Genetic analysis of Turner syndrome in Tunisian patients: from diagnosis to management

Background/aim Turner syndrome (TS) is a rare sex chromosome abnormality in women, occurring in approximately one in 2500 live births, associated with a wide range of clinical stigmata of which short stature, ovarian dysgenesis, and dysmorphic features are the most frequent. Morbidity and mortality are clearly increased compared with the general population, and the average age at diagnosis is quite delayed. Even if the majority of females with TS have a non-mosaic 45,X karyotype, several karyotype variations exist, including short or long arm deletion, ring X isochromosome of the long arm, and 45,X 46,XX mosaicism. This explains the large phenotypic and genetic heterogeneities of TS, which make the diagnosis and especially the management increasingly difficult. We present in this work a genetic study of TS in the Tunisian population to establish a genotype–phenotype correlation, which would be of great help for the diagnosis and the care of patients. Patients and methods A total of 26 unrelated Tunisian girls were included in this study. All patients underwent a complete clinical and biochemical examination as well as karyotyping. The screening for the SRY gene was carried out by fluorescence in-situ hybridization or by PCR. Results Cytogenetic results showed a prevalence of the 45,X karyotype in 46% of patients and various proportions of the other karyotypes. However, genotype–phenotype correlation revealed several discrepancies regarding the major signs and the age at diagnosis. The comparison of the approaches used for the screening of the SRY gene showed that karyotyping is unable to detect low 45,X/46,XY mosaicism and that it is the PCR that would be able to do, eliciting its role to make a reliable diagnosis. Conclusion The karyotype alone is not sufficient to make a TS diagnosis in cases of weak mosaicism, and the great heterogeneity that reigns the syndrome elicits an epigenetic and transcriptomic exploration of several genes that recently seem to be involved in the disease

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous