Tegumentary manifestations of Noonan and Noonan-related syndromes

OBJECTIVES: Noonan and Noonan-related syndromes are common autosomal dominant disorders with neuro-cardio-facial-cutaneous and developmental involvement. The objective of this article is to describe the most relevant tegumentary findings in a cohort of 41 patients with Noonan or Noonan-related syndromes and to detail certain aspects of the molecular mechanisms underlying ectodermal involvement. METHODS: A standard questionnaire was administered. A focused physical examination and a systematic review of clinical records was performed on all patients to verify the presence of tegumentary alterations. The molecular analysis of this cohort included sequencing of the following genes in all patients: PTPN1, SOS1, RAF1, KRAS, SHOC2 and BRAF. RESULTS: The most frequent tegumentary alterations were xeroderma (46%), photosensitivity (29%), excessive hair loss (24%), recurrent oral ulcers (22%), curly hair (20%), nevi (17%), markedly increased palmar and plantar creases (12%), follicular hyperkeratosis (12%), palmoplantar hyperkeratosis (10%), café-au-lait spots (10%) and sparse eyebrows (7%). Patients with mutations in PTPN11 had lower frequencies of palmar and plantar creases and palmar/plantar hyperkeratosis compared with the other patients. CONCLUSIONS: We observed that patients with mutations in genes directly involved in cell proliferation kinase cascades (SOS1, BRAF, KRAS and RAF1) had a higher frequency of hyperkeratotic lesions compared with patients with mutations in genes that have a more complex interaction with and modulation of cell proliferation kinase cascades (PTPN11). .

A clinical follow-up of 35 Brazilian patients with Prader-Willi Syndrome

OBJECTIVE: Prader-Willi Syndrome is a common etiology of syndromic obesity that is typically caused by either a paternal microdeletion of a region in chromosome 15 (microdeletions) or a maternal uniparental disomy of this chromosome. The purpose of this study was to describe the most significant clinical features of 35 Brazilian patients with molecularly confirmed Prader-Willi syndrome and to determine the effects of growth hormone treatment on clinical outcomes. METHODS: A retrospective study was performed based on the medical records of a cohort of 35 patients diagnosed with Prader-Willi syndrome. The main clinical characteristics were compared between the group of patients presenting with microdeletions and the group presenting with maternal uniparental disomy of chromosome 15. Curves for height/length, weight and body mass index were constructed and compared between Prader-Willi syndrome patients treated with and without growth hormone to determine how growth hormone treatment affected body composition. The curves for these patient groups were also compared with curves for the normal population. RESULTS: No significant differences were identified between patients with microdeletions and patients with maternal uniparental disomy for any of the clinical parameters measured. Growth hormone treatment considerably improved the control of weight gain and body mass index for female patients but had no effect on either parameter in male patients. Growth hormone treatment did not affect height/length in either gender. CONCLUSION: The prevalence rates of several clinical features in this study are in agreement with the rates reported in the literature. Additionally, we found modest benefits of growth hormone treatment but failed to demonstrate differences between patients with microdeletions and those with maternal uniparental disomy. The control of weight gain in patients with Prader-Willi syndrome is complex and does not depend exclusively on growth hormone treatment.

Estudo comparativo entre a síndrome antifosfolípide primária e a secundária: características clínico-laboratoriais em 149 pacientes / Comparative study between primary and secondary antiphospholipid syndrome: clinic and laboratorial characteristics of 149 patients

OBJETIVOS: O presente estudo tem como objetivo analisar as características clínicas, laboratoriais e imunológicas dos pacientes com síndrome antifosfolípide (SAF) e comparar indivíduos portadores da síndrome primária com portadores da secundária. PACIENTES E MÉTODOS: Foi analisado o banco de dados de 149 pacientes com SAF do Serviço de Reumatologia do HC-FMUSP que satisfaziam os critérios de classificação para SAF. RESULTADOS: A amostra consistiu de 140 (94 por cento) mulheres e 9 (6 por cento) homens, com média de idade de 39,7 ± 11,6 anos. A SAF primária perfez o total de 50 (33,8 por cento) pacientes. As tromboses arteriais foram mais significativamente freqüentes no grupo de SAF primária em relação à secundária (56 por cento versus 35,7 por cento, p = 0,02), mais especificamente a presença da síndrome de Sneddon (8 por cento versus 0, p = 0,012) e isquemia de extremidades (18 por cento versus 5 por cento, p = 0,017). Com exceção de catarata, que foi mais freqüente no grupo associado ao LES (10 por cento versus 0, p = 0,017), não se observou diferenças significativas em relação às outras comorbidades. Em relação aos auto-anticorpos, o grupo de SAF secundária apresentou significativamente maior prevalência de FAN (99 por cento versus 60 por cento, p < 0,0001), anti-ENA (45,9 por cento versus 22 por cento, p = 0,007) e anti-Ro/SS-A (43 por cento versus 8 por cento, p < 0,0001). Com exceção da anticardiolipina IgG que foi mais freqüentemente observada no grupo de SAF secundária (84,7 por cento versus 60 por cento, p = 0,0018), os outros anticorpos antifosfolípides (anticardiolipina IgM e anticoagulante lúpico) não diferiram entre os grupos. CONCLUSÕES: O presente estudo identificou população de SAF primária que apresenta maior freqüência de fenômenos trombóticos arteriais, mais especificamente a síndrome de Sneddon e isquemia de extremidades, em relação aos pacientes com SAF secundária. Reforçou, também, o papel de auto-anticorpos na...

OBJECTIVES: The aim of this study was to analyze the prevalence and characteristics of the main clinical, immunologic and laboratorial features of antiphospholipid syndrome (APS), and to perform a comparison between primary and secondary forms of APS. PATIENTS AND METHODS: A data base of 149 patients from HCFMUSP who met the preliminary criteria for the classification of APS was analyzed. RESULTS: The pattern consisted of 140 (94 percent) female and 9 (6 percent) male patients with a mean age of 39.7 ± 11.6years. Primary APS was present in 50 (33.8 percent) of the patients. Arterial thrombosis were more found in primary APS compared to secondary APS (56 percent vs. 35.7 percent, p = 0.02), more specifically the presence of Sneddon's syndrome (56 percent vs. 35,7 percent, p = 0.02) and limbs ischaemia (18 percent vs. 5 percent, p = 0.017) were more prevalent in the first group. Except cataract that was more frequently observed in secondary APS group (10 percent vs. 0, p = 0.017), no other significant difference was found regarding comorbidities. In relation to autoantibodies, the secondary APS patients had a more significant prevalence of ANA (99 percent vs. 60 percent, p < 0.0001), anti-ENA (45.9 percent vs. 22 percent, p = 0.007) e anti-Ro/SS-A (43 percent vs. 8 percent, p < 0.0001). Antiphospholipid antibodies (IgM anticardiolipin and lupus anticoagulant) did not differ between the groups, except IgG anticardiolipin that was more found in secondary APS group (84.7 percent vs. 60 percent, p = 0.0018), CONCLUSIONS: the present study showed that primary APS had more arterial thrombotic events, more specifically Sneddon's syndrome and limbs ischemia, than secondary APS. It was also reinforced the role of autoantibodies to identify patients with APS associated to SLE.