Cytogenomic description of a Mexican cohort with differences in sex development.

BACKGROUND: Differences in Sex Development (DSD) is a heterogeneous group of congenital alterations that affect inner and/or outer primary sex characters. Although these conditions do not represent a mortality risk, they can have a severe psycho-emotional impact if not appropriately managed. The genetic changes that can give rise to DSD are diverse, from chromosomal alterations to single base variants involved in the sexual development network. Epidemiological studies about DSD indicate a global frequency of 1:4500-5500, which can increase to 1:200-300, including isolated anatomical defects. To our knowledge, this study is the first to describe epidemiological and genetic features of DSD in a cohort of Mexican patients of a third-level care hospital. METHODS: Descriptive and retrospective cross-sectional study that analyzed DSD patients from 2015 to 2021 attended a Paediatric Hospital from Mexico City. RESULTS: One hundred one patients diagnosed with DSD were registered and grouped into different entities according to the Chicago consensus statement and the diagnosis defined by the multidisciplinary group. Of the total, 54% of them belong to the chromosomal DSD classification, 16% belongs to 46, XX and 30% of them belongs to the 46, XY classification. CONCLUSION: The frequency for chromosomal DSDs was consistent with the literature; however, we found that DSD 46, XY is more frequent in our cohort, which may be due to the age of the patients captured, the characteristics of our study population, or other causes that depend on the sample size.

Hallazgos citogenéticos y edad materna en pacientes con síndrome down en un hospital de referencia pediátrico en el Perú

Introducción: El síndrome Down es un trastorno congénito originado por una trisomía total o parcial del cromosoma 21 y es considerada la causa genética más común de malformaciones congénitas y discapacidad intelectual. El objetivo de este estudio fue describir las alteraciones citogenéticas de pacientes con Síndrome Down y su relación con la edad materna. Métodos: Estudio transversal, descriptivo-analítico. Se incluyó 436 pacientes con Síndrome Down admitidos en el Instituto Nacional de Salud del Niño durante el período 2017-2019. Se analizaron las variables: alteración citogenética y edad materna. Resultados: Se encontró que el 99,3% (n=433) de pacientes presentaron algún tipo de alteración citogenética y tres pacientes presentaron cariotipo normal. La edad de los pacientes al momento de la toma de muestra estuvo comprendida entre los 0,03 y 17 años, la relación masculino/femenino fue de 1.2:1. La alteración citogenética más frecuente fue la trisomía 21 libre (94,7%), seguida por la translocación Robertsoniana (n=16) y el mosaicismo (n=6). En el caso de la edad materna se encontró una mediana de 37 años (rango: 13-47). Conclusiones: La trisomía 21 libre es la alteración citogenética más común en Síndrome Down; sin embargo, la translocación Robertsoniana y los mosaicismos fueron más frecuentes en edad materna menor de 35 años, sugiriendo que existe otros factores de riesgo diferentes a la edad materna avanzada en este grupo etario.

Introduction: Down syndrome is a congenital disorder caused by a total or partial trisomy of chromosome 21 and is considered the most common genetic cause of congenital malformations and intellectual disability. The objective of this study was to describe the cytogenetic alterations of patients with Down syndrome and their relationship with maternal age. Methods: Cross-sectional, descriptive-analytical study. 436 patients with Down syndrome admitted to the Instituto Nacional de Salud del Niño during the 2017-2019 period were included. The variables analyzed were: cytogenetic diagnosis and maternal age. Results: It was found that 99,3% (n=433) of patients presented some type of cytogenetic alteration and three patients presented a normal karyotype. The age of the patients at the time of sampling was between 0,03 and 17 years, the male/female ratio was 1.2:1. The most frequent cytogenetic alteration was free trisomy 21 (94,7%), followed by Robertsonian translocation (n=16) and mosaicism (n=6). In the case of maternal age, a median of 37 years was found (range: 13-47). Conclusions: Free trisomy 21 is the most common cytogenetic condition in Down syndrome; however, the Robertsonian translocation and mosaicisms were more frequent in patients whose mothers were les than 35 years old, suggesting that there are other risk factors than advanced maternal age in this group.

Molecular profile of patients with myelofibrosis: a 10-year experience

ABSTRACT Objective To analyze the karyotype test and myeloid panel with next-generation sequencing findings in patients with myelofibrosis, and to compare transplant characteristics in patients referred for bone marrow transplantation. Methods Retrospective, single-center study with patients diagnosed with myelofibrosis treated at Hospital Israelita Albert Einstein between 2010 and 2020. Results A total of 104 patients with myelofibrosis were examined. Patients who had not been submitted to tests in our service were excluded. The final sample comprised 69 patients. Of these 69, 56 were submitted to karyotyping and 22 to myeloid panel with next-generation sequencing. Karyotype was normal in 60% of the patients and altered in 40%. The prevalence of high-risk molecular mutations was higher in patients referred for bone marrow transplantation (100% versus 50%). The median follow-up of transplant patients was 2.4 years and the overall survival at 2 years was 80% (95%CI: 62-100%). Conclusion The molecular analysis enables estimating the patient's risk and thus instituting more aggressive treatment such as bone marrow transplant for patients at higher risk, being a relevant tool to guide therapy. Given the significance of molecular analysis for therapeutic decision-making in myelofibrosis, collection and disclosure of data on the prevalence of cytogenetic changes and findings of next-generation sequencing in affected patients is important.

