POS1466 A CASE REPORT OF IRAQI CHILD WITH MONA SYNDROME AND GALACTOSEMIA

Background

MONA) Multicentric Osteolysis, subcutaneous Nodulosis and Athropathy(is a rare autosomal recessive disorder caused by inactivating mutations in the matrix metallopeptidase 2 (MMP2) gene.

It is manifested by osteolysis of the carpal and tarsal bones, progressive joint contractures, and fibrocollagenous nodules (1,2). In addition, there are reports of gingival hypertrophy, pigmented skin lesions, coarse face, corneal opacities, and cardiac defects (1,3). Because of joint contractures and dysmorphic features and radiological findings, it can be misdiagnosed as juvenile idiopathic arthritis and mucopolysaccharidoses respectively(4). Most affected children are apparently normal at birth with symptoms’ onset usually between six months and six years of age (5); the range is from birth to 11 years (2).To date, 51 individuals have been identified with biallelic pathogenic variants in MMP2 (3,6).Here we report a case of child MONA and galactosemia which is not known before.

Objectives

To share this interesting extremely rare presentation and new association

Methods

An eight year old Iraqi boy with Galactosemia at the 4th month of life presented with 4 years history of fractures of his long and short bones after trivial traumas with progressive painful deformities in hands and feet with limitation motion He has seizures, and Atrial septal defects. Intellect is normal, He had coarse facial features, hypertelorism, gum hypertrophy with high arched palate and hirsutism. Painful subcutaneous nodules involving both palms and soles (Figure 1).

Figure 1.

Results

The immunological, hematological and ultrasound were normal. The X-rays showed osteopenia, decrease in joint space and resorption of phalanges with cortical thinning and expansion of the phalangeal and metacarpal bones was a distinct finding (Figure 1). Genetic study revealed Homozygous MMP2 mutation.

Conclusion

Diagnosis of MONA Combined with galactosemia was made.

References

[1]Tuysuz B, Mosig R, Altun G, Sancak S, Glucksman MJ, Martignetti JA. A novel matrix metalloproteinase 2 (MMP2) terminal hemopexin domain mutation in a family with multicentric osteolysis with nodulosis and arthritis with cardiac defects. European journal of human genetics. 2009;17(5):565–72.

[2]Castberg FC, Kjaergaard S, Mosig RA, Lobl M, Martignetti C, Martignetti JA, et al. Multicentric osteolysis with nodulosis and arthropathy (MONA) with cardiac malformation, mimicking polyarticular juvenile idiopathic arthritis: case report and literature review. European journal of pediatrics. 2013;172(12):1657–63.

[3]Bhavani GS, Shah H, Shukla A, Gupta N, Gowrishankar K, Rao AP, et al. Clinical and mutation profile of multicentric osteolysis nodulosis and arthropathy. Am J Med Genet A. 2016 Feb;170A(2):410–7.

[4]L. Kröger et al., “A novel mutation in the matrix metallopeptidase 2 coding gene associated with intrafamilial variability of multicentric osteolysis, nodulosis, and arthropathy,” Mol. Genet. genomic Med., vol. 7, no. 8, p. e802, 2019.

[5]Azzollini J, Rovina D, Gervasini C, Parenti I, Fratoni A, Cubellis MV, et al. Functional characterisation of a novel mutation affecting the catalytic domain of MMP2 in siblings with multicentric osteolysis, nodulosis and arthropathy. Journal of human genetics. 2014;59(11):631–7.

[6]H. Elsebaie, M. A. Mansour, S. M. Elsayed, S. Mahmoud, and T. A. El-Sobky, “Multicentric Osteolysis, Nodulosis, and Arthropathy in Two Unrelated Children with Matrix Metalloproteinase 2 Variants: Genetic-Skeletal Correlations,” 2021.

