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Arshad Cheema H, Fayyaz Z, Saeed A, Nadeem Anjum M, Ijaz S, Alvi MA, Batool SS. Clinical and Genetic Description of Hereditary Chronic Pancreatitis in Pakistani Children. Turk J Gastroenterol 2023; 34:1088-1098. [PMID: 37603299 PMCID: PMC10645277 DOI: 10.5152/tjg.2023.22791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/29/2022] [Indexed: 08/22/2023]
Abstract
BACKGROUND/AIMS The purpose of this study was to identify the spectrum and frequency of pathogenic variants as well as the clinical and genetic insight of hereditary chronic pancreatitis in Pakistani children. MATERIALS AND METHODS The deoxyribonucleic acid of affected probands of 44 unrelated Pakistani families, having hereditary chronic pancreatitis-affected children, were subjected to massive parallel sequencing for candidate reported genes (SPINK1, PRSS1, CFTR, CPA1, CTRC, CBS, AGL, PHKB, and LPL). Data were analyzed using different bioinformatics tools for the variants and in-silico analysis. All the identified variants were validated by direct sequencing of the targeted exons in the probands and their parents. RESULTS There were 50 patients included in this study with confirmed hereditary chronic pancreatitis. Nine known mutations in SPINK1, PRSS1, CFTR, CTRC, CBS, and AGL genes, and 10 novel variants in LPL, CFTR, CTR, and PHKB genes were identified. The identified variants were found in heterozygous, compound heterozygous, and trans-heterozygous forms, with rare allele frequency in the normal population. The novel variants were [c.378C>T(p.Lys126Asn) and c.719G>A(p.Arg240Gln) in CTRC, c.586-3C>A and c.763A>G(p.Arg255Gly) in CPA1, c.1160_1161insT(p.Lys387Asnfs*26), c.784C>T(p.Gln262*), c.1139+1G>A, c.175G>A(p.Gly59Arg) in LPL, c.388C>G(p.leu130val) in CFTR, and c.2327G>A(p.Arg776His in PHKB)]. The phenotypic characteristics were variable and correlated with the relevant variant. CONCLUSIONS The genetic composition plays a significant role in the predisposition of hereditary chronic pancreatitis. The clinical presentation varies with the genetic determinant involved. This information would help in building up a diagnostic algorithm for our population that can be used for genetic screening services in affected cohorts.
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Affiliation(s)
- Huma Arshad Cheema
- Division of Pediatric Medicine, Department of Pediatric Gastroenterology, Hepatology & Nutrition, The Children’s Hospital Lahore, University of Child Health Sciences, Lahore, Pakistan
| | - Zafar Fayyaz
- Division of Pediatric Medicine, Department of Pediatric Gastroenterology, Hepatology & Nutrition, The Children’s Hospital Lahore, University of Child Health Sciences, Lahore, Pakistan
| | - Anjum Saeed
- Division of Pediatric Medicine, Department of Pediatric Gastroenterology, Hepatology & Nutrition, The Children’s Hospital Lahore, University of Child Health Sciences, Lahore, Pakistan
| | - Muhammad Nadeem Anjum
- Division of Pediatric Medicine, Department of Pediatric Gastroenterology, Hepatology & Nutrition, The Children’s Hospital Lahore, University of Child Health Sciences, Lahore, Pakistan
| | - Sadaqat Ijaz
- Department of Forensic Sciences, University of Health Sciences, Lahore, Pakistan
| | - Muhammad Arshad Alvi
- Division of Pediatric Medicine, Department of Pediatric Gastroenterology, Hepatology & Nutrition, The Children’s Hospital Lahore, University of Child Health Sciences, Lahore, Pakistan
| | - Syeda Sara Batool
- Division of Pediatric Medicine, Department of Pediatric Gastroenterology, Hepatology & Nutrition, The Children’s Hospital Lahore, University of Child Health Sciences, Lahore, Pakistan
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Cheema HA, Waheed N, Saeed A, Anjum MN, Fayyaz Z, Ijaz S. The Mutational Landscape Of Genetic Cholestatic Diseases In Pakistani Children. J PAK MED ASSOC 2023; 73:1610-1621. [PMID: 37697751 DOI: 10.47391/jpma.7069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Objectives To report the mutational landscape of a clinically diagnosed cohort of paediatric patients with cholestasis liver diseases. METHODS The retrospective study was conducted at the University of Child Health Sciences, The Children Hospital, Lahore, Pakistan, from December 10, 2021, to March 31, 2022, and comprised data collected from the Paediatric Gastroenterology and Hepatology unit on demographics, clinical and laboratory findings related to children of either gender aged <12 years and diagnosed with cholestatic liver disease from July 2018 to June 2021. The diagnosis was based on clinical and biochemical findings, with no evidence of biliary atresia and metabolic liver disease. Molecular characterisation was done through whole exome sequencing. RESULTS Of the 171 children evaluated, 92(53.8%) were diagnosed with genetic cholestatic disorders. There were 52(56%) boys and 41(44%) girls. The median age at presentation was 19.5 months (interquartile range: 51 months). Consanguinity was found in 82(88.1%) cases, and positive family history with one or more affected siblings was noted in 60(64.5%). Exome sequencing identified pathogenic mutations in 13 genes underlying the hereditary cholestasis; ATP8B1, ABCB11, ABCB4, TJP2, NR1H4, DCDC2, ACOX2, AKR1D1, HSD3B7, ABCC2, USP53, SLC10A1, and SLC51A. Of the 70 variants identified, 50(71.4%) were novel variants. The ABCB11-related hereditary cholestasis was the most frequent 27(29%), followed by ABCB4 (26(27.9%). Homozygosity was frequently seen in all except 8(8.6%) children, who had compound heterozygous pathogenic variants. There was no evidence of phenotypic expression in the carrier parents despite the severe nature of the respective mutations identified in the patients. CONCLUSIONS Genetic heterogeneity of paediatric intrahepatic cholestasis showed recurrent and novel mutations.
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Affiliation(s)
- Huma Arshad Cheema
- Department of Pediatric Medicine, The Children's Hospital, University of Child Health Sciences, Lahore, Pakistan
| | - Nadia Waheed
- Department of Pediatric Medicine, The Children's Hospital, University of Child Health Sciences, Lahore, Pakistan
| | - Anjum Saeed
- Department of Pediatric Medicine, The Children's Hospital, University of Child Health Sciences, Lahore, Pakistan
| | - Muhammad Nadeem Anjum
- Department of Pediatric Medicine, The Children's Hospital, University of Child Health Sciences, Lahore, Pakistan
| | - Zafar Fayyaz
- Department of Pediatric Medicine, The Children's Hospital, University of Child Health Sciences, Lahore, Pakistan
| | - Sadaqat Ijaz
- Department of Forensic Sciences, University of Health Sciences, Lahore, Pakistan
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Aftab S, Khan SA, Malik MI, Imran A, Anjum MN, Saeed A, Qureshi AA, Cheema HA. Clinical spectrum and diagnostic challenges of vitamin D dependent rickets type 1A (VDDR1A) caused by CYP27B1 mutation in resource limited countries. J Pediatr Endocrinol Metab 2023; 36:152-157. [PMID: 36524979 DOI: 10.1515/jpem-2022-0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Vitamin D dependent rickets type 1A (VDDR1A) is a rare autosomal recessive condition due to inactivating mutation of CYP27B1. It mimics clinically, biochemically and rediologically to nutritional and hypophosphatemic rickets. In developing countries like Pakistan, VDDR1A is often misdiagnosed as nutritional rickets or hypophosphatemic rickets due lack of free access to 1,25 (OH) 2 D level and genetic testing. This study was aimed to determine the clinical spectrum and diagnostic challenges of VDDR1A due to CYP27B1 mutation in developing countries. METHODS Retrospective review of all cases of VDDR1A due to CYP27B1 mutation over a period of two years presenting in the Pediatric Endocrine clinic of Hameed Latif Hospital, Lahore, Pakistan. RESULTS Six cases of VDDR1A (4 males) were identified. Mean age of clinical manifestation was 14 (9-24) months. Mean age of presentation to endocrine department was 5.5 (1.5-11.8) years. Growth failure and bony deformities were the most common presentation (n=6), followed by repeated diarrheas and abdominal distension (n=3) and recurrent fractures (n=1). All cases shared same biochemical profile of low/normal calcium, hypophosphatemia, raised alkaline phosphatase, raised PTH, normal/high 25(OH)D and tubular reabsorption of phosphate (TRP) <85%. Patients treated with calcitriol showed rapid healing as compared to those treated with 1-alfacalcidol. CONCLUSIONS We should have a high index of suspicion of VDDR1A in rickets not responding to cholecalciferol therapy.