Alteraciones citogenéticas en pacientes con diagnóstico de infertilidad en Lima, Perú / Cytogenetic abnormalities in patients with infertility diagnosis in Lima, Peru

INTRODUCCIÓN: La infertilidad es una enfermedad multicausal y el componente genético representa uno de sus principales eventos. Si bien la distribución de la infertilidad puede variar entre poblaciones, las parejas de los países con bajos y medianos ingresos pueden verse más afectadas por la infertilidad, con una proporción de alteraciones citogenéticas aún no esclarecidas. OBJETIVO: Evaluar la frecuencia de alteraciones citogenéticas y su correlación con el número de abortos en pacientes peruanas con diagnóstico de infertilidad. MÉTODO: Se realizó un estudio de corte transversal en 400 pacientes de 18 a 60 años, de ambos sexos, con diagnóstico de infertilidad. Se registraron las características clínicas disponibles durante el examen genético y el análisis citogenético convencional fue con bandeo GTG en muestras de sangre periférica. El análisis de correlación se realizó con la prueba de Spearman. RESULTADOS: Del total, 389 pacientes cumplieron los criterios de inclusión, y de estos, 169 (43,44%) tuvieron reportes de abortos (promedio: 2,25, rango: 1-7). Hallamos una correlación significativa ente el número de abortos y las alteraciones citogenéticas (p < 0,000). Reportamos 25/289 (6,43%) alteraciones cromosómicas, de las que 11/25 (44%) fueron heterocromatinas constitutivas y 6/25 (24%) fueron translocaciones reciprocas. Las alteraciones citogenéticas más frecuentes fueron 16qh+ y 9qh+ (ambas con un 16%), y afectaron a 17 (68%) varones. CONCLUSIONES: Existe una moderada frecuencia de alteraciones citogenéticas en pacientes peruanos con diagnóstico de infertilidad, y las alteraciones más frecuentes fueron heterocromatina constitutivas. Además, evidenciamos una correlación significativa ente el número de abortos y las alteraciones citogenéticas.

INTRODUCTION: Infertility is a multicausal disease and the genetic component represents one of its main events. Although the distribution of infertility may vary between populations, couples in low-and-middle-income countries may be more affected by infertility with a proportion of cytogenetic alterations still unclear. OBJECTIVE: To evaluate the frequency of cytogenetic alterations and their correlation with the number of abortions in Peruvian patients with a diagnosis of infertility. METHOD: A cross-sectional study was carried out in 400 patients between 18 and 60 years-old, of both genders with a diagnosis of infertility. The clinical characteristics available during the genetic examination were recorded and the conventional cytogenetic analysis was with GTG banding in peripheral blood samples. The correlation analysis was performed with the Spearman test. RESULTS: Of the total 389 patients who met the inclusion criteria, of these 169 (43.44%) patients had reports of abortions (mean: 2.25, range: 1-7). We found a significant correlation between the number of abortions and cytogenetic alterations (p < 0.000). We report 25/289 (6.43%) chromosomal alterations, where 11/25 (44%) were constitutive heterochromatin, and 6/25 (24%) were reciprocal translocations. The most frequent cytogenetic alterations were 16qh + and 9qh + (both 16%), and affected 17 (68%) men. CONCLUSIONS: There is a moderate frequency of cytogenetic alterations in Peruvian patients diagnosed with infertility, where the most frequent alterations were constitutive heterochromatin. Furthermore, we evidenced a significant correlation between the number of abortions and cytogenetic alterations.

Prenatal cytogenetic diagnosis: results obtained in the specialized laboratory of Clínica Universitaria Colombia from 2013 to 2019.

OBJECTIVE: Prenatal cytogenetic evaluation is a key tool for identifying alterations in pregnant women with high risk for fetal chromosomal abnormalities (CA). In Colombia, there are not large-scale reports about the prevalence and pattern of CA in prenatal cytogenetic analysis. METHOD: A descriptive study was performed from registers of prenatal cytogenetic analysis on amniotic fluid (AF), chorionic villus biopsy (CVS), and fetal blood (FB) samples sent to the specialized laboratory of the Clínica Universitaria Colombia between 2013 and 2019. RESULTS: The prevalence of CA was 20.9%. The trisomies 21, 18, 13, and monosomy X were the most frequent aneuploidies, and the derivative chromosomes were the most frequent structural abnormalities. Although the rate of CA was higher in women over the age of 35 years old; monosomy X, unbalanced rearrangements, and microduplications were associated with the group of women under the age of 35 (p < .05). Trisomies 21 and 18 were the most common aneuploidies identified by FISH and were found to be altered in 52% of the aCGH studies. Ultrasonographic markers associated with CA were the most frequent clinical indication. CONCLUSION: In Colombia, the invasive prenatal cytogenetic analysis continues being an important diagnostic tool available for pregnant women with high risk for fetal CA.

Changing the molecular profile of primary and metastatic breast cancer identified by Foundation One: case report

Objective: To describe a case report of a patient who presented with bilateral breast cancer with progression to metastatic disease, in which immunohistochemical profile of the primary and metastatic tumor was divergent. Methods: This was a study with a descriptive narrative and reflective design, of the case report type, based on secondary data, with information and images obtained from the electronic medical records of the MVSoul system used in the oncology center of a private hospital in the Federal District in Brazil. Data collection was derived from the analysis of data and images of the electronic medical record. Case report: A patient presented with bilateral metastatic breast cancer, and the primary and metastatic breast tumors showed a difference in immunohistochemical profile. Accordingly, we highlight the rarity of the case, the need for biopsies of metastatic lesions because of the molecular heterogeneity of breast cancer and possible discrepancy between the primary tumor and metastases. Spreading knowledge about diagnostic tests and personalized treatment according to tumor molecular characteristics is also essential, especially when the patient does not have a satisfactory therapeutic response, as in the reported case, since the patient had metastases with different molecular profiles confirmed only by of tumor DNA sequencing.

Cytogenetic risk groups for childhood acute myeloid leukemia based on survival analysis in a cancer referral hospital from Perú / [Grupos de riesgo citogenético de leucemia mieloide aguda pediátrica a partir del análisis de supervivencia en un hospital de referencia para cáncer en Perú].

