Clinical case of a noncompaction cardiomyopathy with restrictive filling diastolic dysfunction in a 5-year-old girl

Noncompaction cardiomyopathy is a rare cardiomyopathy, which is characterized by trabeculations and deep intratrabecular recesses, forming a sponge-like appearance of the myocardium. Clinical variability is possible – from asymptomatic patients to congestive heart failure, tromboembolic complications, and even sudden cardiac death. Two-dimensional echocardiography is the preferred diagnostic tool, based on specific criteria, which are not yet definite. Discovery of specific genetic mutations support the diagnosis. The main therapeutic approach is symptomatic – treatment of congestive heart failure and anticoagulant medications.We present a case of a 5-year-old girl, without a family history of chronic diseases, who was referred to our department because of a fever, cough and bilateral pneumonia. Upon admission she was with impaired general condition, with signs of respiratory and congestive heart failure. Echocardiography examination demonstrated noncompaction cardiomyopathy, mostly for the left ventricle, with leading diastolic left ventricular dysfunction with restrictive filling pattern, evaluated by tissue doppler, and pulmonary hypertension.This clinical case demonstrates the rare combination of noncompaction cardiomyopathy with restrictive left ventricular filling pattern, clinically manifested by congestive heart failure and pulmonary hypertension

Clinical aspects of HLA-B27 positive enthesitis-related arthritis in childhood

Introduction: Enthesitis-related arthritis (ERA) is a form of juvenile idiopathic arthritis (JIA) according to the International League Against Rheumatism (ILAR) classification. Enthesitis-related arthritis accounts for 8.6 to 18.9% of all children with JIA. The first clinical sign of ERA is usually asymmetrical arthritis of large joints, especially of the lower extremities. Axial involvement is typically presented by unilateral or bilateral sacroiliitis. Enthesopathy is a unique feature of ERA.Aim: The aim of this study is to determine the most common clinical characteristics in children with HLA-B27 positive ERA.Materials and Methods: We performed a retrospective analysis of 55 patients up to 16 years of age, diagnosed with HLA-B27 positive ERA. We used physical and laboratory tests as well as imaging techniques to assess various clinical aspects of ERA in every patient.Results: Demographic characteristics showed prevalence of male gender—44 boys vs. 11 girls (4:1 ratio). The mean age of onset was 13.3 years for boys and 9.9 years for girls. The most commonly affected joints were as follows: knees in 49% of the cases, ankles—in 43.6%, hip joints—in 36.3%, intertarsal/metatarsophalangeal joints—in 20%. Physical examination found enthesitis in 24 of the patients (43.6%). The most commonly affected entheses were: the site of attachment of the Achilles tendon in 66.6% of the cases, the site of attachment of the plantar fascia in 45.8%, the site of attachment of the patellar tendon in 12.5%. Plain X-ray of the sacroiliac joints detected sacroiliitis in 34 of the patients (61.8%). In over 90% of the cases, the sacroiliitis was bilateral.Conclusion: HLA-B27 positive ERA is a rare pathology in childhood. This study confirms typical epidemiological and clinical characteristics of the disease among Bulgarian children

Genotype differences towards lead chloride harmful action

The aim of the study was to throw more light on the PbCl2 mode of action (MoA) depending on the genotype by the application of three model organisms and microbiological, biochemical, and molecular approaches. Three model systems – Chlamydomonas reinhardtii strain 137C – wild type (WT), Saccharomyces cerevisiae strain D7ts1, and Pisum sativum L. cultivar Ran1 and two experimental schemes – short- and long-term treatments were used. C. reinhardtii and S. cerevisiae cell suspensions (1×106 cells/ml) at the end of the exponential and the beginning of a stationary phase of growth were treated with various PbCl2 concentrations (0.45–3.6 mM) for 2 hours. Lower PbCl2 concentrations (0.03–0.22 mM) were also tested on C. reinhardtii 137C. Short-term treatment for up to 2 days with PbCl2 concentrations in the range of 0.45–3.6 mM and long-term treatment for up to 10 days with concentrations in the range of 0.45–2.7 mM was performed on P. sativum L. seeds and plants, respectively. Long-term treatment with a PbCl2 concentration of 3.6 mM was not tested because of the very strong toxic effect (plant death). The following endpoints were used – for C. reinhardtii: cell survival, “visible” mutations, DNA double-strand breaks (DSBs), malondialdehyde (MDA), intracellular peroxides (H2O2), and photosynthetic pigments; for S. cerevisiae – cell survival, gene conversion, reverse mutation, mitotic crossing-over, DSBs, superoxide anions, MDA and glutathione (GSH); P. sativum L. – germination and root length (short-term treatment), pro-oxidative markers – MDA, H2O2 and photosynthetic pigments (long-term treatment). Genotype differences between C. reinhardtii (0.047 mM) and S. cerevisiae (1.66 mM) were observed by two endpoints: concentrations inducing 50% lethality (LD50) and DSB induction. By contrast, no mutagenic effect was found for both unicellular test models. A slight toxic capacity of PbCl2, measured as inhibition of Pisum sativum L. seed germination and around 20% root length reduction was revealed after the treatment with concentrations equal to or higher than 1.8 mM. The variety of stress responses between the two plant test models was demonstrated by comparing MDA and H2O2. A dose-dependent increase in H2O2 levels and a minor increase of MDA levels (around 9–15%) were measured when C. reinhardtii cells were treated with concentrations in the range of LD20–LD80 (0.03–0.11 mM). Analyzing the kinetics of MDA and H2O2 in pea leaves, the most pronounced effect of concentration was shown for 2.7 mM. A decrease in the photosynthetic pigments was detected in the two experimental designs – short-term on C. reinhardtii and long-term on P. sativum treatments. The pro-oxidative potential was also proven in S. cerevisiae based on increased levels of MDA and superoxide anions and decreased GSH. New information is gained that PbCl2 can affect the DNA molecule and photosynthetic pigments via induction of oxidative stress. Our study revealed that the magnitude of stress response towards PbCl2 is genotype-specific. Our finding that Chlamydomonas reinhardtii is a sensitive test system towards PbCl2 contributes to good strategies for revealing very low levels of contaminants present chronically in main environmental matrices. This is the first report, as far as we know, affirming that PbCl2 can induce DSBs in Chlamydomonas reinhardtii and Saccharomyces cerevisiae