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Affiliation(s)
- Sommayya Aftab
- Department of Paediatric Endocrinology and Diabetes, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan.,Paediatric Endocrinology, Hameed Lateef Hospital, Lahore, Pakistan
| | - Sabeen Abid Khan
- Department of Paediatrics, Shifa College of Medicine, Shifa Tameer-r-Millat University, Islamabad
| | - Munir Iqbal Malik
- Department of Paediatrics, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan.,Consultant Paediatric Gastroenterologist, Shifa International Hospital, Islamabad, Pakistan
| | - Ahmed Imran
- Department of Paediatric Radiology, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Muhammad Nadeem Anjum
- Department of Paediatric Gastroenterology , Hepatology and Nutrition, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Anjum Saeed
- Department of Paediatric Gastroenterology , Hepatology and Nutrition, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Abid Ali Qureshi
- Department of Paediatric Radiology, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Huma Arshad Cheema
- Department of Paediatric Gastroenterology , Hepatology and Nutrition, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
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Aftab S, Shaheen T, Asif R, Anjum MN, Saeed A, Manzoor J, Cheema HA. Management challenges of Rabson Mendenhall syndrome in a resource limited country: a case report. J Pediatr Endocrinol Metab 2022; 35:1429-1432. [PMID: 36106528 DOI: 10.1515/jpem-2022-0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/29/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Rabson Mendenhall syndrome (RMS) is a rare form of insulin resistance syndrome caused by insulin receptor mutation. In term of severity, it lies at an intermediate point on spectrum of insulin resistance with Donohue syndrome flanking the severe and Type A insulin resistance at the mild end. We are reporting a 3.5-month-old boy with RMS along with its management challenges in a resource limited country. CASE PRESENTATION An infant presented at 3.5-month of an age with failure to thrive and fluctuating blood glucose level (hyperglycaemia and hypoglycaemia) along with clinical features of insulin resistance. He was found to have raised HbA1C, high insulin and C peptide level and a homozygous mutation in INSR gene c.1049C>T, (p.Ser350 Leu) confirming the diagnosis of RMS. He was managed with long-acting insulin (Detemir) along with frequent feeding. CONCLUSIONS RMS in resource limited countries could be managed with frequent feeding along with insulin. Early diagnosis and management can improve long term outcome.
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Affiliation(s)
- Sommayya Aftab
- Department of Paediatric Endocrinology and Diabetes, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan.,Consultant Paediatric Endocrinology, Hameed Latif Hospital, Lahore, Pakistan
| | - Tahir Shaheen
- Department of Paediatric Endocrinology and Diabetes, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Rameen Asif
- Department of Paediatric Endocrinology and Diabetes, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Muhammad Nadeem Anjum
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University of Child health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Anjum Saeed
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University of Child health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Jaida Manzoor
- Department of Paediatric Endocrinology and Diabetes, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Huma Arshad Cheema
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University of Child health Sciences, The Children's Hospital, Lahore, Pakistan
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Rehman H, Cheema HA, Alvi MA, Anjum MN, Fayyaz Z, Batool SS, Saeed A. Assessment of Quality of Life Among Children with Inflammatory Bowel Disease. PAFMJ 2022. [DOI: 10.51253/pafmj.v72i5.6845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: To evaluate the quality of life among children with inflammatory bowel disease (IBD) by the inflammatory bowel disease questionnaire.
Study Design: Cross-sectional study.
Place and Duration of the Study: Department of Pediatric Gastroenterology, Children's Hospital and Institution of Child Health, Lahore Pakistan, from Nov 2020 to Apr 2021.
Methodology: A total of 60 cases (Crohn's disease or ulcerative colitis) were enrolled in the study. Quality of life was measured according to the Modified IMPACT-III questionnaire.
Results: There were 38(63.3%) males and 22(36.7%) female children. The mean age was 9.57±3.40 years, while 33(55.0%) children were above ten years. The mean maternal age was found to be 37.10±4.09 years. There were 36(60.0%) children with Crohn's disease, while 24(40.0%) had ulcerative colitis. Children with Crohn's disease were found to have a significantly low quality of life compared to children in the ulcerative colitis group in the social domain (p<0.05). In addition, children with ulcerative colitis had a significantly low quality of life with regard to bowel symptoms (p<0.05).