Introduction: Acute myeloid leukemia is a heterogeneous disorder characterized by immature myeloid cell proliferation. Cytogenetic analysis has revealed the presence of chromosomal aberrations important to patient prognosis. Objective: To determine cytogenetic risk groups of pediatric patients with acute myeloid leukemia according to overall survival. Materials and methods: In this cross-sectional observational study, the clinical records of pediatric patients diagnosed with de novo acute myeloid leukemia admitted to the Instituto Nacional de Enfermedades Neoplásicas between 2001 and 2011 with cytogenetic analysis of bone marrow were included. Cytogenetic risk groups were established according to the criteria of the Medical Research Council. Overall survival curves were generated with the Kaplan-Meier method and compared using the Mantel-Cox test and Cox regression with the software R, version 3.3.2. Results: A total of 130 patients were included, 68 males (52.3%) and 62 females (47.7%), most of them with subtype M2 (33%). The average age was 7.7 years (range: 0-15 years). Chromosomal aberrations were observed in 60.8% of the patients, the most frequent of which was the translocation t(8;21). According to the overall survival analysis, two cytogenetic risk groups were established: favorable and unfavorable. Conclusion: Two groups of cytogenetic risk were determined: high (or unfavorable) and standard (favorable).

Introducción. La leucemia mieloide aguda es una neoplasia heterogénea caracterizada por la proliferación de células mieloides inmaduras. El análisis citogenético ha revelado la presencia de aberraciones cromosómicas de importancia en el pronóstico del paciente. Objetivo. Determinar los grupos de riesgo citogenético de pacientes pediátricos con leucemia mieloide aguda a partir de la supervivencia global. Materiales y métodos. Se hizo un estudio observacional de corte transversal. Se incluyeron los registros clínicos de los pacientes pediátricos con diagnóstico de leucemia mieloide aguda de novo admitidos en el Instituto Nacional de Enfermedades Neoplásicas entre el 2001 y el 2011 y sometidos a análisis citogenético de médula ósea. Los grupos de riesgo citogenético se establecieron según los criterios del Medical Research Council. Las curvas de supervivencia global se elaboraron con el método de Kaplan-Meier y se compararon mediante la prueba de Mantel-Cox y una regresión de Cox, utilizando el programa R, versión 3.3.2. Resultados. Se incluyeron 130 pacientes, 68 varones (52,3 %) y 62 mujeres (47,7 %), mayoritariamente del subtipo M2 (33 %). La edad promedio fue de 7,7 (rango de 0 a 15 años). Se observaron aberraciones cromosómicas en el 60,8 % y la más frecuente fue la traslocación t(8;21). Según el análisis de supervivencia global, se observaron dos grupos de riesgo citogenético: favorable y desfavorable. Conclusión. Se determinaron dos grupos de riesgo citogenético: alto (o desfavorable) y estándar (o favorable).

Caracterización de pacientes con enfermedades genéticas / Characterization of Patients with Genetic Diseases

Introducción: Las enfermedades genéticas se corresponden con variaciones genéticas del desarrollo que precisan ayuda médica, educativa, social o combinaciones de estas. Objetivo: Caracterizar clínica y epidemiológicamente a los pacientes con enfermedades genéticas. Método: Estudio descriptivo transversal. El universo estuvo constituido por los 521 pacientes evaluados en la consulta de asesoramiento genético del municipio Mayarí y la muestra estuvo representada por los 216 pacientes portadores de enfermedades genéticas pertenecientes al Policlínico Universitario 26 de Julio; del Área de Salud de Mayarí, durante el año 2018. Resultados: Predominó el sexo femenino (53,24 por ciento), el grupo de edades de 41 a 50 años (18,06 por ciento), las enfermedades monogénicas (58,8 por ciento), los pacientes con síndrome de Down (20,37 por ciento), los pacientes que no cuentan con antecedentes familiares (54,63por ciento). Conclusiones: Prevalecieron los pacientes con discapacidad mental, con diagnóstico posnatal y con más de 20 años de diagnóstico. El mayor número no realizaba tratamiento. Los pacientes vinculados integralmente a la sociedad resultaron minoría, así como los que tenían antecedentes familiares de enfermedad genética(AU)

Introduction: Genetic diseases are due to developmental genetic variations that require medical, educational and social help, or combinations of these. Objective: To characterize, clinically and epidemiologically, patients with genetic diseases. Method: Descriptive and cross-sectional study. The universe was made up of the 521 patients assessed in the genetic counseling consultation of Mayarí Municipality and the sample was represented by the 216 patients with genetic diseases belonging to 26 de Julio University Polyclinic of the health area of Mayarí, during the year 2018. Results: The female sex predominated (53.24 percent), together with the age group 41-50 years (18.06 percent), monogenic diseases (58.8 percent), patients with Down syndrome (20.37 percent), and patients with no family history of diseases (54.63 percent). Conclusions: Patients with mental disabilities, with postnatal diagnosis and with more than twenty years of diagnosis prevailed. The largest number did not undergo treatment. Patients fully linked to society were a minority, as well as those with a family history of genetic disease(AU)

Grupos de riesgo citogenético de leucemia mieloide aguda pediátrica a partir del análisis de supervivencia en un hospital de referencia para cáncer en Perú / Cytogenetic risk groups for childhood acute myeloid leukemia based on survival analysis in a cancer referral hospital from Perú