Disclosure of Interests

None declared

Pattern of Cancer Among the Yemeni Population

Background: The increased number of reported cases in Yemen is an alarming situation that is considered as an important health problem. The aim of the present paper is to describe the pattern of the cancer among the Yemeni population as regards to age and sex distribution, residency and site of the cancer. Methods: The registered cases of cancer in the abroad treatment office in Al Thawra hospital, Taiz governorate for the year 2012 were revised and analyzed by the author to describe the pattern of cancer. Epi-Info software was used in the analysis of the data. Results: A total of 342 cases were registered for abroad treatment during the period of the study. Sex distribution showed male to female ratio of 48% and 52% respectively. The most leading sites of cancer among females were: breast (20%), musculo-skeletal (16%), digestive and endocrine (12%). Among males they were: digestive system (26%), musculo-skeletal (20%), brain (11%), and respiratory system (9%). 61% of the studied cases were among the age group (21-50) years with a maximum peak between (21-40) years. Most of the cancer cases were from Taiz city (45%). Conclusion: Cancer of the breast among females and digestive system among males comprised the majority of registered cases. Residency distributions showed Taiz city preponderance (45%). However increasing the awareness of the public about the problem of cancer and its risk factors beside improving the facilities for early detection of cancer as well as establishing registration centers for cancer in different parts in Yemen and further studies by health professionals to investigate the risk factors for cancer are mandatory.

Mental health in Syrian children with a focus on post-traumatic stress: a cross-sectional study from Syrian schools

PURPOSE

Studies show that conflict can negatively affect psychological health. The Syrian crisis is 8 years old and yet little is known about the impact of the conflict on the well-being of Syrians who remain. This gap was addressed by conducting an empirical study on the mental health burden of Syrian children in two areas of the country.

METHODS

492 children between 8 and 15 years were randomly selected from schools in Damascus and Latakia. The incidence of psychological disorder symptoms was measured using self-report screening instruments, the Children's Revised Impact of Event Scale (CRIES-8) and the Revised Children's Anxiety and Depression Scale (RCADS-25). Simultaneously, sociodemographic and traumatic event information was collected. Binary logistic regression was used to identify factors that influence the development of post-traumatic stress disorder (PTSD) symptoms.

RESULTS

In our sample, 50.2% of students were internally displaced and 32.1% reported a negative experience. 60.5% of those tested had at least one probable psychological disorder with PTSD the most common (35.1%), followed by depression (32.0%), and anxiety (29.5%). Binary logistic regression indicated that PTSD symptoms were predicted by: living in Damascus [odds ratio (OR) 2.36, 95% confidence interval (CI) 1.51-3.69], being female (1.54, 1.02-2.34), having depression and anxiety (2.55, 1.48-4.40), and the negative experiences; displacement and daily warzone exposure (1.84, 1.02-3.30 and 2.67, 1.08-6.60).

CONCLUSIONS

Syrian children are experiencing traumatic events and war-associated daily stresses that are hugely impacting psychological well-being. Our data offer guidance for mental health providers regarding risk factors and highlights the use of the school system to reach suffering children.

Alkali subhalides: high-pressure stability and interplay between metallic and ionic bonds

The high pressure stability of alkali subhalides is rationalized by means of a thorough chemical bonding analysis.

Genetic performance and general combining ability of oil palm Deli dura x AVROS pisifera tested on inland soils

The performance of 11 oil palm AVROS (Algemene Vereniging van Rubberplanters ter Oostkust van Sumatra) pisiferas was evaluated based on their 40 dura x pisifera (DxP) progenies tested on inland soils, predominantly of Serdang Series. Fresh fruit bunch (FFB) yield of each pisiferas ranged from 121.93 to 143.9 kg palm⁻¹ yr⁻¹ with trial mean of 131.62 kg palm⁻¹ yr⁻¹. Analysis of variance (ANOVA) showed low genetic variability among pisifera parents for most of the characters indicating uniformity of the pisifera population. This was anticipated as the AVROS pisiferas were derived from small population and were inbred materials. However, some of the pisiferas have shown good general combining ability (GCA) for certain important economic traits. Three pisiferas (P1 (0.174/247), P3 (0.174/498), P11 (0.182/308)) were identified of having good GCA for FFB yield while pisiferas P1 (0.174/247), P10 (0.182/348), and P11 (0.182/308) were good combiners for oil-to-bunch ratio (O/B). The narrow genetic base of these materials was the main obstacle in breeding and population improvement. However, efforts have been made to introgress this material with the vast oil palm germplasm collections of MPOB for rectifying the problem.