Noonan syndrome patients with short stature at a single paediatric endocrinology centre

Introduction: Noonan syndrome (NS) is caused by mutations in RAS/MAPK signalling pathway genes. Growth hormone (GH) treatment is an established yet not fully standardized treatment. Aim: The aim of this article is to assess the first 2 years of GH treatment in NS patients at a single centre.Patients and Methods: A total of 20 (16 males) NS clinically diagnosed regularly followed patients participated (2011–2020). Of these, 9 (45%) had cardiac defects, and 8 (40%) had short stature. Growth hormone deficiency (GHD) was confirmed in 5 patients who started GH treatment, and 2 were treated as short, small for gestational age children. Patients underwent anthropometry, clinical, laboratory and imaging investigations.Results: The mean age at NS diagnosis was 7.8 ± 3.4 years (1.3 ÷ 10.5), and at GH start 9.1 ± 1.5 years. At GH start, SDSheight was -3.42±0.58 (-4.1 ÷ -2.6), SDSweight -3.07 ± 0.58 (-3.73 ÷ -2.27), and SDSIGF1 -1.12 ± 0.98 (-2.44 ÷ 0.25). The mean BA at diagnosis was delayed by 2.6 ± 0.9 years. The GH starting dose was 0.035 ± 0.005 mg/kg/d, and changed little thereafter.The growth velocity for the 1st year of treatment was 8.9 ± 1.4 cm, and for the 2nd year 6.9±1.1 cm. The first year ΔSDSheight was 0.72 (p = 0.002), ΔSDSweight was 0.83 (p = 0.025), the 2nd year increments being insignificant. The 1st and 2nd year ΔSDSIGF1 were 1.70 (p = 0.007) and 0.25 (n.s.), resp. Bone age remained significantly delayed. No treatment side effects were observed.Conclusion: Our study showed that GH-treated NS patients follow the general growth patterns. In order to improve outcomes, the treatment should be further standardized

STING-associated vasculopathy with onset in infancy: the first case in Bulgaria and review of the literature

AbstractWe report a clinical case of a 4-year-and-10-month-old boy whose first symptoms (fever and tachypnoea) were noticed at the age of 6 months. In the upcoming months, skin acral violaceous plaques developed. Failure to thrive and growth impairment were detected. In the journey to find the correct diagnosis, a lot of diseases were suspected. The final diagnosis was suggested after more than 2 years since the first symptoms had appeared. A multi-detector computed tomography of the chest with low radiation dose protocol showed signs of interstitial lung disease (ILD). Next-Generation Sequencing was done, and it revealed a pathogenic heterozygous N154S mutation (NM_198282.4 (Stimulator of IFN genes STING1):c.461A > G (p.Asn154Ser)) in STING1 gene. Treatment with JAK-inhibitor baricitinib was started at the age of 3 years and 10 months. The presence of cutaneous vasculopathy, lung involvement, laboratory signs of inflammation, recurrent fevers and failure to thrive should indicate STING1 gene analysis. STING-associated vasculopathy of infantile-onset (SAVI) is one of the newly identified type I interferonopathies. SAVI is characterized by systemic inflammation via the overproduction of type I IFN due to heterozygous gain-of-function mutations in STING1. The onset of the symptoms of SAVI is usually early in infancy with recurrent fevers accompanied by increased acute phase reactants and ulcerating skin lesions

Saccharomyces cerevisiae yeast cells as a test system for assessing Zeocin toxicity