Resumen | Introducción. La leucemia mieloide aguda es una neoplasia heterogénea caracterizada por la proliferación de células mieloides inmaduras. El análisis citogenético ha revelado la presencia de aberraciones cromosómicas de importancia en el pronóstico del paciente. Objetivo. Determinar los grupos de riesgo citogenético de pacientes pediátricos con leucemia mieloide aguda a partir de la supervivencia global. Materiales y métodos. Se hizo un estudio observacional de corte transversal. Se incluyeron los registros clínicos de los pacientes pediátricos con diagnóstico de leucemia mieloide aguda de novo admitidos en el Instituto Nacional de Enfermedades Neoplásicas entre el 2001 y el 2011 y sometidos a análisis citogenético de médula ósea. Los grupos de riesgo citogenético se establecieron según los criterios del Medical Research Council. Las curvas de supervivencia global se elaboraron con el método de Kaplan-Meier y se compararon mediante la prueba de Mantel-Cox y una regresión de Cox, utilizando el programa R, versión 3.3.2. Resultados. Se incluyeron 130 pacientes, 68 varones (52,3%) y 62 mujeres (47,7%), mayoritariamente del subtipo M2 (33%). La edad promedio fue de 7,7 (rango de 0 a 15 años). Se observaron aberraciones cromosómicas en el 60,8% y la más frecuente fue la traslocación t(8;21). Según el análisis de supervivencia global, se observaron dos grupos de riesgo citogenético: favorable y desfavorable. Conclusión. Se determinaron dos grupos de riesgo citogenético: alto (o desfavorable) y estándar (o favorable).

Abstract | Introduction: Acute myeloid leukemia is a heterogeneous disorder characterized by immature myeloid cell proliferation. Cytogenetic analysis has revealed the presence of chromosomal aberrations important to patient prognosis. Objective: To determine cytogenetic risk groups of pediatric patients with acute myeloid leukemia according to overall survival. Materials and methods: In this cross-sectional observational study, the clinical records of pediatric patients diagnosed with de novo acute myeloid leukemia admitted to the Instituto Nacional de Enfermedades Neoplásicas between 2001 and 2011 with cytogenetic analysis of bone marrow were included. Cytogenetic risk groups were established according to the criteria of the Medical Research Council. Overall survival curves were generated with the Kaplan-Meier method and compared using the Mantel-Cox test and Cox regression with the software R, version 3.3.2. Results: A total of 130 patients were included, 68 males (52.3%) and 62 females (47.7%), most of them with subtype M2 (33%). The average age was 7.7 years (range: 0-15 years). Chromosomal aberrations were observed in 60.8% of the patients, the most frequent of which was the translocation t(8;21). According to the overall survival analysis, two cytogenetic risk groups were established: favorable and unfavorable. Conclusion: Two groups of cytogenetic risk were determined: high (or unfavorable) and standard (favorable).

Diagnóstico citogenético en una paciente afectada por discapacidad intelectual. Estado Portuguesa, Venezuela / Cytogenetic diagnosis in a patient affected by intellectual disability in Portuguesa State, Venezuela

RESUMEN Introducción: las alteraciones cromosómicas tanto de número como de estructura, son causa importante de morbilidad y mortalidad. Afectan a aproximadamente uno de cada doscientos recién nacidos vivos, siendo la principal causa de discapacidad intelectual. Objetivo: describir el diagnóstico citogenético en una paciente afectada con discapacidad intelectual. Presentación del caso: infante de seis años de edad que es llevado a consulta de asesoramiento genético por presentar discapacidad intelectual, dismorfias y baja talla. Se realiza historia clínica genética, se aplica método clínico y diagnóstico citogenético. Se utilizó bandeo cromosómico GTG y se analizaron 25 metafases. Se realiza cariotipo donde se diagnostica una aberración cromosómica estructural (translocación compleja) en 25 metafases estudiadas, se evidencia la presencia de cuatro cromosomas autosómicos involucrados y los puntos de ruptura: 46,XX, t(7;10;14;18)(p22;q11.1;q31;q11.1). Conclusiones: el estudio permitió ofrecer un diagnóstico, definir el riesgo de recurrencia en la descendencia y mejorar el tratamiento. Se demostró la importancia del asesoramiento genético como herramienta en el nivel primario de salud.

ABSTRACT Introduction: chromosomal alterations both in number and structure are an important cause of morbidity and mortality. They affect approximately one out of every two-hundred live newborns, being the main cause of intellectual disability. Objective: to describe the cytogenetic diagnosis in a patient affected with intellectual disability. Case report: a 6-year-old child who was taken for genetic counseling due to intellectual disability, dysmorphias and short small height. Genetic clinical history was taken; clinical method and cytogenetic diagnosis were applied; GTG chromosome banding was applied and 25 metaphases were analyzed. A structural chromosomal aberration (complex translocation) was diagnosed in 25 metaphases studied, showing the presence of four (4) autosomal chromosomes involved and the breakpoints: 46,XX, t(7;10;14;18)(p22;q11.1;q31;q11.1). Conclusions: the study made possible to provide a diagnosis, define the risk of recurrence in the offspring and improve treatment, supporting the importance of genetic counseling which is a significant tool at primary health care level.

The correlation between micronuclei count and smoking behavior: a hospital-based study / Correlación entre recuento de micronúcleos y hábito tabáquico: un estudio hospitalario

Background: Micronucleus is a microscopically visible cyto-plasmic chromatin mass in the extranuclear vicinity, originating from aberrant mitosis, which consists of eccentric chromosomes that have failed to reach spindle poles during mitosis. The present study was designed to evaluate and compare cytogenetic changes in the buccal mucosa of smokers and non-smokers based on the occurrence of micronuclei. The study aimed to determine the correlation between the micronuclei count and the frequency and duration of smoking habit. Materials and Methods: Two groups (smokers and non-smokers) of 34 individuals each were examined. Cytological buccal smears were taken from participants using a moistened wooden spatula and stained with standard Papanicolaou stain. Presence of micronuclei was assessed at 40X magnification using a light microscope and a count per 500 cells was determined. The results of the study were analyzed statistically using Mann-Whitney U test, Spearman's rank correlation coefficient and Student t-test. Result: Smears from smokers showed a significant increase in the total number of micronuclei per 500 cell count compared to non-smokers. There was a strong positive correlation between the occurrence of micronuclei and the frequency and duration of smoking. A age-related increase in older age groups was also observed. Conclusion: The study reveals a strong positive correlation between the occurrence of micronuclei and the frequency and duration of smoking. This observation is vital in the utilization of the micronuclei detection in smears as a prognostic, educational and interventional tool in the management of patients with smoking habits.

