Uma causa muito rara de espasmos infantis

Psychomotor development regression or delay associated with epilepsy represent a diagnostic challenge. The diagnostic approach should take into account age group, epileptic syndrome, physical and neurological data, and organ and/or system involvement. Herein is reported the case of a toddler for whom hair development, epileptic seizure evolution, and electroencephalographic findings were key for Menkes kinky hair disease diagnosis. The typical electroclinical evolution in this syndrome has rarely been previously reported. A 22-month-old boy, born at 35 weeks, was admitted to the hospital by the age of two months due to epileptic seizures. Physical examination revealed dysmorphic facial features, pectus excavatum, and inguinal hernias. Antiepileptic drugs were initiated and one month later the patient was readmitted with recurrent epileptic seizures. Transfer to a hospital with Pediatric Neurology support was required, where light-toned and pleated skin, sparse hair, failure to thrive, and axial hypotonia were remarked. Initial investigation with general metabolic, neuroimaging, ophthalmological, and microarray study revealed no changes. Electroencephalograms were markedly abnormal, initially with focal changes and later with hypsarrhythmia. Considering the patient’s phenotype, copper serum level was analysed, with null value. Molecular study confirmed Menkes kinky hair disease and copper histidine therapy was initiated. Menkes kinky hair disease should be considered in infants with global developmental delay, severe hypotonia, refractory epilepsy, and typical hair and skin changes occurring early in life. However, neonatal diagnosis is hampered by age-unspecific signs and symptoms. Despite being a rare and fatal entity, timely diagnosis allowing early therapy institution and avoiding unnecessary additional tests and prompt genetic counseling are of utmost importance.info:eu-repo/semantics/publishedVersio

Defeitos congénitos da glicosilação

Congenital disorders of glycosylation are a highly variable, rapidly expanding family of genetic diseases that result from defects in the synthesis of glycans. The vast majority of these monogenic diseases are inherited in an autosomal recessive way, but some types follow an autosomal dominant or X-linked inheritance. The present work aimed to review the state of the art of congenital disorders of glycosylation, including available therapeutic options, and present a simplified diagnostic approach to this group of diseases. Congenital disorders of glycosylation can be classified into four categories: N-linked glycosylation defects, O-linked glycosylation defects, combined glycosylation defects, and glycosphingolipid and glycosylphosphatidylinositol anchor synthesis defects. The phenotype may range from mild to severe, depending on disease severity. Clinical features include dysmorphic features, neurologic, dermatologic, cardiac, endocrine, immunologic, hematologic, gastrointestinal and liver involvement, and skeletal muscle abnormalities. As there is no universal or pathognomonic sign or symptom and no sensitive diagnostic test, it is of foremost importance to keep a high index of suspicion of these diseases. When a congenital disorder of glycosylation is suspected, the first step in screening is to perform serum transferrin isoelectric focusing. Molecular genetic testing is the most specific diagnostic test. Treatment is usually symptomatic, with specific treatment only available for some of these disorders. Since congenital defects of glycosylation may affect any organ at any age and have variable clinical presentation, they should be considered in the differential diagnosis of any patient with multiorgan involvement.info:eu-repo/semantics/publishedVersio

Genes, crianças e pediatras

VACTERL association is characterized for vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities. In this patient we found a also a poor weight gain and microcephaly associated with normochromic and normocytic, anemia, uncontrolled glycemia (hypoglycemia and hyperglycemia) and glycosuria with tubulopathy, nephrotic proteinuria and metabolic acidosis with hyperlactacidemia with led us to suspect and confirm a mitochondrial respiratory chain defect.info:eu-repo/semantics/publishedVersio

Iron-sulfur Cluster ISD11 Deficiency (LYRM4 Gene) Presenting as Cardiorespiratory Arrest and 3-methylglutaconic Aciduria