Conclusion: Overall scores showed a low quality of life among children with IBD. Children with Crohn's disease had significantly low social QoL, while children with ulcerative colitis showed significantly low QoL regarding bowel symptoms.
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Waheed N, Saeed A, Ijaz S, Fayyaz Z, Anjum MN, Zahoor Y, Cheema HA. Variability of clinical and biochemical phenotype in liver phosphorylase kinase deficiency with variants in the phosphorylase kinase (PHKG2) gene. J Pediatr Endocrinol Metab 2020; 33:1117-1123. [PMID: 32697758 DOI: 10.1515/jpem-2019-0603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/05/2020] [Indexed: 11/15/2022]
Abstract
Background PHKG2-related liver phosphorylase kinase deficiency is inherited in autosomal recessive pattern and is a rare type of liver glycogenosis. We demonstrated the clinical presentation and genetic determinants involved in children with PHKG2- related liver phosphorylase kinase deficiency. Methodology Ten Pakistani children with liver phosphorylase kinase from seven different families, were enrolled over a period of 18 months. All regions of the PHKG2 gene spanning exons and splicing sites were evaluated through targeted exome sequencing. Variants were analyzed using different bioinformatics tools. Novel variants were reconfirmed by direct sequencing. Results Seven different variants were identified in PHKG2 gene including five novel variants: three stop codons (c.226C>T [p.R76*], c.454C>T [p.R152*] and c.958C>T [p.R320*]), one missense variant c.107C>T (p.S36F) and one splice site variant (c.557-3C>G). All five novel variants were predicted to be damaging by in Silico analysis. The variants are being transmitted through recessive pattern of inheritance except one family (two siblings) has compound heterozygotes. Laboratory data revealed elevated transaminases and triglycerides, normal creatinine phosphokinase and uric acid levels but with glycogen loaded hepatocytes on liver histology. Conclusion PHKG2 related liver phosphorylase kinase deficiency can mimic both liver glycogenosis type I (glucose-6-phosphatase deficiency) & III(amylo-1,6 glucosidase) and characterized by early childhood onset of hepatomegaly, growth restriction, elevated liver enzymes and triglycerides. Molecular analysis would be helpful in accurate diagnosis and proper treatment. The symptoms and biochemical abnormalities in liver glycogenosis due phosphorylase kinase deficiency tend to improve with proper dietary restrictions but need to be monitored for long-term complications such as liver fibrosis and cirrhosis.
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Affiliation(s)
- Nadia Waheed
- Department of Pediatric Medicine, Division of Pediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & Institute of Child Health, Lahore, Pakistan
| | - Anjum Saeed
- Department of Pediatric Medicine, Division of Pediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & Institute of Child Health, Lahore, Pakistan
| | - Sadaqat Ijaz
- Department of Pediatric Medicine, Division of Pediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & Institute of Child Health, Lahore, Pakistan
| | - Zafar Fayyaz
- Department of Pediatric Medicine, Division of Pediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & Institute of Child Health, Lahore, Pakistan
| | - Muhammad Nadeem Anjum
- Department of Pediatric Medicine, Division of Pediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & Institute of Child Health, Lahore, Pakistan
| | - Yasir Zahoor
- Department of Pediatric Medicine, Division of Pediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & Institute of Child Health, Lahore, Pakistan
| | - Huma Arshad Cheema
- Department of Pediatric Medicine, Division of Pediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & Institute of Child Health, Lahore, Pakistan
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Abstract
Objective: Genetic variation analysis of rare autosomal recessive Niemann-Pick disease (NPD) Pakistani patients. Methods: We sequenced the SMPD1 gene including its all coding and flanking regions in seven unrelated sporadic patients suffering from Niemann-Pick disease through targeted exome sequencing. Genetic variants mapping and their protein predictions were evaluated using different bioinformatics tools and clinical phenotypes were correlated. The study was conducted from January 2018 to March 2019 at The Children’s Hospital Lahore. Results: We have mapped five different mutations in SMPD1 gene of enrolled patients with a novel homozygous missense variant (c.1718G>C) (p.Trp573Ser) in one patient. A missense mutation (c.1267C>T) (p.His423Tyr) has been identified in three unrelated patients. A nonsense mutation (c.1327C>T) (p.Arg443Term) and one missense mutation (c.1493G>A) (p.Arg498His) mapped in one patient each. A compound heterozygous mutation has been mapped in one patient (c.740G>A) (p.Gly247Asp); (c.1493G>A) (p.Arg498His). Pathogenic effect of novel variant has been predicted through in-silico analysis and has not been reported in general overall population in the globe. Conclusion: This is the first report of genetic demographic assessment of Niemann-Pick disease in Pakistan. The mapped mutations would be helpful to build a disease variants algorithm of Pakistani population. This will be used for determining disease clinical magnitude along with provision of genetic screening services in affected families.