Circulating estradiol and osteoprotegerin as determinants of bone turnover and bone density in postmenopausal women

Osteoprotegerin (OPG) is a recently identified cytokine that acts as a decoy receptor for the receptor activator of NF kappa B ligand. OPG has been shown to be an important inhibitor of osteoclast differentiation and activation in rodent models. Estrogen is known to suppress bone resorption, and the action of estrogen on bone may be mediated by OPG. The relationship between endogenous estrogen and circulating OPG levels and bone status in human populations is unclear. Thus, the aim of this study was to investigate the relationship between biochemical markers of bone turnover and bone density and circulating OPG and endogenous estradiol levels in a population-based cohort of postmenopausal women. Subjects were 180 women ages 55-91 yr (mean age, 67 yr). Serum estradiol was measured using an auto-analyzer. Serum concentrations of OPG were determined by ELISA. Markers of bone formation and resorption were measured by standard methods. Bone mineral density at total body, total hip, femoral neck, and lumbar spine was measured by dual energy x-ray absorptiometry. There was a significant inverse relationship between estradiol and all bone turnover markers (r-values from -0.46 to -0.23; P < 0.05). Serum estradiol was positively related to absolute bone density at all sites and to change in bone density at the hip and femoral neck by univariate analysis (r-values from 0.15-0.29; P < 0.05). We observed a weak inverse association between OPG and serum-based bone turnover markers (r-values -0.18 and -0.16; P < 0.05). There was a significant positive relationship between OPG and bone mineral density at total body, total hip, and femoral neck (r-values from 0.17-0.2; P < 0.05) by univariate analysis, which was lost after adjustment for age and body mass index. There was a significant weak positive relationship between circulating OPG and serum estradiol (r = 0.18; P < 0.02). We observed no significant relationships between OPG and bone turnover markers measured in urine. We conclude that the variation in circulating endogenous estradiol levels is an important factor contributing to levels of bone turnover and bone density at the menopause. Our observations also suggest that circulating levels of OPG may reflect OPG activity in bone and are related to circulating endogenous levels of estradiol. We have previously reported high levels of variability in urine markers of bone resorption, and we suggest that this could account for the absence of a significant association between these markers and circulating OPG.

Redox properties of isradipine and its electrochemical detection in the HPLC determination of the compound in human serum

The electrochemical behaviour of isradipine in a mixed solution of Britton-Robinson buffer (pH 11.8):acetonitrile:methanol (6:3:1, v/v) was studied by cyclic voltammetry and spectroelectrochemistry using an optically transparent thin layer electrode of carbon cloth. The cyclic voltammogram showed several peaks whose shape and potentials depended on the pH. The peak at 330 nm, corresponding to the absorbance of the dihydropyridine ring, disappeared after electrolysis at a potential that was more positive than the oxidation peak. The oxidation peak corresponds to the oxidation of the dihydropyridine ring. Peak height at pH 11.8 was proportional to isradipine concentration. On the basis of the redox properties of isradipine, HPLC was conducted applying electrochemical detection on a polybutadiene coated alumina column using an alkaline mobile phase. The method was applied for the determination of isradipine content in human serum. A good linear relationship between isradipine concentration and peak height was found in the concentration range of 2-200 ng/mL with a correlation coefficient of 0.9924. The detection limit was 0.5 ng/mL. The within-day and day-to-day variation were examined for control human serum and percentage relative standard deviation ranged from 0.5 to 6.7. Interference from many other coadministered drugs was studied in the specified experimental conditions. Photo and heat stabilities of the compound were also studied.

Chromatographic assay and pharmacokinetic studies of propofol in human serum

A high-performance liquid chromatographic system with automated precolumn extraction was developed for the determination of propofol in human serum. Propofol of directly injected serum sample was enriched on a protein-coated mu Bondapak phenyl precolumn while serum constituents such as proteins and salts were eluted to waste. Thereafter, using an on-line column-switching system, the drug was quantitatively transferred and separated on a second analytical column followed by spectrophotometric determination at 270 nm. Good precision, accuracy and linearity were obtained over a range of 30-3000 ng/mL propofol in human serum. The developed method proved to be fast, simple, reproducible, reliable and therefore convenient for propofol monitoring from serum. The recovery of propofol in serum samples from the lowest to the highest concentration ranged from 96.84 to 100.16% (n = 5). The assay was applied to study the pharmacokinetic of the drug in six women undergoing elective caesarean section under general anaesthesia induced with a single intravenous bolus dose of propofol (2.5 mg/kg).

