacional de triagem neonatal. A fim de apresentar uma proposta de triagem neonatal ampliada por espectrometria de massas em tandem na Colômbia, completa, concisa, detalhada e de acordo com a legislação colombiana, as necessidades e as características da população. A implementação de um programa nacional desse tipo tem um grande impacto na saúde pública e deve ser liderada pelo Estado, com a participação e o apoio de profissionais da saúde, da academia, das associações de pacientes e da indústria farmacêutica.


Subject(s)
Humans , Neonatal Screening , Public Health , Genetic Diseases, Inborn , Metabolism, Inborn Errors
4.
Rev. cuba. pediatr ; 91(3): e872, jul.-set. 2019.
Article in Spanish | LILACS (Americas), CUMED | ID: biblio-1093713
5.
Arch. argent. pediatr ; 117(4): 267-270, ago. 2019. tab
Article in English, Spanish | LILACS (Americas), BINACIS | ID: biblio-1054935

ABSTRACT

La deficiencia de glucosa-6-fosfato deshidrogenasa es la enzimopatía eritrocitaria causada por mutaciones en el gen G6PD, cuya herencia está ligada al cromosoma X. Se analizan las características clínicas y de laboratorio de 24 individuos con deficiencia de G6PD durante 25 años. La edad mediana al momento del diagnóstico fue 10,2 años (rango: 0,6-56,4). El 54,2 % de los pacientes fueron asintomáticos, mientras que el 25 % presentó anemia hemolítica crónica no esferocítica; el 12,5 %, ictericia neonatal y anemia hemolítica posinfecciones, y el 8,3 %, anemia hemolítica aguda pos ingesta de habas. Los 24 pacientes estudiados presentaron variantes descritas previamente en la literatura. Las características clínicas observadas estuvieron acordes con las variantes encontradas. Veintiuna mujeres, pertenecientes a la rama materna de los individuos afectados, pudieron ser identificadas por biología molecular como portadoras de la deficiencia, por lo que recibieron el consejo genético correspondiente.


Glucose-6-phosphate dehydrogenase deficiency is an erythrocyte enzyme disorder caused by mutations in the G6PD gene, which has an X-linked inheritance. Here we analyze the clinical and laboratory characteristics of 24 subjects with G6PD deficiency over 25 years. Their median age at diagnosis was 10.2 years (range: 0.6-56.4). No symptoms were observed in 54.2 % of patients, whereas 25 % had chronic non-spherocytic hemolytic anemia; 12.5 %, neonatal jaundice and postinfectious hemolytic anemia; and 8.3 %, acute hemolytic anemia after ingestion of fava beans. The 24 studied patients had variants that had been previously described in the bibliography. The clinical characteristics observed here were consistent with the variants found. A total of 21 women from the maternal line of affected subjects were identified as deficiency carriers using molecular biology techniques, so they received the corresponding genetic counseling.


Subject(s)
Humans , Male , Female , Child , Diagnosis , Glucosephosphate Dehydrogenase Deficiency , Metabolism, Inborn Errors , Molecular Biology
6.
Yonsei Medical Journal ; : 1061-1066, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-762053

ABSTRACT

PURPOSE: Newborn screening (NBS) programs are important for appropriate management of susceptible neonates to prevent serious clinical problems. Neonates admitted to neonatal intensive care units (NICU) are at a potentially high risk of false-positive results, and repetitive NBS after total parenteral nutrition is completely off results in delayed diagnosis. Here, we present the usefulness of a targeted next-generation sequencing (TNGS) panel to complement NBS for early diagnosis in high-risk neonates. MATERIALS AND METHODS: The TNGS panel covered 198 genes associated with actionable genetic and metabolic diseases that are typically included in NBS programs in Korea using tandem mass spectrometry. The panel was applied to 48 infants admitted to the NICU of Severance Children's Hospital between May 2017 and September 2017. The infants were not selected for suspected metabolic disorders. RESULTS: A total of 13 variants classified as likely pathogenic or pathogenic were detected in 11 (22.9%) neonates, including six genes (DHCR7, PCBD1, GAA, ALDOB, ATP7B, and GBA) associated with metabolic diseases not covered in NBS. One of the 48 infants was diagnosed with an isobutyl-CoA dehydrogenase deficiency, and false positive results of tandem mass screening were confirmed in two infants using the TNGS panel. CONCLUSION: The implementation of TNGS in conjunction with conventional NBS can allow for better management of and earlier diagnosis in susceptible infants, thus preventing the development of critical conditions in these sick infants.