Antecedentes: El micronúcleo es una masa de cromatina citoplasmática microscópicamente visible en el área extranuclear, que se origina a partir de la mitosis aberrante, y que consiste en cromosomas excéntricos que no han podido alcanzar los polos del huso durante la mitosis. El presente estudio fue diseñado para evaluar y comparar los cambios citogenéticos en la mucosa bucal de fumadores y no fumadores en función de la aparición de micronúcleos. El estudio tuvo como objetivo determinar la correlación entre el recuento de micronúcleos y la frecuencia y duración del hábito de fumar. Materiales and Métodos: Se examinaron dos grupos (fumadores y no fumadores) de 34 individuos cada uno. Se tomaron frotis bucales citológicos de todos los participantes con una espátula de madera humedecida y se tiñeron con la tinción estándar de Papanicolaou. La presencia de micronúcleos se evaluó al microscopio óptico con un aumento de 40X y se determinó un recuento por 500 células. Los resultados del estudio se analizaron estadísticamente utilizando la prueba U de Mann-Whitney, el coeficiente de correlación de rango de Spearman y la prueba t de Student. Resultados: Los frotis de fumadores mostraron un aumento significativo en el número total de micronúcleos por 500 células en comparación con los no fumadores. Hubo una fuerte correlación positiva entre la aparición de micronúcleos y la frecuencia y duración del tabaquismo. También se observó un aumento relacionado con la edad en los grupos de mayor edad. Conclusión: el estudio revela una fuerte correlación positiva entre la aparición de micronúcleos y la frecuencia y duración del tabaquismo. Esta observación es vital en la utilización de la detección de micronúcleos en frotis como una herramienta pronostica, educativa e intervencionista en el manejo de pacientes con hábitos de fumar.

Diagnóstico prenatal citogenético en Cienfuegos: años 2007-2018 / Prenatal Cytogenetic Diagnosis in Cienfuegos: Years 2007-2018

RESUMEN Fundamento: el diagnóstico prenatal citogenético forma parte de la atención que se brinda a la embarazada de alto riesgo y es un componente indispensable de los programas preventivos de genética que impulsa la Organización Mundial de la Salud. Objetivo: exponer los resultados del diagnóstico prenatal citogenético en la provincia Cienfuegos entre los años 2007 y 2018. Método: se realizó un estudio descriptivo, retrospectivo, análisis estadístico y de serie cronológica desarrollado en el Centro Provincial de Genética Médica de Cienfuegos acerca de todos los diagnósticos prenatales citogenéticos que se realizaron entre los años 2007 y 2018. Se analizaron: causas de estudio, cantidad de diagnósticos realizados, tipos de anomalías detectadas, relación entre las causas del estudio con los resultados del diagnóstico. Estos diagnósticos se obtuvieron de la base de datos del laboratorio de la Institución y se realizó una valoración cualitativa y cuantitativa de su comportamiento en el periodo analizado. Los resultados se presentan en tablas mediante números absolutos y porcentajes. Resultados: en el período estudiado se determinaron 3260 diagnósticos prenatales citogenéticos, de ellos 83 presentaron alteraciones cromosómicas, para un 2,6 % de positividad. Solo el 33, 7 % de los casos positivos y sanos portadores tienen menos de 37 años. La anomalía cromosómica más frecuente fue la trisomía libre del 21 (45,8 %), las aberraciones estructurales fueron el 21,7 %, los mosaicos el 13,3 %, y el motivo de indicación más frecuente entre los casos positivos fue la edad materna avanzada (45 casos). Conclusiones: los indicadores analizados se comportan de manera similar a los reportados en en el 2012 y en la literatura de Cuba y del mundo.

ABSTRACT Background cytogenetic prenatal diagnosis is part of the care provided to the high-risk pregnant woman and is an indispensable component of preventive genetic programs promoted by the World Health Organization. Objective: to expose the results of the cytogenetic prenatal diagnosis in the Cienfuegos province between 2007 and 2018. Method: a descriptive, retrospective, statistical and chronological series analysis was carried out at the Provincial Center of Medical Genetics of Cienfuegos about all the cytogenetic prenatal diagnoses made between 2007 and 2018. There were analyzed: causes of study, number of diagnoses made, types of anomalies detected, relationship between causes of the study with the results of the diagnosis. Diagnoses were obtained from the database of the Institution's laboratory and a qualitative and quantitative assessment of their behavior was carried out during the period analyzed. The results are presented in tables using absolute numbers and percentages. Results: 3260 cytogenetic prenatal diagnoses were determined during the study period, 83 of them presented chromosomal alterations, for 2,6 % positivity. Only 33,7 % of positive cases and healthy carriers are under 37 years old. The most frequent chromosomal abnormality was the free trisomy of 21 (45,8 %), the structural aberrations were 21,7 %, the mosaics were 13,3 %, and the most frequent reason for indication among the positive cases was age advanced maternal (45 cases). Conclusions: the indicators analyzed behave similarly to those reported in 2012, in the literature of Cuba and the world.