Anti-infective efficacy of antiseptic-coated intramedullary nails

The coating of medical devices with antimicrobial agents has recently emerged as a potentially effective method for the prevention of device-related infections. We examined the anti-infective efficacy of intramedullary nails coated with an antiseptic combination of chlorhexidine and chloroxylenol in a rabbit model of device-related infection after fixation of an open tibial fracture. The rabbits were randomized to receive 2.8-by-100-millimeter stainless-steel tibial intramedullary nails that either were uncoated or were coated with antiseptic. After administration of anesthesia and preoperative antibiotic prophylaxis, a tibial fracture was created and then reduced with insertion of the intramedullary nail. A bacterial inoculum of 10(6) colony-forming units of Staphylococcus aureus was injected into the intramedullary canal, and the wound was sutured. Radiographs of the tibiae were made postoperatively, and the rabbits were monitored daily. They were killed at six weeks, or earlier if there was dehiscence of the wound, the fracture became grossly unstable, or the rabbit failed to thrive. The use of the antiseptic-coated nails was associated with a significantly lower rate of device-related osteomyelitis (two of twenty-two; 9 per cent) than the use of the uncoated nails (thirteen of twenty-one; 62 per cent) (p = 0.0003). The radiographic and histopathological findings were generally similar in the two groups of rabbits. Antiseptic agents were not detected in serum. The results suggest that antiseptic-coated fracture-fixation devices provide significant local protection against Staphylococcus aureus, which is the most common cause of infections related to orthopaedic devices.

Stereoselective metabolic study of famprofazone

Famprofazone (1) metabolites were studied in human urine after medication by 50 mg oral dose. The human urine was collected over 48 h from six volunteers at time intervals of 6, 12, 24 and 48 h. The amount of famprofazone metabolites were recovered from the urine samples by application of Extrelut extraction method. The resultant extracts were derivatized using N-methyl-N-trimethylsilytrifluoroacetamide (MSTFA) for trimethylsilylation followed by N-methyl-bis-trifluoroacetamide (MBTFA) for trifluoroacetylation. Methamphetamine (2) and 3-hydroxymethyl-propyphenazone (3), excreted in human urine, were identified as famprofazone metabolites by gas chromatography-mass spectrometry (GC-MS). The quantitative results revealed that the average amounts of 2 and 3, excreted in human urine were equal to 2.6 and 4 mg, respectively, through 48 h. However, 3 was analysed after enzymatic hydrolysis of the urine samples using beta-glucuronidase/arylsulphatase. The excreted methamphetamine enantiomers could be separated by application of indirect GC-technique using S-(-)-N-trifluoroacetylprolyl chloride (TPC) as a chiral derivatizing agent. The average amount of (-)-methamphetamine isomer excreted in the urine was found to be three fold those of the (+)-isomer.

Horseshoe kidney is associated with an increased relative risk of primary renal carcinoid tumor

PURPOSE

Carcinoid tumor is a rare neoplasm of the kidney with an unknown histogenesis. Of only 31 cases previously reported in the literature 4 arose within horseshoe kidneys. We report a case of primary carcinoid tumor arising within a horseshoe kidney and discuss the unique insight it provided into the pathogenesis of this tumor.

MATERIALS AND METHODS

We reviewed in detail all 31 reported cases of renal carcinoid tumor and, using reported incidence rates of horseshoe kidney, we calculated the relative risk of renal carcinoid tumor arising within a horseshoe kidney. Immunohistochemical staining for neuroendocrine related markers was performed on tissue sections from the present carcinoid tumor, the adjacent kidney and 5 control samples of normal renal parenchyma.

RESULTS

Of the reported tumors 15.6% occurred in horseshoe kidneys, yielding a calculated relative risk of 62. The present tumor was multifocal, arising from the wall of a cystic lesion and possibly representing a dilated calix within the isthmus. Intestinal epithelium lining the cyst cavity exhibited multifocal neuroendocrine cell hyperplasia with an immunohistochemical profile identical to that of the carcinoid tumor cells.

CONCLUSIONS

The relative risk of renal carcinoid tumor developing in a horseshoe kidney is markedly greater than that for Wilms tumor or transitional cell carcinoma. The clinical course of renal carcinoid tumor arising within a horseshoe kidney appears to be more benign than that of the nonhorseshoe variant. Our observations support the hypothesis that renal carcinoid tumors may arise from neuroendocrine cells within foci of metaplastic or teratomatous epithelium within the kidney.