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31497476/In the era of genomics, the number of genes linked to mitochondrial disease has been quickly growing, producing massive knowledge on mitochondrial biochemistry. LYRM4 gene codifies for ISD11, a small protein (11 kDa) acting as an iron-sulfur cluster, that has been recently confirmed as a disease-causing gene for mitochondrial disorders. We present a 4-year-old girl patient, born from non-consanguineous healthy parents, with two episodes of cardiorespiratory arrest after respiratory viral illness with progressive decreased activity and lethargy, at the age of 2 and 3 years. She was asymptomatic between crisis with regular growth and normal development. During acute events of illness, she had hyperlactacidemia (maximum lactate 5.2 mmol/L) and urinary excretion of ketone bodies and 3-methylglutaconic acid, which are normalized after recovery. A Next Generation Sequence approach with a broad gene panel designed for mitochondrial disorders revealed a novel probably pathogenic variant in homozygosity in the LYRM4 gene [p.Tyr31Cys (c.92A>G)] with Mendelian segregation. Functional studies in the skeletal muscle confirmed a combined deficiency of the mitochondrial respiratory chain (I, II, and IV complexes). To our knowledge, this is the third case of LYRM4 deficiency worldwide and the first with 3-methylglutaconic aciduria, not reported in any Fe-S cluster deficiency. Remarkably, it appears to be no neurological involvement so far, only with life-threating acute crisis triggered by expectably benign autolimited illnesses. Respiratory chain cofactors and chaperones are a new field of knowledge and can play a remarkable effect in system homeostasis.Fundação para a Ciência e a Tecnologia, Grant/Award Number: PTDC/DTP‐PIC/2220/2014; NORTE2020, Grant/Award Number: NORTE‐01‐0246‐FEDER‐000014info:eu-repo/semantics/publishedVersio

Meios eficazes de controlo que assegurem o cumprimento do artº35º, do CSC

Envolto em mistério e com vários artigos de opinião à mistura, o artº 35º do CSC entra em vigor ao fim de 15 anos, tendo, a partir daí, sofrido alterações significativas, encontrando-se hoje diferente na sua génese. O que se pretendeu desenvolver com este trabalho foi dissecar a evolução legislativa do artº 35º,do CSC, desde a sua publicação, e os efeitos práticos na sua essência, não esquecendo a desproteção ocorrida no que concerne às sociedades por quotas, uma vez que estiveram sem regulamentação para o caso da perda grave de capital. O principal objetivo traduziu-se em analisar, levantar questões e encontrar as motivações que levaram, ao longo destes anos, o legislador comercial a não insistir no (in)cumprimento dos procedimentos , criando a convicção de que se pode legislar, só porque sim, sem aplicabilidade prática e resultado sério . Foram observadas as posições consagradas no direito comparado e os modelos vigentes, inspirados na diretriz comunitária, concluindo-se que o legislador português criou a norma mais “papão” dos Estados-membros, legislando com diligência excessiva. Não deixou de ser interessante entender que não existem consequências para a perda de metade do capital social. Que aos responsáveis não se aplicam as penalizações criminais nem civis previstas e que a verdadeira intenção do legislador foi vã, quanto ao âmbito obrigacional desta norma, porque não há aplicação e/ou fiscalização do seu cumprimento, concluindo-se que não existem meios eficazes de controlo que assegurem o cumprimento do artº 35º, do CSC.Fifteen years later and since then subjected to significant changes, CSC’s Article 35 shall enter into force notwithstanding it has been shrouded in mystery and blended by several articles of opinion is presently much different than in its genesis. The aim of this work is to develop a deeper insight into Article 35 legislative evolution since its publication and practical purposes in essence, not forgetting the fault to protect private companies because regulation for severe capital loss cases was still missing. Thus, the main objective has resulted in analysing, raising questions and searching the motivations that over the years led the commercial legislature not to insist on the procedures’ (non)enforcement creating the belief that one legislates just because one can without any practical applicability and serious results thereof. Enshrined positions were observed in comparative law and the EU directives inspired current models concluding that the Portuguese legislature has created the utmost "bogeyman" standards of all Member States, legislating with excessive diligence. It has not ceased to be always interesting to understand that there are no consequences for the loss of half of the capital. That the criminal and civil penalties provided by law are not enforced to those accountable and that the real aim of the legislator related to the mandatory scope of this standard was in vain because there is no application and/or monitoring of compliance and enforcement. It is therefore concluded that there are no effective means of control and to ensure CSC’s Article 35 implementation and enforcement