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Affiliation(s)
- Huma Arshad Cheema
- Dr. Huma Arshad Cheema, MBBS, MCPS, DPGN. Department of Pediatric Gastroenterology and Hepatology, The Children's Hospital & The Institute for Child Health, Lahore, Pakistan
| | - Iqra Ghulam Rasool
- Iqra Ghulam Rasool, M.Phil. Institute of Biochemistry & Biotechnology, University of Veterinary & Animal Sciences, Lahore, Pakistan
| | - Muhammad Nadeem Anjum
- Dr. Muhammad Nadeem Anjum, MBBS, FCPS. Department of Pediatric Gastroenterology and Hepatology, The Children's Hospital & The Institute for Child Health, Lahore, Pakistan
| | - Muhammad Yasir Zahoor
- Dr. Muhammad Yasir Zahoor, PhD. Institute of Biochemistry & Biotechnology, University of Veterinary & Animal Sciences, Lahore, Pakistan
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Zahoor MY, Cheema HA, Ijaz S, Anjum MN, Ramzan K, Bhinder MA. Mapping of IDUA gene variants in Pakistani patients with mucopolysaccharidosis type 1. J Pediatr Endocrinol Metab 2019; 32:1221-1227. [PMID: 31473686 DOI: 10.1515/jpem-2019-0188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/28/2019] [Indexed: 12/26/2022]
Abstract
Background Mucopolysaccharidosis type 1 (MPS1) is a rare debilitating multisystem lysosomal disorder resulting due to the deficiency of α-L-iduronidase enzyme (IDUA), caused by recessive mutations in the IDUA gene. Lack or improper amount of the IDUA enzyme results in the improper metabolism of mucopolysaccharides or glycosaminoglycans (GAGs). These large sugar molecules accumulate in lysosomes within cells leading to different systemic complications. The estimated global incidence of MPS1 is 1:100,000 live births for the Hurler and 1:800,000 for the Scheie phenotypes. Methods Thirteen MPS1-affected children from 12 unrelated cohorts were enrolled. All coding and flanking regions of the IDUA gene were sequenced. Bioinformatics tools were used for data analysis and protein prediction for clinical correlations. Results Six IDUA gene mutations were mapped co-segregating with the recessive pattern of inheritance including a novel variant. A novel missense variant c.908T > C (p.L303P) was mapped in two affected siblings in a cohort in the homozygous form. The variant c.1469T > C (p.L490P) was mapped in five unrelated patients and c.784delC (p.H262Tfs*55) was mapped in three unrelated patients, while mutations c.1598C > G (p.P533R), c.314G > A (p.R105Q) and c.1277ins9 (p.[A394-L395-L396]) were mapped in a single patient each. Conclusions Multisystem disorders and a wide range of clinical presentation impede the evaluation of patients as well as make it difficult to differentiate between different phenotypes of MPS. Early and accurate diagnosis is crucial for the disease management and implementation of an expanded new-born genetic screening program for inborn errors of metabolism including MPS1. We recommend c.784delC (p.H262Tfs*55) and c.1469T > C (p.L490P) as first-line genetic markers for the molecular diagnosis of MPS1 in Pakistan.