Cytogenetic abnormalities, WHO classification, and evolution of children and adolescents with acute myeloid leukemia

ABSTRACT Objectives: To describe cytogenetic and molecular abnormalities observed in children and adolescents with acute myeloid leukemia (AML), classify AML according to the World Health Organization (WHO) classifications from 2008 and 2016, and evaluate the prognosis according to clinical characteristics and cytogenetic abnormalities. Methods: A retrospective longitudinal study was performed on a population of 98 patients with AML, aged up to 16 years, seen in a single hospital from 2004 to 2015. Results: Among the 80 patients for whom it was possible to analyze the karyotype, 78.7% had chromosomal changes, the most frequent being t(15;17)(q22;q21). Of the 86 patients for whom we had cytogenetic or molecular data, making it possible to classify their AML according to the WHO classification, 52.3% belonged to the group with recurrent genetic abnormalities, 22% to the "AML not otherwise specified" group, 18.6% to the group with myelodysplasia-related cytogenetic changes, and 7% to the group with Down syndrome-related leukemia. Five-year overall survival (OS) for the whole group was 49.7% ± 5.2%. In the univariate and multivariate analyses, patients with myelodysplasia-related cytogenetic changes (OS 28.1% ± 12.2%) and those with "AML not otherwise specified" (OS 36.1% ± 11.2%) had an unfavorable prognosis when compared to patients with AML with recurrent genetic abnormalities (OS 71% ± 5.8%) and patients with Down syndrome-related AML (OS 83% ± 15.2%, p = 0.011). Conclusions: The results corroborate the importance of cytogenetic abnormalities as a prognostic factor and indicate the need for cooperative and prospective studies to evaluate the applicability of the WHO classification in the pediatric population.

Cytogenetic abnormalities, WHO classification, and evolution of children and adolescents with acute myeloid leukemia.

OBJECTIVES: To describe cytogenetic and molecular abnormalities observed in children and adolescents with acute myeloid leukemia (AML), classify AML according to the World Health Organization (WHO) classifications from 2008 and 2016, and evaluate the prognosis according to clinical characteristics and cytogenetic abnormalities. METHODS: A retrospective longitudinal study was performed on a population of 98 patients with AML, aged up to 16 years, seen in a single hospital from 2004 to 2015. RESULTS: Among the 80 patients for whom it was possible to analyze the karyotype, 78.7% had chromosomal changes, the most frequent being t(15;17)(q22;q21). Of the 86 patients for whom we had cytogenetic or molecular data, making it possible to classify their AML according to the WHO classification, 52.3% belonged to the group with recurrent genetic abnormalities, 22% to the "AML not otherwise specified" group, 18.6% to the group with myelodysplasia-related cytogenetic changes, and 7% to the group with Down syndrome-related leukemia. Five-year overall survival (OS) for the whole group was 49.7%±5.2%. In the univariate and multivariate analyses, patients with myelodysplasia-related cytogenetic changes (OS 28.1%±12.2%) and those with "AML not otherwise specified" (OS 36.1%±11.2%) had an unfavorable prognosis when compared to patients with AML with recurrent genetic abnormalities (OS 71%±5.8%) and patients with Down syndrome-related AML (OS 83%±15.2%, p=0.011). CONCLUSIONS: The results corroborate the importance of cytogenetic abnormalities as a prognostic factor and indicate the need for cooperative and prospective studies to evaluate the applicability of the WHO classification in the pediatric population.

The most relevant chromosomal abnormalities in the north of Rio Grande do Sul, Brazil: 26 years of cytogenetic analysis.

From 1992 to 2018, cytogenetic analyses were successfully performed to explore the chromosomal abnormalities of 729 patients, who utilised a pioneering counselling service in the city of Passo Fundo in the northern part of the Brazilian state of Rio Grande do Sul. This city is characterised by a large conglomerate of private and public hospitals. A classical cytogenetic analysis and G-banding were performed using the patient samples. Although normal karyotypes were observed for 562 of the cases, 167 individuals evidenced chromosomal alterations. Among those, 110 exhibited numerical alterations (65.86%), 41 demonstrated structural modifications (24.55%) and 16 showed both numerical and structural chromosomal changes (9.58%). This study describes the diversity of the chromosomal alterations in this region, which have not been previously examined. After 26 years of study, the findings are discussed herein in a self-critical form.

Complex karyotype including ring chromosome 11 in a patient with acute myeloid leukemia: case report

ABSTRACT CONTEXT: Complex karyotypes in acute myeloid leukemia (AML) are characterized by an overall low response rate with frequent relapses after clinical treatment. CASE REPORT: Here, we describe the case of a 61-year-old obese female with clinically diagnosed AML who presented a complex karyotype involving an uncommon abnormality: ring chromosome 11. Immunophenotypic analysis confirmed the diagnosis. Classical and molecular cytogenetic analyses, using GTG banding and FISH (fluorescence in situ hybridization), revealed the presence of complex structural rearrangement involving r(11), add(12)(p13), der(5) and der(13). CONCLUSIONS: Molecular cytogenetic analysis is suitable for better identification and characterization of chromosomal rearrangements in AML. Case reports like this, as well as population-based studies, are necessary for understanding the karyotypic changes that occur in humans.

Clinical and cytogenetic characterization of a patient with tetrasomy 18p / Caracterización clínica y citogenética de un paciente con tetrasomía 18p

The 18p tetrasomy is a structural chromosomal abnormality with the presence of an extra isochromosome 18p, caused by a nondisjunction failure during maternal meiosis II. This additional i(18p) occurs in 1 of 180,000 live-born children worldwide, affecting males and females equally. It is characterized by craniofacial dysmorphisms; ears, nose and throat (ENT) abnormalities; musculoskeletal alterations; and global development delay. We aim to present the clinical and cytogenetic findings of a 3-year-10-month-old Latin American male with i(18p), to support the gene dosage effects, comparing his features with the ones reported in literature. This patient was product of the second pregnancy of a 39-year-old woman and the first son of a 49-year-old man. His main clinical features were microcephaly, facial dysmorphism, generalized hypotonia, and developmental delay. A blood sample of the patient was required to perform a GTG-banded karyotype and a fluorescence in situ hybridization (FISH) for chromosome 18 short arm. In addition, an SNP microarray analysis was carried out to detect genomic imbalances. Cytogenetic analysis revealed the presence of a metacentric supernumerary marker chromosome. The FISH study confirmed the origin of the marker chromosome by showing two signals for the 18p subtelomere and an intermediate signal for the 18 centromere. The microarray analysis showed a copy number gain of 18,385 Mb within the 18p.Tetrasomy tends to be a result of de novo events. The presence of the patient's isochromosome could be explained by advanced maternal age as it is known that this factor has high influence in isochromosome formation. Despite that there were no genes associated with the i(18p)'s clinical manifestations, these features are negatively correlated with dosage effects of the entire short arm. Physical and language therapy was recommended to the patient; the family received medical orientation, and awareness in family planning was raised.

La tetrasomía 18p es una anormalidad cromosómica estructural con la presencia de un isocromosoma extra 18p, causado por una no disyunción durante la meiosis materna II. Este adicional i(18p) ocurre en 1 de 180.000 niños nacidos vivos en todo el mundo, y afecta a hombres y mujeres por igual. Se caracteriza por dismorfias craneofaciales; anomalías en oídos, nariz y garganta (ENT); alteraciones musculoesqueléticas y del desarrollo global. Nuestro objetivo es presentar los hallazgos clínicos y citogenéticos de un varón latinoamericano de 3 años y 10 meses de edad con i(18p), para explicar los efectos de dosificación génica, comparando sus características con las reportadas en la literatura. Este paciente es producto del segundo embarazo de una mujer de 39 años y el primer hijo de un hombre de 49 años. Sus principales características clínicas fueron microcefalia, dismorfia facial, hipotonía generalizada y retraso global en el desarrollo. Se requirió una muestra de sangre del paciente para realizar un cariotipo con bandas GTG y una hibridación fluorescente in situ (FISH) para el análisis del brazo corto del cromosoma 18. Además, se llevó a cabo un análisis de microarreglos para detectar desequilibrios genómicos. El análisis citogenético reveló la presencia de un cromosoma supernumerario metacéntrico. Mientras que el estudio FISH confirma el origen del cromosoma marcador al mostrar dos señales para subtelómeros 18p y una señal intermedia para el centrómero 18. El análisis de microarreglos mostró una ganancia en el número de copias de 18,385 Mb dentro de la región 18p.La tetrasomía tiende a ser el resultado de eventos de novo. El isocromosoma del paciente podría explicarse por la edad materna avanzada, ya que se sabe que tiene una gran influencia en su formación. A pesar de que no hay genes asociados con las manifestaciones clínicas de i(18p), estas características están negativamente correlacionadas con los efectos de dosificación de todo el brazo corto. Se le recomendó terapia física y de lenguaje al paciente, la familia recibió orientación médica y se concientiza sobre la planificación familiar.

Detección de translocaciones cromosómicas mediante diagnóstico citogenético. Cienfuegos, 2006-2016 / Detection of chromosomal translocations by cytogenetic diagnosis. Cienfuegos, 2006-2016

Fundamento: Las alteraciones cromosómicas causan frecuentemente pérdidas de embarazos e infertilidad, y son una causa importante de retraso mental. El diagnóstico precoz permite la extensión del estudio a las familias de los portadores de estas translocaciones. Objetivo: identificar las translocaciones cromosómicas mediante diagnóstico citogenético. Métodos: se realizó un estudio descriptivo retrospectivo de los casos estudiados entre 2006 y 2016 de fetos diagnosticados con alguna translocación, los cuales se concentraron en 10 familias (25 individuos en total). Los datos fueron tomados de los registros del CPGMC, que contienen los diagnósticos prenatales cromosómicos realizados a la población de riesgo, y los estudios posnatales realizados en sangre periférica a los padres y otros familiares de los fetos. Fueron analizadas las siguientes variables: diagnóstico (enfermo, sano portador), tipo de aberración cromosómica (estructural, numérica), vía de heredabilidad de las aberraciones estructurales (padre o madre), y fórmula cromosómica y tipo de translocación.Resultados: del total de casos positivos y portadores diagnosticados prenatalmente, el 76,71 % fueron aberraciones numéricas. De los 17 casos de aberraciones estructurales, 13 fueron translocaciones cromosómicas, (balanceadas y no balanceadas), todas ellas heredadas de uno de los progenitores. Fueron identificados, mediante diagnóstico prenatal y posnatal, dos individuos enfermos y 23 sanos portadores en las familias estudiadas. Conclusión: existe en la provincia Cienfuegos un conjunto de personas sanas, pero portadoras de translocaciones cromosómicas, las cuales pueden transmitir a sus descendientes, lo que se traduce en la posibilidad de que estos nazcan con malformaciones.

Background: Chromosomal abnormalities frequently cause pregnancy losses and infertility, and they are an important cause of mental retardation. Early diagnosis allows extending the study to the families of these translocations carriers.Objective: to identify chromosomal translocations by cytogenetic diagnosis.Methods: a retrospective description was conducted of the studied cases between 2006 and 2016 of fetuses diagnosed with some translocation, which were grouped in 10 families (25 individuals). Data were taken from the CPGMC records, which contain the prenatal chromosomal diagnoses of population at risk, and postnatal studies in peripheral blood performed to parents and other fetuses relatives. The following variables were analyzed: diagnosis (sick, healthy carrier), type of chromosomal aberration (structural, numerical), heritability pathway of structural anomalies (father or mother), chromosome formula and type of translocation.Results: out of all positive cases and carriers diagnosed prenatally, 76.71% were numerical anomalies. From 17 cases of structural anomalies, 13 were chromosomal translocations, (balanced and unbalanced), all inherited from one of the progenitors. Two sick individuals and 23 healthy carriers in the studied families were identified by prenatal and postnatal diagnosis.Conclusion: in the Cienfuegos province, there is a healthy group of people who carry chromosomal translocations, which can be transmited to their descendants; therefore with the possibility that they are born with malformations.