Subject(s)
Complement System Proteins , Delayed Diagnosis , Diagnosis , Early Diagnosis , Humans , Infant , Infant, Newborn , Intensive Care Units, Neonatal , Korea , Mass Screening , Metabolic Diseases , Metabolism, Inborn Errors , Oxidoreductases , Parenteral Nutrition, Total , Tandem Mass Spectrometry
7.
J. pediatr. (Rio J.) ; 95(supl.1): S49-S58, 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1002472

ABSTRACT

Abstract Objectives: This study aimed to review the literature on the repercussions of the different inborn errors of immunity on growth, drawing attention to the diagnosis of this group of diseases in patients with growth disorders, as well as to enable the identification of the different causes of growth disorders in patients with inborn errors of immunity, which can help in their treatment. Data sources: Non-systematic review of the literature, searching articles since 2000 in PubMed with the terms "growth", "growth disorders", "failure to thrive", or "short stature" AND "immunologic deficiency syndromes", "immune deficiency disease", or "immune deficiency" NOT HIV. The Online Mendelian Inheritance in Man (OMIN) database was searched for immunodeficiencies and short stature or failure to thrive. Data summary: Inborn errors of immunity can affect growth in different ways, and some of them can change growth through multiple simultaneous mechanisms: genetic syndromes; disorders of the osteoarticular system; disorders of the endocrine system; reduction in caloric intake; catabolic processes; loss of nutrients; and inflammatory and/or infectious conditions. Conclusions: The type of inborn errors of immunity allows anticipating what type of growth disorder can be expected. The type of growth disorder can help in the diagnosis of clinical conditions related to inborn errors of immunity. In many inborn errors of immunity, the causes of poor growth are mixed, involving more than one factor. In many cases, impaired growth can be adjusted with proper inborn errors of immunity treatment or proper approach to the mechanism of growth impairment.


Resumo Objetivos: Revisão da literatura sobre as repercussões dos diferentes erros inatos da imunidade sobre o crescimento, chamar a atenção para o diagnóstico desse grupo de doenças em pacientes que apresentem desordens do crescimento, assim como permitir que se identifiquem as diferentes causas de alterações do crescimento em pacientes com erros inatos da imunidade, o que pode auxiliar em seu manejo. Fonte dos dados: Revisão não sistemática da literatura, com busca de artigos desde 2000 no Pubmed com os termos "growth" ou "growth disorders" ou "failure to thrive" ou "short stature" AND "immunologic deficiency syndromes" ou "immune deficiency disease" ou "imune deficiency" NOT HIV. E buscas na base OMIN (Online Mendelian Inheritance in Man) por imunodeficiências e baixa estatura ou falha no crescimento ("failure to thrive"). Síntese dos dados: Há diferentes modos pelos quais os erros inatos da imunidade podem afetar o crescimento e alguns deles podem alterar o crescimento por múltiplos mecanismos simultâneos: síndromes genéticas; afecções do aparelho osteoarticular; afecções do sistema endócrino; redução de aporte calórico; processos catabólicos: perda de nutrientes, assim como afecções inflamatórias e/ou infecciosas. Conclusões: O tipo de erros inatos da imunidade permite prever que tipo de alteração no crescimento devemos esperar. O tipo de alteração no crescimento pode auxiliar no diagnóstico de condições clínicas associadas aos erros inatos da imunidade. Em muitos erros inatos da imunidade, as causas do crescimento deficiente são mistas, envolvem mais de um fator. Em muitos casos, o prejuízo do crescimento pode ser corrigido com o adequado tratamento dos erros inatos da imunidade ou adequada abordagem do mecanismo que causa o prejuízo do crescimento.