Results after two years of follow-up with an adult team

Funding: This article was supported by National Funds through FCT-Fundação para a Ciência e a Tecnologia, I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020).We aimed to report the implementation of a phenylketonuria (PKU) transition program and study the effects of follow-up with an adult team on metabolic control, adherence, and loss of follow-up. Fifty-five PKU patients were analysed in the study periods (SP): 2 years before (SP1) and after the beginning of adult care (SP2). Retrospective data on metabolic control and number of clinic appointments were collected for each SP, and protein intakes were analysed. In SP2, three patients (6%) were lost to follow-up. There was a small but statistically significant increase in median number of annual blood spots from SP1 to SP2: 11 (7–15) vs. 14 (7–20); p = 0.002. Mean ± SD of median blood Phe remained stable (525 ± 248 µmol/L vs. 552 ± 225 µmol/L; p = 0.100); median % of blood Phe < 480 µmol/L decreased (51 (4–96)% vs. 37 (5–85)%; p = 0.041) and median number of clinic appointments increased from SP1 to SP2: (5 (4–6) vs. 11 (8–13); p < 0.001). No significant differences were found regarding any parameter of protein intake. Our results suggest that the implementation of an adult service was successful as impact on metabolic control was limited and attendance remained high. Continuous dietetic care likely contributed to these results by keeping patients in fol-low-up and committed to treatment.publishersversionpublishe

Trimetilaminúria (Síndroma de odor a peixe) uma doença subestimada: espectro mutacional da população portuguesa

Pretende-se com este trabalho divulgar a capacidade instalada de estudo desta doença, esclarecer a etiologia de casos investigados e tentar correlacionar o genótipo/fenótipo da doença, minimizando os impactos psicossociais que esta patologia acarreta. Por outro lado, pretende-se também alertar para a necessidade do estudo desta patologia de uma forma integrada com a farmacogenética, uma vez que certos genótipos poderão condicionar a atuação de um determinado fármaco

Metabolic control of patients with phenylketonuria in a portuguese metabolic centre comparing three different recommendations

Funding Information: Conflicts of Interest: M.F.A. received grants from Glutamine, Nutricia, Merck Serono, Biomarin, Orphan and Lifediet to attend scientific meetings. A.M. has received research funding and honoraria from Nutricia, Vitaflo International and Merck Serono. She is a member of the European Nutritionist Expert Panel (Biomarin), a member of Sapropterin Advisory Board (Biomarin), a member of the advisory board entitled ELEMENT (Danone-Nutricia), and a member of an advisory board for Arla and Applied Pharma Research. A.P. received an educational grant from Cambrooke Therapeutics and grants from Vitaflo, Nutricia, Merck Serono, Biomarin, and Mevalia to attend scientific meetings. J.C.R. is a member of the European Nutritionist Expert Panel (Biomarin), the Advisory Board for Applied Pharma Research and Nutricia, and received honoraria as a speaker from APR, Merck Serono, Biomarin, Nutricia, Vitaflo, Cambrooke, PIAM and Lifediet. Funding Information: Funding: CINTESIS—UIDB/4255/2020 a program financially supported by Fundação para a Ciência e Tecnologia/Ministério da Educação e Ciência, through national funds is acknowledged. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.Blood phenylalanine (Phe) is used as the primary marker to evaluate metabolic control. Our study aimed to describe the metabolic control of patients with phenylketonuria (PKU) comparing three different treatment recommendations (European guidelines/US guidelines/Portuguese consensus). This was a retrospective, observational, single centre study in patients with PKU collecting data on blood Phe levels from 2017. Nutritional intake data and sapropterin (BH4) prescription were collected at the last appointment of 2017. The final sample studied included 87 patients (48% females) [13 hyperphenylalaninemia; 47 mild PKU; 27 classical PKU] with a median age of 18 y (range: 1–36 y). The median number of blood Phe measurements for patients was 21 (range: 6–89). In patients aged < 12 y, the median blood Phe level was 300 µmol/L (range 168–480) and 474 µmol/L (range 156–1194) for patients ≥ 12 y. Overall, a median of 83% of blood Phe levels were within the European PKU guidelines target range. In patients aged ≥ 12 years, there was a higher median % of blood Phe levels within the European PKU guidelines target range (≥12 y: 84% vs. <12 y: 56%). In children < 12 y with classical PKU (n = 2), only 34% of blood Phe levels were within target range for all 3 guidelines and 49% with mild PKU (n = 11). Girls had better control than boys (89% vs. 66% median Phe levels within European Guidelines). Although it is clear that 50% or more patients were unable to achieve acceptable metabolic control on current treatment options, a globally agreed upper Phe target associated with optimal outcomes for age groups is necessary. More studies need to examine how clinics with dissimilar resources, different therapeutic Phe targets and frequency of monitoring relate to metabolic control.publishersversionpublishe