Síndrome de Turner mixoploide: aberración estructural del cromosoma Y y su correlación con los dermatoglifos / Mixoploid turner Syndrome with a Y-chromosome structural aberration and its correlation with dermatoglyphs

Resumen ANTECEDENTES El análisis citogenético del síndrome de Turner suele ser una línea monosómica X. Son raros los casos reportados con más de una línea celular y aún menos con aberraciones estructurales del cromosoma Y. No es común que se incluyan análisis dermatoglíficos. CASO CLÍNICO Paciente de 8 años de edad, que al examen físico no evidenció ninguna característica fenotípica propia del síndrome de Turner, excepto talla baja, 1.28 cm (por debajo del percentil 3). La laparoscopia exploradora mostró al útero hipoplásico, trompas rudimentarias, cintillas ováricas hipoplásicas delgadas y anillos inguinales normales sin evidencia de hernias, no se detectó tejido testicular. El resultado de la citogenética convencional en sangre periférica fue de: 46,XY; bandeo "C" 46,XY; FISH 45,X[230]/46,XY[117]/46,X,dic.Y[64]. La dactiloscopia con aumento de verticilos coincidió con el aumento del número de crestas mayor al reportado como normal (127 ± 0.8), en quiroscopia ángulo ATD (92°), número de crestas a-b (86) y el porcentaje de t (24.3%). CONCLUSIÓN Se discute uno de los pocos casos reportados en la bibliografía de síndrome de Turner con tres líneas celulares diferentes, resultantes de un evento no disfuncional poscigótico y estructural cromosómico, así como el análisis de la dactiloscopia y quiroscopia y los aspectos genéticos, medio ambientales y bioquímicos de los dermatoglifos, coincidentes con los del síndrome clásico.

Abstract BACKGROUND Usually, cytogenetic analysis of Turner´s syndrome is presented as a single monosomic X cell line. Are rare the reported cases in which there are multiple cell lines and even less frequent descriptions of structural chromosomal aberrations of the Y-chromosome. Additionally, the cases reported to date do not include finger/palm process analysis. We present an infrequent case of a Turner syndrome with three different cell lines including a structural aberration of the Y-chromosome and to correlate with finger process and palm process analysis. CLINICAL CASE A 8-year-old female patient who did not show any Turnerian syndrome phenotypic characteristics except low height, 1.28 cm (under 3th percentile). Exploratory laparoscopy shows hypoplastic uterus, with rudimentary tubes, thin hypoplastic ovaries and normal inguinal rings without evidence of hernias. No testicular tissue was detected. Conventional cytogenetic findings in peripheral blood are: 46, XY; "C" banding 46, XY; FISH 45, X [230] / 46, XY [117] /46,X,dic.Y [64]. Finger process with increase of whorls was observed, coinciding with the increase in the number of ridges higher than that reported as normal (127 ± 0.8) and in the palm process the atd angle (92º), number of a-b crests (86) and the percentage of t (24.3%). CONCLUSION We discuss one of the few cases reported in the scientific literature of Turner syndrome with three different cell lines results from a non-dysfunctional post-zygotic etiology and its chromosomic structure; as well as the results of genetic, environmental and biochemical aspects of the finger/palm process and their correlation with the classical syndrome.

Chironomus alchichica sp. n. (Diptera: Chironomidae) from Lake Alchichica, Mexico.

Morphological analysis of all developmental stages (except female), mitochondrial DNA sequences from cytochrome c oxidase subunit I (cox1) and cytological analysis of the polytene chromosomes were used to describe a new species of Chironomus found in the littoral and profundal zones of an endorheic, warm-monomictic lake in Mexico. Male imago is distinguished by the shape of superior volsella and by an antennal and bristle ratio lower than two. The pupa is characterized by the spur morphology of abdominal segment VIII. There is also a continuous row of hooklets on abdominal segment II. The larva is distinguished by a combination of antenna, mentum, mandible, and pecten epipharyngis characteristics, and abdominal ventral tubules. Molecular and cytological analysis supported the morphological differences found. The maximum likelihood tree obtained shows that Chironomus alchichica sp. n. clusters together with Chironomus decorus-group sp. 2 Butler et al. (1995) (bootstrap support = 92%), but genetic p-distances within C. alchichica sp. n. (0.004) were lower than the p-distances between other species of the decorus-group (C. decorus-group sp. 2, Chironomus bifurcatus Wülker et al., 2009 and Chironomus maturus Johannsen, 1908) confirming that it is a different species. The new species belongs to thummi cytocomplex, (decorus-group), with chromosome set- 2n = 8 and chromosome arm combinations: AB CD EF G. Karyologically, the species is closest to Chironomus riihimaekiensis Wülker (1973). This species has very compact salivary gland chromosomes with well heterochromatinized centromere regions in chromosomes AB CD G. Several fixed homozygous inversions distinguish arm A of the species from that of C. riihimaekiensis. Arm E differs from that of C. riihimaekiensis by simple fixed homozygous inversion. Some similarities in band sequences of this arm were found with species from the decorus-group as Chironomus blaylocki Wülker et al., 2009 and C. bifurcatus (decorus-group). The position of the key constrictions in chromosome G: Nucleolar organizer (NOR) and Balbiani rings (BRs) is similar to the species of decorus-group. C. alchichica sp. n. has been found in soft sediments rich in organic matter in well mineralized waters (where conductivity >10 mS cm-1) and with a high pH (≥9). The profundal zone is inhabited only during the mixing period, when dissolved oxygen is present.