Subject(s)
Humans , Growth Disorders/etiology , Immunologic Deficiency Syndromes/complications , Metabolism, Inborn Errors/complications , Immunologic Deficiency Syndromes/classification , Metabolism, Inborn Errors/classification
8.
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-776787

ABSTRACT

OBJECTIVE@#To assess the value of dry blood spot tandem mass spectrometry for the diagnosis of autism spectrum disorder (ASD).@*METHODS@#Peripheral blood samples of 277 autistic children were collected. Their amino acid and carnitine profiles were detected by liquid chromatography tandem mass spectrometry. Urine samples of suspected patients were collected for verification by gas chromatography mass spectrometry. Blood samples were also taken for genetic testing.@*RESULTS@#Of the 277 children with ASD, 19 (6.9%) were suspected to be with inborn error of metabolism (IEM), which included 6 cases with amino acidemia, 9 with organic acidemia and 4 with fatty acidemia. Three cases of phenylketonuria, one case of homocysteinemia, one case of propionemia, one case of methylmalonic acidemia, one case of glutaric acidemia, one case of isovaleric acidemia, one case of argininemia, one case of citrullinemia I and four cases of primary carnitine deficiency were confirmed by genetic testing, which yielded an overall diagnostic rate of 5.1% (14/277).@*CONCLUSION@#Our result has provided further evidence for the co-occurrence of ASD and IEM. Tandem mass spectrometry has a great value for the diagnosis and treatment of ASD in childhood.


Subject(s)
Amino Acid Metabolism, Inborn Errors , Diagnosis , Autism Spectrum Disorder , Diagnosis , Child , Dried Blood Spot Testing , Gas Chromatography-Mass Spectrometry , Humans , Metabolism, Inborn Errors , Diagnosis , Tandem Mass Spectrometry
9.
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-776745

ABSTRACT

OBJECTIVE@#To determine the incidence and mutational types of fatty acid oxidation disorders (FAOD) in central-northern region of Guangxi.@*METHODS@#A total of 62 953 neonates were screened for FAOD during December 2012 and December 2017. Acyl-carnitine profiling of neonatal blood sample was performed by tandem mass spectrometry using dry blood spots on a filter paper. The diagnosis of FAOD was confirmed by organic acid profiling of urea and genetic testing.@*RESULTS@#Eighteen cases of FAOD were diagnosed among the 62 953 neonates. Among these, primary carnitine deficiency (PCD) was the most common type (n=13), which was followed by short-chain acyl-CoA dehydrogenase deficiency (SCADD) (n=2), medium-chain acyl-CoA dehydrogenase deficiency (MCADD) (n=1), multiple acyl-CoA dehydrogenase deficiency (MADD) (n=1), and carnitine palmitoyltransferase II deficiency (CPT II D) (n=1). Genetic testing has revealed two previously unreported variants, i.e., c.337G to A (p.Gly113Arg) of ACADS gene and c.737G TO T (p.Gly246Val) of ETFA gene.@*CONCLUSION@#PCD is the most common FAOD in central-northern Guangxi. Tandem mass spectrometry combined with genetic testing may facilitate early diagnosis of FAOD.