Leigh Syndrome Spectrum: A Portuguese Population Cohort in an Evolutionary Genetic Era

Mitochondrial diseases are the most common inherited inborn error of metabolism resulting in deficient ATP generation, due to failure in homeostasis and proper bioenergetics. The most frequent mitochondrial disease manifestation in children is Leigh syndrome (LS), encompassing clinical, neuroradiological, biochemical, and molecular features. It typically affects infants but occurs anytime in life. Considering recent updates, LS clinical presentation has been stretched, and is now named LS spectrum (LSS), including classical LS and Leigh-like presentations. Apart from clinical diagnosis challenges, the molecular characterization also progressed from Sanger techniques to NGS (next-generation sequencing), encompassing analysis of nuclear (nDNA) and mitochondrial DNA (mtDNA). This upgrade resumed steps and favored diagnosis. Hereby, our paper presents molecular and clinical data on a Portuguese cohort of 40 positive cases of LSS. A total of 28 patients presented mutation in mtDNA and 12 in nDNA, with novel mutations identified in a heterogeneous group of genes. The present results contribute to the better knowledge of the molecular basis of LS and expand the clinical spectrum associated with this syndrome.info:eu-repo/semantics/publishedVersio

Advances in the diagnosis of mitochondrial diseases by next generation sequencing

O recente desenvolvimento da tecnologia de sequenciação de nova geração (NGS) revolucionou o diagnóstico molecular das doenças genéticas raras, de difícil diagnóstico, tais como as doenças mitocondriais. O estudo destas patologias foi implementado em 1993 pelo nosso grupo e até à data foram investigados mais de 2500 doentes portugueses. Muitos destes doentes ainda não dispõem de diagnóstico molecular, pelo que foi desenvolvida uma estratégia de NGS para a identificação da mutação causal. A sequenciação de um painel de 209 genes nucleares associados a doenças mitocondriais e do DNA mitocondrial completo por NGS, foi realizada num sequenciador MiSeq (Illumina). O estudo de 145 doentes permitiu identificar 41 mutações causais e caraterizar 35 doentes. Esta investigação contribuiu para esclarecer a etiologia molecular destes doentes (35/145; 24%), ii) alargar o espetro mutacional destas patologias e, iii) oferecer um aconselhamento genético e um eventual diagnóstico pré-natal aos casais em risco. O desenvolvimento de um painel, específico para estas patologias, tem um caráter inovador e reforça o nosso Centro como laboratório nacional para o estudo e investigação de doenças mitocondriais.Recent development of high throughput, next-generation sequencing (NGS) technology has revolutionized the research and molecular diagnosis of hardto- diagnose genetic disorders such as mitochondrial disorders. The study of these diseases was implemented in 1993 by our group and to date more than 2,500 Portuguese patients have been investigated. As many of these patients do not yet have molecular diagnosis, an NGS strategy was developed to identify the causal mutation. NGS was performed in a MiSeq Illumina instrument using a custom mitochondrial gene panel with around 209 genes involved in mitochondria metabolism and the entire human mitochondrial genome. The study of 145 patients allowed the identification of 41 causal mutations and the molecular characterization of 35 patients. This investigation contributed to i) identify the pathogenic mutations in the studied patients (35/145; 24%), ii) expand the mutational spectrum in the etiology of these disorders, and iii) propose an accurate genetic counseling. Custom design panels have been widely used for molecular heterogeneous disorders however, the development of this panel will be innovative in our country strengthening our Center as a national reference for the study and research of mitochondrial disorders.Estudo financiado por: Fundação da Ciência e Tecnologia (PTDC/DTP-PIC/2220/2014, Genetic Defects of Mitochondrial Diseases: a Next Generation Sequencing Approach) - implementação da tecnologia de NGS e o desenho de um painel de genes nucleares aplicado ao diagnóstico das doenças mitocondriais; Programa NORTE 2020 (NORTE-01-0246-FEDER-000014, DESVENDAR “DEScobrir, VENcer as Doenças rARas”) - aquisição de equipamentos para a realização da sequenciação de nova geração.info:eu-repo/semantics/publishedVersio