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Affiliation(s)
- Muhammad Yasir Zahoor
- Molecular Biology and Forensic Laboratory, Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Huma Arshad Cheema
- Department of Pediatric Gastroenterology and Hepatology, The Children's Hospital and The Institute for Child Health, Lahore, Pakistan
| | - Sadaqat Ijaz
- Molecular Biology and Forensic Laboratory, Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Nadeem Anjum
- Department of Pediatric Gastroenterology and Hepatology, The Children's Hospital and The Institute for Child Health, Lahore, Pakistan
| | - Khushnooda Ramzan
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Munir Ahmad Bhinder
- Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore, Pakistan
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Anjum MN, Cheema HA, Malik HS, Hashmi MA. Clinical Spectrum Of Solitary Rectal Ulcer In Children Presenting With Per-Rectal Bleed. J Ayub Med Coll Abbottabad 2017; 29:74-77. [PMID: 28712179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults and less common in children. The objective of this study was to determine the frequency and clinical spectrum of solitary rectal ulcer in children with bleeding per rectum. METHODS This study was conducted in the Department of Paediatric Gastroenterology Hepatology& Nutrition; The Children's Hospital & The Institute of Child Health, Lahore, from January-December 2015. Total 187 children presenting with per-rectal bleeding who underwent colonoscopy were entered in the study. Demographic and presenting clinical features; colonoscopy and histopathology findings were recorded. Data was analysed using SPSS-20. RESULTS Out of a total of 187 children with bleeding per rectum, 21 (11.23%) were diagnosed with solitary rectal ulcer. Males were 15 (71.43%) and females were 6 (28.57%) with age range 8-12 years. Mucus in stool 14 (66.7%), constipation 12 (57.1%) and tenesmus 10 (47.6%) were the most common clinical presentations. Colonoscopic finding are solitary erythmatous ulcerative lesion was seen in 8 (38.09%) children, multiple ulcerative lesions in colon 6 (28.57%), multiple ulcerative lesions in rectum 5 (23.81%), polypoidal growth in colon and hyperaemic rectal mucosa in 1 (4.76%) each. Histopathological findings were consistent with SRUS in all the cases. CONCLUSIONS The frequency of SRUS was high (19.6%) in patients with per-rectal bleed. Mucus in stool, constipation and tenesmus were the most common clinical presentations. Colonoscopic and histopathological findings were helpful in the confirmation of the underlying aetiology.
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Affiliation(s)
- Muhammad Nadeem Anjum
- Department of Paediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & The Institute of Child Health, Lahore, Pakistan
| | - Huma Arshad Cheema
- Department of Paediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & The Institute of Child Health, Lahore, Pakistan
| | - Hassan Suleman Malik
- Department of Paediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & The Institute of Child Health, Lahore, Pakistan
| | - Muhammad Almas Hashmi
- Department of Paediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & The Institute of Child Health, Lahore, Pakistan
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Tarazi M, Mayooran N, Philip B, Anjum MN, O'Regan K, Doddakula K. Anomalous right upper lobe venous drainage. J Surg Case Rep 2016; 2016:rjw043. [PMID: 27016516 PMCID: PMC4807615 DOI: 10.1093/jscr/rjw043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Lung resections are usually not associated with significant bleeding, but can be fatal, especially in cases of video-assisted thoracoscopic surgery (VATS). Anomalous vascular structures could be a major reason for unexpected bleeding in such surgeries. We present a case of an aberrant upper lobe pulmonary vein that was encountered posterior to the right upper lobe bronchus during a right upper lobectomy via thoracotomy. The anomalous pulmonary vein was identified preoperatively on a computed tomography (CT) scan and hence was looked for before dividing the bronchus. Many centres are adopting the VATS approach for performing lung resections. If an anomalous vein is present posterior to the bronchus, it might be in a blind spot and could be damaged inadvertently, leading to profuse and potentially fatal bleeding. We conclude that the identification of anomalous vascular structures prior to surgery with the help of CT helps in avoiding adverse outcomes.
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Affiliation(s)
- M Tarazi
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Republic of Ireland
| | - N Mayooran
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Republic of Ireland
| | - B Philip
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Republic of Ireland
| | - M N Anjum
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Republic of Ireland
| | - K O'Regan
- Department of Radiology, Cork University Hospital, Cork, Republic of Ireland
| | - K Doddakula
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Republic of Ireland
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Tarazi M, Chan N, Mayooran N, Neagu R, Philip B, Anjum MN, Doddakula K. A Prospective study of the National Early Warning Score in Cardiothoracic Surgery. J Cardiothorac Surg 2015. [PMCID: PMC4695750 DOI: 10.1186/1749-8090-10-s1-a344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Tarazi M, Mayooran N, Anwer M, Anjum MN, Doddakula K. A case of lung volume reduction surgery with decortication for a septic patient in respiratory failure. Int J Surg Case Rep 2015; 17:89-91. [PMID: 26588664 PMCID: PMC4701825 DOI: 10.1016/j.ijscr.2015.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 10/22/2015] [Accepted: 10/31/2015] [Indexed: 11/16/2022] Open
Abstract
Decortication and lung volume reduction surgery are both major operations and each has its independent risk of morbidity and mortality. Bullae can produce signs and radiologic appearances of pneumothorax and it is important to differentiate them before treatment. The differentiation between giant bulla and pneumothorax can be very difficult and often leads to inaccurate diagnosis and management. The NETT trial showed that patients most likely to benefit from lung volume reduction surgery have heterogeneously distributed emphysema involving the upper lung zones predominantly. Our case demonstrates the feasibility of achieving an excellent overall outcome with a combination of complex procedures.
