Usher Syndrome

Usher syndrome (USH) is the most common genetic condition responsible for combined loss of hearing and vision. Balance disorders and bilateral vestibular areflexia are also observed in some cases. The syndrome was first described by Albrecht von Graefe in 1858, but later named by Charles Usher, who presented a large number of cases with hearing loss and retinopathy in 1914. USH has been grouped into three main clinical types: 1, 2, and 3, which are caused by mutations in different genes and are further divided into different subtypes. To date, nine causative genes have been identified and confirmed as responsible for the syndrome when mutated: MYO7A, USH1C, CDH23, PCDH15, and USH1G (SANS) for Usher type 1; USH2A, ADGRV1, and WHRN for Usher type 2; CLRN1 for Usher type 3. USH is inherited in an autosomal recessive pattern. Digenic, bi-allelic, and polygenic forms have also been reported, in addition to dominant or nonsyndromic forms of genetic mutations. This narrative review reports the causative forms, diagnosis, prognosis, epidemiology, rehabilitation, research, and new treatments of USH.

AN AYURVEDIC MANAGEMENT OF SPINAL MUSCULAR ATROPHY (SMA) – A CASE STUDY

Spinal Muscular Atrophy (SMA) is the second leading genetic disorder inherited in the autosomal recessive pattern due to the absence of the SMN1 gene characterized by loss of motor neurons and progressive muscle wasting, often leading to dependent life and decreased life span. In Ayurveda, this condition can be considered as Kulaja Vyadhi wherein the patient’s Mamsa and Snayu is affected by Vata. This can be regarded as Mamsa-Snayugata Sarvanga Vata. It is said that Prakruta Vata dosha is the life, it is the strength, it is the sustainer of the body, it holds the body and life together. If it is Vikruta it produces Sankocha, Khanja, Kubjatva, Pangutva, Khalli and Soshana of Anga. So, in this disease aggravated Vata does the vitiation of Mamsa and Snayu thus leading to Soshana of both, resulting in Stambha, Nischalikarana of Avayava. A 21years female patient was admitted to our I.P.D with c/o of reduced strength in all four limbs leading to the inability to walk and to maintain erect posture during standing and sitting positions. Based on Ayurvedic principles the patient was initially subjected to Avaranahara Chikitsa followed by Brimhana line of management. Keywords: Mamsagata vata, Snayugata vata, Sarvanga vata, Spinal muscular atrophy (SMA)

Mode of inheritance of syndactyly in selected human families in Bahawalnagar, Pakistan

Syndactyly is joining or merging of web in feet and hands digits. It is inherited by autosomal dominant, autosomal recessive, x-linked, and y-linked manner. Its prevalence is around 1 in 2000 live birth. Non-syndromic syndactyly is classified into nine types. In this study, we find out prevalence, percentage, types, and mode of inheritance of syndactyly in families of district Bahawalnagar. The survey was carried out in hospitals, schools, and villages of district Bahawalnagar to find out the patients with congenital syndactyly. Three families with cousin marriages were selected for pedigrees. These families had 2:1 of foot and hand syndactyly. The percentage of complete and incomplete syndactyly was recorded 50% in all families. The mode of inheritance was autosomal dominant and autosomal recessive pattern because of two types of syndactyly type I (SD1) and syndactyly type I-c. In families Bwn1, Bwn2, and Bwn3 the percentage of family members associated with syndactyly was 16%, 9.7%, and 6.89% respectively. It was further noted that all male members of all families were affected with syndactyly. This study finds out the type I (SD1) and type I-c syndactyly in the studied sample population.

BERNARD SOULIER SYNDROME IN PREGNANCY

Bernard-Soulier syndrome is an inherited platelet disorder, transmitted in an autosomal recessive pattern. Thrombocytopenia and large defective platelets are characteristics, often presents early with bleeding symptoms, such as epistaxis, ecchymosis, menometrorrhagia, and gingival or gastrointestinal bleeding. Diagnosis can be conrmed by platelet aggregation studies and ow cytometry. Differential diagnosis includes other inherited giant platelet disorders, as well as von Willebrand disease and immune thrombocytopenic purpura. During pregnancy, it can present as recurrent rst trimester miscarriages, antepartum, intrapartum and postpartum haemorrhage. Treatment remains generally supportive with platelet transfusions and recombinant factor VII has also been described in literature.

The molecular genetics of UV-Sensitive syndrome; a rare dermal anomaly

UV-Sensitive syndrome (UVSS) is a rare skin disorder that is characterized by heterogeneous phenotypic spectrum of skin freckling, telangiectasia and acute sunburn. UV-Sensitive syndrome (UVSS) usually inherit in autosomal recessive pattern. So far, only 18 patients from nine different families (i.e. Japanese, French, Israeli, Iranian and Pakistani) have been reported in the scientific literature. Its precise prevalence is still unknown, but according to an estimation, it prevails with the ratio of 1:100,000 worldwide. Until now, only three genes have been reported to be involved in UV-Sensitive syndrome, including ERCC6, ERCC8 and UVSSA. Among these genes, UVSSA is reported to be more prevalent among different ethnicities, including Pakistan as well. Physiologically, UV-Sensitive syndrome genes are involved in transcription-coupled nucleotide excision pathway. In order to reduce the disease severity, Continuous..