Subject(s)
Acyl-CoA Dehydrogenase , Genetics , Carnitine , Blood , Carnitine O-Palmitoyltransferase , China , Electron-Transferring Flavoproteins , Genetics , Humans , Infant, Newborn , Lipid Metabolism, Inborn Errors , Diagnosis , Genetics , Metabolism, Inborn Errors , Diagnosis , Multiple Acyl Coenzyme A Dehydrogenase Deficiency , Diagnosis , Neonatal Screening , Tandem Mass Spectrometry
10.
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-775043

ABSTRACT

OBJECTIVE@#To establish a congenital chloride diarrhea (CCD)-associated SLC26A3 c.392C>G (p.P131R) polymorphism-expressing cell model, and to investigate its biological function.@*METHODS@#The sequence of the SLC26A3 gene in GenBank was used to design the upstream and downstream single-guide RNA (sgRNA) that could specifically recognize the 392 locus of the SLC26A3 gene, and the sgRNA was mixed with the pSpCas9-puro vector after enzyme digestion to construct an eukaryotic recombinant expression plasmid (pSpCas9-SLC26A3). Caco-2 cells were transfected with the recombinant plasmid and synthesized single-stranded DNA oligonucleotides (ssODNs), and Taqman genotyping assay and Sanger sequencing were used to identify the expression of SLC26A3 c.392C>G (p.P131R) in Caco-2 cells. Wild-type Caco-2 cells were selected as normal control group and the Caco-2 cells with successful expression of SLC26A3 c.392C>G (p.P131R) was selected as P131R group. Both groups were treated with 100 ng/mL tumor necrosis factor-α (TNF-α), and then the normal control group was named as TNF-α group, and the P131R group was named as TNF-α+P131R group. Electric cell-substrate impedance sensing (ECIS) assay was used to evaluate the change in the monolayer barrier function of intestinal epithelial cells in the above four groups, and Western blot was used to measure the change in the expression of SLC26A3 protein in the normal control group and the P131R group.@*RESULTS@#The eukaryotic recombinant expression plasmid (pSpCas9-SLC26A3) was successfully constructed. Both Taqman genotyping assay and Sanger sequencing confirmed the successful establishment of the Caco-2 cell model of SLC26A3 c.392C>G (p.P131R) expression. ECIS assay showed that compared with the normal control group, the P131R group had a significant increase in the monolayer permeability of intestinal epithelial cells (PG (p.P131R) can reduce the expression of SLC26A3 protein, increase the monolayer permeability of intestinal epithelial cells, and thus lead to diarrhea.


Subject(s)
Caco-2 Cells , Chloride-Bicarbonate Antiporters , Genetics , Diarrhea , Genetics , Humans , Intestinal Mucosa , Metabolism, Inborn Errors , Genetics , Polymorphism, Single Nucleotide , Sulfate Transporters , Genetics , Tight Junctions , Tumor Necrosis Factor-alpha
11.
Article in English | WPRIM (Western Pacific) | ID: wprim-741368

ABSTRACT

Hyperammonemia can be caused by several genetic inborn errors of metabolism including urea cycle defects, organic acidemias, fatty acid oxidation defects, and certain disorders of amino acid metabolism. High levels of ammonia are extremely neurotoxic, leading to astrocyte swelling, brain edema, coma, severe disability, and even death. Thus, emergency treatment for hyperammonemia must be initiated before a precise diagnosis is established. In neonates with hyperammonemia caused by an inborn error of metabolism, a few studies have suggested that peritoneal dialysis, intermittent hemodialysis, and continuous renal replacement therapy (RRT) are effective modalities for decreasing the plasma level of ammonia. In this review, we discuss the current literature related to the use of RRT for treating neonates with hyperammonemia caused by an inborn error of metabolism, including optimal prescriptions, prognosis, and outcomes. We also review the literature on new technologies and instrumentation for RRT in neonates


Subject(s)
Ammonia , Astrocytes , Brain Edema , Coma , Diagnosis , Edema , Emergency Treatment , Humans , Hyperammonemia , Infant, Newborn , Metabolism , Metabolism, Inborn Errors , Peritoneal Dialysis , Plasma , Prescriptions , Prognosis , Renal Dialysis , Renal Replacement Therapy , Urea
12.
Sci. med. (Porto Alegre, Online) ; 28(3): ID31385, jul-set 2018.
Article in Portuguese | LILACS (Americas) | ID: biblio-963647