Introduction Decortication and lung volume reduction surgery are both major operations and each has its independent risk of morbidity and mortality. Case report We present the case of a 41 year old gentleman with left sided empyema and giant bullae of the upper lobe with an active air leak that was transferred to our tertiary referral centre for further management. We performed emergency left thoracotomy, decorticated the left lower lobe with extensive lung volume reduction surgery of the upper lobe. Patient’s respiratory status significantly improved along with excellent radiological results. Conclusion Our case demonstrates that a combination of complex procedures is feasible with excellent outcomes.
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Affiliation(s)
- M Tarazi
- Department of Cardiothoracic Surgery, Cork University Hospital, Ireland.
| | - N Mayooran
- Department of Cardiothoracic Surgery, Cork University Hospital, Ireland.
| | - M Anwer
- Department of Cardiothoracic Surgery, Cork University Hospital, Ireland.
| | - M N Anjum
- Department of Cardiothoracic Surgery, Cork University Hospital, Ireland.
| | - K Doddakula
- Department of Cardiothoracic Surgery, Cork University Hospital, Ireland.
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Parker W, Heon J, Anjum MN, Gingras C, Daly M, Freeman C. Poster - Thur Eve - 56: A Comprehensive System for Classifying, Recording and Analyzing Incidents, Accidents, and Other Events in a Radiotherapy Practice. Med Phys 2010. [DOI: 10.1118/1.3476161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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D'Ancona G, Hargrove M, Hinchion J, Ramesh BC, Chughtai JZ, Anjum MN, O'Donnell A, Aherne T. Coronary grafts flow and cardiac pacing modalities: how to improve perioperative myocardial perfusion. Eur J Cardiothorac Surg 2004; 26:85-8. [PMID: 15200984 DOI: 10.1016/j.ejcts.2004.03.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2003] [Revised: 02/20/2004] [Accepted: 03/10/2004] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Aim of this study was to investigate modifications of coronary grafts flow during different pacing modalities after CABG. MATERIALS AND METHODS Two separate prospective studies were conducted in patients undergoing CABG and requiring intraoperative epicardial pacing. In a first study (22 patients) coronary grafts flows were measured during dual chamber pacing (DDD) and during ventricular pacing (VVI). In a second study (10 patients) flows were measured during DDD pacing at different atrio-ventricular (A-V) delay periods. A-V delay was adjusted in 25 ms increments from 25 to 250 ms and flow measurements were performed for each A-V delay increment. A transit time flowmeter was used for the measurements. RESULTS An average of 3.4 grafts/patient were performed. In the first study, average coronary graft flow was 47.4+/-20.8 ml/min during DDD pacing and 41.8+/-18.2 ml/min during VVI pacing (P = 0.0004). Furthermore average systolic pressure was 94.3+/-10.1 mmHg during DDD pacing and 89.6+/-12.2 mmHg during VVV pacing (P = 0.0007). No significant differences in diastolic pressure were recorded during the two different pacing modalities. In the second study, maximal flows were achieved during DDD pacing with an A-V delay of 175 ms (54+/-9.6 ml/min) and minimal flows were detected at 25 ms A-V delay (38.1+/-4.7 ml/min) (P=ns). No significant differences in systolic or diastolic blood pressure were noticed during the different A-V delays. CONCLUSION Grafts flowmetry provides an extra tool to direct supportive measures such as cardiac pacing after CABG. DDD mode with A-V delay around 175 ms. should be preferred to allow for maximal myocardial perfusion via the grafts.
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Affiliation(s)
- Giuseppe D'Ancona
- Department of Cardiac Surgery, Cork University Hospital, Cork, Ireland.
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