Can simple and low-cost motor function assessments help in the diagnostic suspicion of Duchenne muscular dystrophy? / Avaliações simples da função motora e de baixo custo podem ajudar na suspeita diagnóstica da distrofia muscular de Duchenne?

Abstract Objective: Duchenne muscular dystrophy, an X-linked genetic disease, leads to progressive muscle weakness mainly in the lower limbs. Motor function tests help to monitor disease progression. Can low-cost, simple assessments help in the diagnostic suspicion of Duchenne muscular dystrophy? The authors aim to define the sensitivity of time to rise from the floor, time to walk 10 meters, and time to run 10 meters, evaluating them as eventual diagnostic screening tools. Methods: This is an analytical, observational, retrospective (1998-2015), and prospective study (2015-2018). Cases were recruited from the database of the pediatric neurology department and the healthy, from child care consultations, with normal gait development (up to 15 months) and without other comorbidities (neuromuscular, pulmonary, heart diseases) from the same university hospital. Results: 128 Duchenne muscular dystrophy patients and 344 healthy children were analyzed, equally distributed in age groups. In Duchenne muscular dystrophy, there is a progressive increase in the means of the times to perform the motor tests according to the age group, which accelerates very abruptly after 7 years of age. Healthy children acquire maximum motor capacity at 6 years and stabilize their times. The time to rise showed a p-value <0.05 and a strong association (effect size [ES] >0.8) in all age groups (except at 12 years), with time to walk 10 meters from 9 years, and with time to run 10 meters , from 5 years. The 100% sensitivity points were defined as follows: time to rise, at 2 s; time to walk 10 meters, 5 s; time to run 10 meters, 4 s. Conclusions: Time to rise is a useful and simple tool in the screening of neuromuscular disorders such as Duchenne muscular dystrophy, a previously incurable disease with new perspectives for treatment.

Resumo Objetivo: A distrofia muscular de Duchenne, doença genética ligada ao X, determina fraqueza muscular progressiva principalmente em membros inferiores. Os testes de função motora ajudam a monitorar a progressão da doença. Avaliações simples de baixo custo podem ajudar na suspeita diagnóstica da distrofia muscular de Duchenne? Objetivamos definir a sensibilidade do tempo levantar, tempo andar 10 metros e tempo correr 10 metros, avaliando-os como eventuais ferramentas de triagem diagnóstica. Métodos: Estudo analítico, observacional, retrospectivo (1998 até 2015) e prospectivo (2015 até 2018). Os casos foram recrutados do banco de dados do serviço de neurologia infantil e os saudáveis, de consultas de puericultura, com desenvolvimento de marcha normal (até os 15 meses) e sem outras comorbidades (neuromusculares, pneumopatias, cardiopatias), do mesmo hospital universitário. Resultados: Foram analisados 128 pacientes com distrofia muscular de Duchenne e 344 saudáveis, distribuídos igualmente em faixas etárias. Na distrofia muscular de Duchenne ocorre aumento progressivo das médias dos tempos para realizar as provas motoras, de forma acentuada a partir dos 7 anos. Os saudáveis estabilizam os tempos a partir dos 6 anos, adquirindo capacidade motora máxima. O tempo de levantar apresentou p-valor <0,05 e forte associação (TE >0,8) em todas as faixas etárias (exceto aos 12 anos), tempo de andar 10 metros a partir de 9 anos e o tempo de correr 10 metros, dos 5 anos. Os pontos de 100% sensibilidade foram definidos: tempo de levantar aos 2 segundos; tempo de andar, 5 segundos e tempo de correr 10 metros, 4 segundos. Conclusões: O tempo de levantar é útil e simples na triagem de doenças neuromusculares como a distrofia muscular de Duchenne, doença antes incurável com novas perspectivas de tratamento.

Family factors in developmental delays in children under six years old

Development delay in children under 6 years old is prevalent not only in both developed and developing countries. It is alarming that the number of delayed children is increasing. It is obliging to find out the family factors that possibly affect developmental delays in children six years old and younger. The objectives of the study were the following: (1) Describe the characteristics of families of children with developmental delays. (2) Determine the factors that significantly relate with developmental delays when comparing families of children, with delays and without delays. The sample was composed of 52 delayed children and their families, and 52 normal children and their families who were purposively chosen. The data was collected from March to May 2011 with the approval of the Saint Louis University Research Ethics Committee. The Metro Manila Developmental Screening Test was used  to test child development. The Parent Behavior Checklist was used to assess  parenting behavior of mothers. A questionnaire was used to collect family and child factors. The results of analysis revealed that higher frequencies of delays occurred in children one (23.08%) and three (23.08%) years of age; first born or only child (36.54%), and in households with three children or less (32.69%). Families of delayed children are of low socio-economic status, whose mother predominantly scored low in all categories of parenting. It was also found out that more frequencies  of delays occurred in the fine motor adaptive sector (86.54%), followed by the language (69.23%), gross motor (38.46%) and personal-social (32.69%) sectors respectively. Results of the chi square test revealed that expectation parenting behavior is significantly associated to developmental delay in the gross-motor sector (p 0.005) in children under six years of age. Developmental delays in the gross motor sector in the three to less than six-year-olds are significantly associated with father's occupation (p 0.009) and expectation parenting behavior (p 0.022). Analysis of factors associated with developmental delays when comparing delayed and normal children revealed that family factors are not significantly associated with developmental delays. A sub-analysis of age groups however revealed that mother's occupation and developmental delays are significantly associated in the three to less that six-year-old age group (p 0.026). It is concluded that children with developmental delays belong to families with disadvantaged socioeconomic status whose mothers scored low in all subscales of parenting behaviors; and family characteristics, parenting behaviors of the mother and child characteristics are not significantly related to developmental delays  in children under six years old. Therefore, health workers should be more vigilant in identifying children with developmental delays regardless of family characteristics.

A Nine-Month-Old Boy With Isodicentric Chromosome 15: A Case Report

Isodicentric chromosome 15 [idic(15)] is a rare chromosomal abnormality that occurs due to inverted duplication of chromosome 15q. It is associated with many clinical findings such as early central hypotonia, developmental delay, cognitive dysfunction, autism spectrum disorders, and seizure. Delayed development is a common problem referred to pediatric rehabilitation clinics. A 9-month-old boy with delayed development was referred to our clinic for assessment and treatment. On chromosomal analysis, he was diagnosed as idic(15) syndrome with 47,XY,+idic(15)(q12) on karyotyping. Herein we describe his clinical manifestations and provide a brief review of the related literature.

Mosaic Ring Chromosome 6 in an Infant with Significant Patent Ductus Arteriosus and Multiple Congenital Anomalies

The clinical features of ring chromosome 6 include central nervous system anomalies, growth retardation, facial dysmorphism and other congenital anomalies. Ring chromosome 6 occurs rarely and manifests as various phenotypes. We report the case of mosaic ring chromosome 6 by conventional karyotyping in a 7-day-old male infant diagnosed with a large patent ductus arteriosus (PDA) with hypoplasia of aortic valve and aortic arch. These have not been previously reported with ring chromosome 6. He recovered from heart failure symptoms after ligation of the PDA. He showed infantile failure to thrive and delayed milestone in a follow-up evaluation. To the best of our knowledge, this is the first report of a Korean individual with ring chromosome 6 and hemodynamically significant PDA.