ABSTRACT

OBJETIVOS: Relatar o caso de um recém-nascido com deficiência de glicerol quinase, no qual foi identificada uma mutação isolada ainda não descrita no gene GK. DESCRIÇÃO DO CASO: Um recém-nascido com 10 dias de vida foi trazido ao serviço de urgência por recusa alimentar com 24 horas de evolução. Ao exame físico apresentava perda de 31% do peso de nascimento e sinais de desidratação. Os exames laboratoriais constataram presença de acidose metabólica com anion gap aumentado, creatinina 2,41mg/dL, ureia 306 mg/dL, hipernatremia (182mEq/L), hipercalemia (6,8mEq/L), hipercloremia (151mEq/L), transaminase glutâmico-oxalacética 879U/L, transaminase glutâmico-pirúvica 243U/L, triglicerídeos 725mg/dL. A cromotagrafia de ácidos orgânicos revelou hiperglicerolemia e glicerolúria compatíveis com deficiência de glicerol quinase. O estudo genético revelou uma mutação ainda não descrita: c.187T>C (p.S63P) em hemizigotia no gene GK. CONCLUSÕES: A causa mais frequente de desidratação hipernatrêmica no período neonatal é a hipogalatia materna. Nos casos mais graves de desidratação outras etiologias devem ser consideradas, incluindo causas metabólicas como a deficiência de glicerol quinase. Neste caso foi encontrada uma mutação no gene GK ainda não descrita.


AIMS: To report the case of a newborn with glycerol kinase deficiency, in which an isolated mutation not yet described in the GK gene was identified. CASE DESCRIPTION: A neonate with 10 days of age was brought to the emergency department for refusal to feed with 24 hours of evolution. Physical examination showed a loss of 31% of birth weight and signs of dehydration. Laboratory tests revealed a metabolic acidosis with increased anion gap, creatinine 2.41mg/dL, urea 306mg/dL, hypernatremia (182mEq/L), hyperkalemia (6.8mEq/L), hyperchloremia (151mEq/L), glutamic-oxalacetic transaminase 879U/L, glutamic-pyruvic transaminase 243U/L, triglycerides 725mg/dL. Chromotagraphy of organic acids revealed hyperglycerolemia and glyceroluria compatible with glycerol kinase deficiency. The genetic study revealed a mutation not yet described: c.187T>C (p.S63P) as hemizygote status in the GK gene. CONCLUSIONS: The most frequent cause of hypernatremic dehydration in the neonatal period is maternal hypogalactia. In more severe cases of dehydration, other etiologies should be considered, including metabolic causes such as glycerol kinase deficiency. In this case a mutation not yet described in the GK gene was found.


Subject(s)
Glycerol Kinase/deficiency , Metabolism, Inborn Errors , Infant, Newborn , Dehydration , Hypernatremia
13.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-715113

ABSTRACT

OBJECTIVE: 3-Methylcrotonyl CoA carboxylase deficiency (3MCCD) is classified as organic acid disease due to leucine catabolism. It is among the most common inborn errors of metabolism identified on newborn screening test using tandem mass spectrometry. There is a broad spectrum of clinical presentations. 3-Methylcrotonyl CoA carboxylase converts 3-methylcrotonyl-CoA to 3-methylglutaconyl-CoA using biotin as a coenzyme in mitochondria. Restricting protein diets and supplementing carnitine, glycine, and biotin are known treatments. We reported this study to find out clinical symptoms, type of gene mutation, and effect of treatment. METHODS: This study was based on retrospective data of patients with 3MCCD in Soonchunhyang University Seoul Hospital and Soonchunhyang University Bucheon Hospital between April 2009 to August 2016. RESULTS: All 10 infants were born term infants and had no symptoms. During the neonatal period, abnormalities were detected in the new born screening test using tandem mass spectrometry, 3-hydroxyisovalerylcarnitine was increased. 3-Methylcrotonylglycine (3MCG) and 3-hydroxyisovalreric acid (3HIVA) were examined in urine organic acid assay. The results showed that 3MCG was increased in all 10 children. Except for three of the 10 children, 3HIVA was increased. Genetic tests were performed on all 10 children. MCCC1 gene mutations were detected in four patients and MCCC2 mutations were detected in six patients. After diagnosis, all children were recommended leucine-restricted diets, and seven of the 10 patients started to feed on leucine free formula for the treatment of 3MCCD. CONCLUSION: According to our data, all patients has no symptoms and are shown normal development. There were no clinical symptoms or changes in prognosis according to gene mutation type.


Subject(s)
Biotin , Carnitine , Child , Diagnosis , Diet , Glycine , Humans , Infant , Infant, Newborn , Leucine , Mass Screening , Metabolism , Metabolism, Inborn Errors , Mitochondria , Neonatal Screening , Prognosis , Retrospective Studies , Seoul , Tandem Mass Spectrometry
14.
Egyptian Journal of Hospital Medicine [The]. 2018; 71 (3): 2712-2714
in English | IMEMR (Eastern Mediterranean) | ID: emr-192520

ABSTRACT

Background: Inherited metabolic abnormality was a common influential factor in the pathogenesis of intractable epilepsy. Screening of inborn metabolic abnormality in children with intractable epilepsy should be conducted as early as possible, to achieve early treatment and improve their prognosis


Methods: Descriptive study was conducted in Outpatient Neurology Clinic -Ain Shams University Pediatric Hospital. It included 30 [12 male and 18 female] patients with intractable epilepsy during the period from February 2017 to December 2017. All patients presented with drug resistant epilepsy.subjected to full history talking, clinical examination and were investigated by serum lactate, serum ammonia, arterial blood gases, Extended Metabolic Screen using tandem mass spectrometry, urinary organic acids, fundus examination, EEG and neuroimaging


Results: Abnormal urinary organic acid analysis was present in 5 patients as follows: 3-hydroxyglutaric acid in one patient, increase lactic acid in three patients and 2-oxoglutaric in one patient. Plasma amino acid analysis results were alanine elevation in 4 patients, elevated C5-DC in one patient, abnormal co-carnitine in three patients, 2 of them had low concentration and one had high concentration, elevated glycine in two patients and phenylalanine elevation in only one


Conclusion: Inherited metabolic abnormality was a common influential factor in the pathogenesis of intractable epilepsy


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Tandem Mass Spectrometry , Metabolism, Inborn Errors
15.
Article in English | WPRIM (Western Pacific) | ID: wprim-715593

ABSTRACT

Infant formula is classified into standard cow's milk-based and special formulas. This review aimed at summarizing the types of special milk formulas currently sold in Korea, and the appropriate indications for the use of these formulas; lactose free formula, soy-based formula, protein hydrolysate formula, amino acid-based formula, preterm formula, medium chain triglyceride formula, low-phosphorus formula, protein-energy-enriched formula, and formulas for inborn errors of metabolism.


Subject(s)
Humans , Infant Formula , Infant , Korea , Lactose , Metabolism, Inborn Errors , Milk , Protein Hydrolysates , Soybeans , Triglycerides
17.
Rev. paul. pediatr ; 35(3): 258-264, jul.-set. 2017. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-902853