Having unique genetic machinery and a high degree of conservation with higher eukaryotes, the yeast Saccharomyces cerevisiae is recognised as a smart experimental system for studying the modes of chemical toxicity. The present study was undertaken to elucidate the changes in the intracellular redox homeostasis and key macromolecule structure following exposure to Zeocin. Cell populations of logarithmic, quiescent (Q) and non-quiescent (NQ) cells of Saccharomyces cerevisiae BY4741 were used as a model to examine the cytotoxic effect of this radiomimetic. The levels of endogenous ROS, oxidized lipids, carbonylated proteins, and glutathione were analysed after treatment with Zeocin (IC50). An increase in ROS production and respectively increased oxidative stress was detected in all three types of cell populations, with the highest degree being observed in proliferating S. cerevisiae BY4741 cells. The stress response of both proliferating and stationary phase (Q and NQ) cells to Zeocin included an overexpression of glutathione. The quiescent cells also showed very low DNA susceptibility to high Zeocin concentration (100–300 µg/ml), presented as no induced double-strand breaks (DSBs) in the macromolecule. Based on our research it could be concluded that the cellular physiological state is a critical factor determining the resistance to environmental stress with Q cells being the most robust

Autosomal-recessive mutations in SLC34A1 encoding sodium-phosphate cotransporter 2A cause idiopathic infantile hypercalcemia

Idiopathic infantile hypercalcemia (IIH) is characterized by severe hypercalcemia with failure to thrive, vomiting, dehydration, and nephrocalcinosis. Recently, mutations in the vitamin D catabolizing enzyme 25-hydroxyvitamin D3-24-hydroxylase (CYP24A1) were described that lead to increased sensitivity to vitamin D due to accumulation of the active metabolite 1,25-(OH)2D3. In a subgroup of patients who presented in early infancy with renal phosphate wasting and symptomatic hypercalcemia, mutations in CYP24A1 were excluded. Four patients from families with parental consanguinity were subjected to homozygosity mapping that identified a second IIH gene locus on chromosome 5q35 with a maximum logarithm of odds (LOD) score of 6.79. The sequence analysis of the most promising candidate gene, SLC34A1 encoding renal sodium-phosphate cotransporter 2A (NaPi-IIa), revealed autosomal-recessive mutations in the four index cases and in 12 patients with sporadic IIH. Functional studies of mutant NaPi-IIa in Xenopus oocytes and opossum kidney (OK) cells demonstrated disturbed trafficking to the plasma membrane and loss of phosphate transport activity. Analysis of calcium and phosphate metabolism in Slc34a1-knockout mice highlighted the effect of phosphate depletion and fibroblast growth factor-23 suppression on the development of the IIH phenotype. The human and mice data together demonstrate that primary renal phosphate wasting caused by defective NaPi-IIa function induces inappropriate production of 1,25-(OH)2D3 with subsequent symptomatic hypercalcemia. Clinical and laboratory findings persist despite cessation of vitamin D prophylaxis but rapidly respond to phosphate supplementation. Therefore, early differentiation between SLC34A1 (NaPi-IIa) and CYP24A1 (24-hydroxylase) defects appears critical for targeted therapy in patients with IIH

Autosomal-Recessive Mutations in SLC34A1 Encoding Sodium-Phosphate Cotransporter 2A Cause Idiopathic Infantile Hypercalcemia

Idiopathic infantile hypercalcemia (IIH) is characterized by severe hypercalcemia with failure to thrive, vomiting, dehydration, and nephrocalcinosis. Recently, mutations in the vitamin D catabolizing enzyme 25-hydroxyvitamin D3-24-hydroxylase (CYP24A1) were described that lead to increased sensitivity to vitamin D due to accumulation of the active metabolite 1,25-(OH)2D3. In a subgroup of patients who presented in early infancy with renal phosphate wasting and symptomatic hypercalcemia, mutations in CYP24A1 were excluded. Four patients from families with parental consanguinity were subjected to homozygosity mapping that identified a second IIH gene locus on chromosome 5q35 with a maximum logarithm of odds (LOD) score of 6.79. The sequence analysis of the most promising candidate gene, SLC34A1 encoding renal sodium-phosphate cotransporter 2A (NaPi-IIa), revealed autosomal-recessive mutations in the four index cases and in 12 patients with sporadic IIH. Functional studies of mutant NaPi-IIa in Xenopus oocytes and opossum kidney (OK) cells demonstrated disturbed trafficking to the plasma membrane and loss of phosphate transport activity. Analysis of calcium and phosphate metabolism in Slc34a1-knockout mice highlighted the effect of phosphate depletion and fibroblast growth factor-23 suppression on the development of the IIH phenotype. The human and mice data together demonstrate that primary renal phosphate wasting caused by defective NaPi-IIa function induces inappropriate production of 1,25-(OH)2D3 with subsequent symptomatic hypercalcemia. Clinical and laboratory findings persist despite cessation of vitamin D prophylaxis but rapidly respond to phosphate supplementation. Therefore, early differentiation between SLC34A1 (NaPi-IIa) and CYP24A1 (24-hydroxylase) defects appears critical for targeted therapy in patients with IIH.status: publishe