Updating the Genetic Landscape of Inherited Retinal Dystrophies

Inherited retinal dystrophies (IRD) are a group of diseases characterized by the loss or dysfunction of photoreceptors and a high genetic and clinical heterogeneity. Currently, over 270 genes have been associated with IRD which makes genetic diagnosis very difficult. The recent advent of next generation sequencing has greatly facilitated the diagnostic process, enabling to provide the patients with accurate genetic counseling in some cases. We studied 92 patients who were clinically diagnosed with IRD with two different custom panels. In total, we resolved 53 patients (57.6%); in 12 patients (13%), we found only one mutation in a gene with a known autosomal recessive pattern of inheritance; and 27 patients (29.3%) remained unsolved. We identified 120 pathogenic or likely pathogenic variants; 30 of them were novel. Among the cone-rod dystrophy patients, ABCA4 was the most common mutated gene, meanwhile, USH2A was the most prevalent among the retinitis pigmentosa patients. Interestingly, 10 families carried pathogenic variants in more than one IRD gene, and we identified two deep-intronic variants previously described as pathogenic in ABCA4 and CEP290. In conclusion, the IRD study through custom panel sequencing demonstrates its efficacy for genetic diagnosis, as well as the importance of including deep-intronic regions in their design. This genetic diagnosis will allow patients to make accurate reproductive decisions, enroll in gene-based clinical trials, and benefit from future gene-based treatments.

Awareness of Retinopathy among Sickle Cell Patients

Background: Sickle cell disease (SCD) is a haemoglobinopathy that is inherited in an autosomal recessive pattern. Retinopathy is a complication of SCD, which varies from mild peripheral retinopathy to severe proliferative retinopathy that can cause loss of vision. Methods: A cross-sectional study was conducted from June 2020 to January 2021 aiming to determine the knowledge of retinopathy among patients with sickle cell disease using a validated self-administered questionnaire. Result: A total of 166 respondents completed the questionnaire. Females constituted the majority of participants (62.7%). The age group 31–40 years consitituted 28.3% and were associated with higher knowledge scores. The average knowledge score was also significantly higher in respondents from the Eastern region (B = 1.82, P < 0.05) compared to respondents from Riyadh. The main reason for not having an eye check was the perceived lack of importance of visits among 56.8%. Conclusion: Sickle cell disease patients are prone to complications such as retinopathy which can be detected by frequent follow-up. Almost half of the studied sample showed above average knowledge of retinopathies related to sickle cell disease.

Biomarkers in Glycogen Storage Diseases: An Update

Glycogen storage diseases (GSDs) are a group of 19 hereditary diseases caused by a lack of one or more enzymes involved in the synthesis or degradation of glycogen and are characterized by deposits or abnormal types of glycogen in tissues. Their frequency is very low and they are considered rare diseases. Except for X-linked type IX, the different types are inherited in an autosomal recessive pattern. In this study we reviewed the literature from 1977 to 2020 concerning GSDs, biomarkers, and metabolic imbalances in the symptoms of some GSDs. Most of the reported studies were performed with very few patients. Classification of emerging biomarkers between different types of diseases (hepatics GSDs, McArdle and PDs and other possible biomarkers) was done for better understanding. Calprotectin for hepatics GSDs and urinary glucose tetrasaccharide for Pompe disease have been approved for clinical use, and most of the markers mentioned in this review only need clinical validation, as a final step for their routine use. Most of the possible biomarkers are implied in hepatocellular adenomas, cardiomyopathies, in malfunction of skeletal muscle, in growth retardation, neutropenia, osteopenia and bowel inflammation. However, a few markers have lost interest due to a great variability of results, which is the case of biotinidase, actin alpha 2, smooth muscle, aorta and fibroblast growth factor receptor 4. This is the first review published on emerging biomarkers with a potential application to GSDs.

Xeroderma Pigmentosum in Children: Report of 4 Cases

: Xeroderma pigmentosum (XP) is a rare genetic disorder inherited in an autosomal recessive pattern. Patients with XP are extremely sensitive to ultraviolet (UV) radiation that leads to defective DNA repair. People with XP often suffer from problems in the eyes, face, neck, and other areas of the body, frequently exposed to sunlight. It is characterized by photosensitivity, dry skin, pigmentary changes of the skin, premature skin aging, and a considerable increase in incidence rates of malignant skin tumors. There is no cure for XP. In this article, we have described four patients from two families, three of whom had malignant skin tumors.

Tyrosinemia Type 1 – A case report

Tyrosinemia Type 1 is a rare inherited metabolic disorder attributable to a deficiency of enzyme fumaryl acetoacetate hydrolase. It has an autosomal recessive pattern of inheritance. It often presents with liver disease or liver failure with predominant bleeding tendencies, Fanconi syndrome and or rickets with neurological crisis. Diagnosis is based on clinical features, increased tyrosine and methionine in plasma and the presence of succinylacetone in urine. Untreated patient develops liver failure, cirrhosis and hepatocellular carcinoma and end stage of renal failure. Here we describe a 9 months old infant presented with massive ascites with hepatosplenomegaly, coagulopathy and hypoalbuminemia. The diagnosis of tyrosinemia type 1 was confirmed based on clinical and biochemical findings. We highlight the need for early diagnosis and initiating treatment at the earliest which improves the quality of life in these patients. Here we report a nine month old male infant presented with abdominal distension, hepatomegaly and ascities diagnosed as Tyrosinemia Type 1. Bangladesh J Child Health 2019; VOL 43 (3) :174-176