ABSTRACT

RESUMO Objetivo: Avaliar a apresentação clínica inicial dos casos com diagnóstico confirmado de erros inatos do metabolismo (EIM) em um serviço de referência em atendimento pediátrico. Métodos: Estudo clínico, observacional, com delineamento transversal e de coleta retrospectiva em consulta ambulatorial de 2009 a 2013. Critério de inclusão: paciente encaminhado para investigação de EIM. Critério de exclusão: diagnóstico prévio de EIM. Variáveis analisadas: dados de identificação; situação atual da investigação diagnóstica; história familiar; apresentação clínica inicial; alterações laboratoriais. Os dados foram analisados por meio de estatística descritiva Resultados: Incluídos 144 pacientes, sendo 62,5% do sexo masculino. A mediana de idade foi de 2,6 anos e a média de 4,3 ± 4,7 anos. Doze pacientes (8,3%) tiveram o diagnóstico confirmado (três com aminoacidopatias, três com acidemias orgânicas, dois com distúrbios do ciclo da ureia e quatro com doenças de depósito lisossômico). Déficit cognitivo e convulsões foram os sinais e sintomas iniciais; seguidos de retardo de crescimento, atraso do desenvolvimento neuropsicomotor, convulsões e hepatomegalia. As principais alterações laboratoriais encontradas foram hiperamonemia e acidose metabólica. Conclusões: O diagnóstico dos EIM ainda traz desafios à prática pediátrica. Neste estudo foram identificados os seguintes fatores: dificuldade de acesso aos exames laboratoriais específicos, reduzido número de especialistas e pouca difusão do conhecimento nas faculdades da área da saúde. O diagnóstico precoce dos EIM tem impacto fundamental no tratamento e prevenção das sequelas, devendo ser considerado já nas hipóteses diagnósticas iniciais.


ABSTRACT Objective: To assess the initial clinical presentation of confirmed cases of inborn errors of metabolism (IEM) at a reference facility for pediatric care. Methods: Cross-sectional, observational and descriptive study with data collection of outpatients, from January 2009 to December 2013. Inclusion criterion: referral to IEM investigation. Exclusion criterion: prior diagnosis of IEM. Analyzed variables: identification data; status of diagnostic investigation; family history of IEM; initial clinical presentation, laboratory abnormalities related to the hypothesis of IEM. Descriptive statistical methods were used in the data analysis. Results: We included 144 patients in the study, of which 62.5% were male. The mean and median ages were, respectively, 4.3 ± 4.7 years and 2.6 years. Twelve patients (8.3%) had a confirmed diagnosis of IEM (three with aminoacidopathies, three with organic acidemias, two with urea cycle disorders and four with lysosomal storage diseases). Cognitive impairment and seizures were the initial signs and symptoms, followed by growth retardation, neuropsychomotor developmental delay, seizures and hepatomegaly. The main laboratory abnormalities in the diagnosis were hyperammonemia and metabolic acidosis. Conclusions: The diagnosis of IEM still creates challenges to the pediatric practice. In this study, we identified the following factors: difficulty to access specific laboratory tests, reduced number of experts and poor dissemination of knowledge among healthcare schools. The early diagnosis of IEM majorly impacts the treatment and prevention of sequelae and should be considered in the initial diagnostic hypotheses.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Metabolism, Inborn Errors/diagnosis , Referral and Consultation , Cross-Sectional Studies , Hospitals, Pediatric
19.
Pediátr. Panamá ; 46(2): 87-92, agosto-septiembre 2017.
Article in Spanish | LILACS (Americas) | ID: biblio-848340

ABSTRACT

Resumen Las enfermedades neurometabólicas constituyen un grupo de patologías poco frecuentes y en notable expansión, de difícil diagnóstico y complicado manejo. Este artículo pretende desarrollar una orientación práctica frente a la sospecha de una enfermedad metabólica, a partir del análisis de la neuroimagen. Es muy importante para el neuropediatra sospecharlas pero siempre en función de los antecedentes , de los signos y síntomas neurológicos (retardo del desarrollo, déficit cognitivo, epilepsia refractaria, distonía, crisis metabólicas o la presencia de signos extraneurológicos inexplicados), de los hallazgos bioquímicos y de la neuroimagen. En muchas ocasiones los hallazgos son totalmente inespecíficos, sin embargo en otras situaciones la neuroimagen, en especial la resonancia magnética craneal (RM), puede ser muy orientadora o simplemente especí ca de una enfermedad metabólica. El examen pormenorizado de la RM valorando el compromiso de la sustancia blanca, de la sustancia gris, de los ganglios basales o del cerebelo podrá orientar hacia un grupo concreto de enfermedades metabólicas. Además con la RM espectroscópica (RME) y con las técnicas de difusión se pueden orientar/diagnosticar algunos errores Innatos del Metabolismo (EIM), seguir la evolución o incluso valorar la respuesta a la terapia.