Ultrasound-guided fine-needle aspiration of nonpalpable breast lesions. Cytologic and histologic findings

Between 1989 and 1992, 651 nonpalpable breast lesions in 586 patients were aspirated using the ultrasound-guided technique at M.D. Anderson Cancer Center. Cytologic diagnoses were as follows: malignant, 167; suspicious, 30; benign, 211; cysts, 168; atypical ductal hyperplasia, 4; and insufficient for diagnosis, 71. In all cystic and most benign lesions, fine-needle aspiration (FNA) confirmed the benign clinical findings, and surgery was not performed. Of the 483 solid lesions, 254 were subsequently treated surgically, either because of suspicious mammographic or sonographic findings or because of positive or suspicious cytologic findings. The cytologic diagnoses in these cases were as follows: 132 (52%) malignant, 65 (25%) benign, 26 (10%) suspicious, 4 (2%) atypical, and 27 (11%) insufficient for diagnosis. The sensitivity of ultrasound-guided FNA for the diagnosis of malignant lesions was 91%, specificity 77%, and overall accuracy 84%. There were four (2%) false-negative results. Diagnostic failures were attributed to the small size of the lesions, histologic type, and inexperience in localization and cytologic interpretation of tubular carcinoma. One (1%) false-positive diagnosis was made (atypical ductal hyperplasia misdiagnosed as carcinoma). The authors' findings indicate that ultrasound-guided FNA offers a reliable and simple alternative to open biopsy of nonpalpable breast lesions. The efficacy of this technique depends primarily on accurate localization of the biopsy needle and on skillful cytologic interpretation of certain breast lesions.

Extraskeletal myxoid chondrosarcoma. A clinicopathologic study of ten patients with long-term follow-up

Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma that has been reported to have a relatively good prognosis. The authors report ten patients with EMC on whom there was a minimum follow-up of 10 years. The patients' ages ranged from 31 to 72 years (mean, 57 years); there were six men and four women (seven white, three black). The tumor locations included the knee area and thigh (three patients each), the shoulder (two patients), and the leg and foot (one patient each). The tumors ranged from 3.5 to 18 cm in greatest dimension (median, 11.5 cm). All cases had typical histologic features. Lung metastases developed in all patients but one, and three patients had extrathoracic metastases (one in regional lymph nodes; one in subcutis; and one widespread). Four of the patients who had metastases also had local recurrence, as did the only patient without known metastases. Seven patients died of tumor at 4, 5, 8, 10, 15, 16, and 17 years, respectively, and the three remaining patients were alive with metastatic disease at latest follow-up of 13, 14, and 16 years. The authors' results are distinctly different from those previously reported in series with shorter follow-up times. The authors conclude that extraskeletal myxoid chondrosarcomas are indolent but resilient and capricious tumors with a high potential for metastasis, especially to the lungs, over the long-term.

Extraskeletal myxoid chondrosarcoma. A clinicopathologic study of ten patients with long-term follow-up

Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma that has been reported to have a relatively good prognosis. The authors report ten patients with EMC on whom there was a minimum follow-up of 10 years. The patients' ages ranged from 31 to 72 years (mean, 57 years); there were six men and four women (seven white, three black). The tumor locations included the knee area and thigh (three patients each), the shoulder (two patients), and the leg and foot (one patient each). The tumors ranged from 3.5 to 18 cm in greatest dimension (median, 11.5 cm). All cases had typical histologic features. Lung metastases developed in all patients but one, and three patients had extrathoracic metastases (one in regional lymph nodes; one in subcutis; and one widespread). Four of the patients who had metastases also had local recurrence, as did the only patient without known metastases. Seven patients died of tumor at 4, 5, 8, 10, 15, 16, and 17 years, respectively, and the three remaining patients were alive with metastatic disease at latest follow-up of 13, 14, and 16 years. The authors' results are distinctly different from those previously reported in series with shorter follow-up times. The authors conclude that extraskeletal myxoid chondrosarcomas are indolent but resilient and capricious tumors with a high potential for metastasis, especially to the lungs, over the long-term.