Abstract Neurometabolic diseases constitute a group of rare diseases and in remarkable expansion, with difficult diagnosis and complicated management. This article aims to develop a practical orientation to the suspicion of a metabolic disease, based on the neuroimaging analysis. Neurological signs and symptoms (developmental delay, cognitive deficit, refractory epilepsy, dystonia, metabolic crises or the presence of unexplained extraneurologic signs) are very important for the neuropediatrician, but always on the basis of their antecedents, biochemical findings and of neuroimaging. In many cases neuroimaging (specially cranial magnetic resonance) (MRI) ndings are totally non-specific, however in other situations the neuroimaging can be very suspicious or simply specific to a metabolic disease. Detailed examination with MRI of white matter, gray matter, basal ganglia, or cerebellum may be directed towards a speci c group of metabolic diseases. In addition to the spectroscopic MRI and di usion techniques, some EIM can be targeted / diagnosed, follow the evolution or even evaluate the response to therapy.


Subject(s)
Pregnancy , Neuroimaging , Metabolism, Inborn Errors , Neurologic Manifestations
20.
Pediátr. Panamá ; 46(2): 93-98, agosto-septiembre 2017.
Article in Spanish | LILACS (Americas) | ID: biblio-848341

ABSTRACT

Resumen La mayoría de los Errores Innatos del Metabolismo (EIM) no tienen un tratamiento efectivo. Las terapias tradicionales tratan de reducir los sustratos, reemplazar el producto no formado, que puede ser esencial y suplementar con cofactores. También se emplea la activación de vías alternativas para la eliminación de productos intermedios tóxicos, como en el caso de los defectos del ciclo de la urea y para algunas condiciones, se dispone de la terapia de reemplazo enzimático (TRE), del trasplante de células hematopoyéticas y del trasplante hepático. En los últimos años se han desarrollado nuevas estrategias e caces para tratar estas enfermedades. Con esta revisión, se busca explicar de forma sencilla las distintas opciones terapéuticas más recientes, y en algunos casos, tratamientos prometedores para ciertos errores innatos de metabolismo (EIM). En concreto se hará referencia en primer lugar al uso terapéutico de pequeñas moléculas activas, que han surgido en las últimas dos décadas como un enfoque promisorio para el tratamiento de este heterogéneo grupo de trastornos, que incluyen terapia para restauración de la lectura, chaperonas farmacológicas, reguladores de la proteostasis, inhibidores de sustrato e inductores de autofagia. Estas pequeñas moléculas actúan en diferentes niveles celulares, y el conocimiento de los distintos procesos proporciona nuevas herramientas para establecer un tratamiento innovador.


Abstract Most Inborn Errors of Metabolism diseases do not have an effective treatment. Traditional therapies try to reduce substrates, replace non-formed product, which may be essential and supplement with cofactors. Activation of alternative routes for the disposal of toxic intermediates is also employed, as in the case of urea cycle defects for some conditions, enzyme replacement therapy (ERT), Hematopoietic Cell Transplantation and liver transplantation are available. In recent years new effective strategies have been developed to treat these diseases. This review seeks to explain in a simple way the different therapeutic options and, in some cases, promising treatments for certain inborn errors of metabolism (IEM). Specifically, reference will be made first to the therapeutic use of small active molecules, which have emerged in the last two decades as a promising approach for the treatment of this heterogeneous group of disorders, including: read-through therapy, pharmacological chaperones, protease inhibitors, substrate inhibitors and autophagy inducers. These small molecules act on different cellular levels, and the knowledge of the different processes provides new tools to establish an innovative treatment.


Subject(s)
Humans , Metabolism, Inborn Errors
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