Utility of the Serum Protein Electrophoresis in the Opportunistic Screening for the Deficiency of Alpha-1 Antitrypsin.

BACKGROUND: A deficiency in alpha-1 antitrypsin (AAT1) is a rare disorder that represents a significant health threat and early diagnostic priority issue. We investigated the usefulness of the serum protein electrophoresis (SPE) as an opportunistic screening tool for AAT1 deficiency. METHODS: For 6 months, all SPE carried out for any reasons were evaluated in our center. In those with less than 3% of alpha-1 globulins, AAT1 concentrations were studied. The SERPINA1 gene was subsequently sequenced in those patients displaying concentrations below 100 mg/dL. RESULTS: Out of the total, 14 patients (0.3%) were identified with low AAT1 concentrations, with 11 of them agreeing to enter the study. Of those, mutations in the SERPINA1 gene were discovered in 10 patients (91%). Heterozygous mutations were detected in seven patients; three had the c.1096G>A mutation (p.Glu366Lys; Pi*Z), two had the c.863A>T mutation (p.Glu288Val; Pi*S), one had the c.221_223delTCT mutation (p.Phe76del; Pi*Malton), and the last one had the c.1066G>A (p.Ala356Thr) mutation, which was not previously described. Finally, one patient had the c.863A>T mutation in homozygosis, whereas two double heterozygous patients c.863A>T/c.1096G>A were detected. CONCLUSIONS: An altered result in the concentration of AAT1 anticipates a mutation in the SERPINA1 gene in a manner close to 91%. The relationship between a decrease in the alpha-1 globulin band of the SPE and an alteration in the AAT1 concentration is direct in basal states of health. The SPE is presented as a highly sensitive test for opportunistic screening of AAT1 deficiency.

Treatment of melasma with platelet-rich plasma: A self-controlled clinical trial.

Melasma is a common circumscribed hypermelanosis of sun-exposed areas of the skin. Platelet-Rich Plasma therapy has been evidenced to inhibit melanin synthesis in animals and humans. To determine the effectiveness of platelet-rich plasma as a treatment for melasma. Twenty female patient with melasma were involved in this study. The intervention included three Platelet-Rich Plasma application sessions at 15-day intervals. Patients were evaluated before and after treatment. Variables measured included the facial melanin concentration using the melasma area and severity index score, melasma quality of life scale satisfaction grade, and histologic changes. Mean age was 41 ± 7 years. An initial MELASQOL score of 42 ± 14.8 and final score of 16.6 ± 7.2 (p = 0.008) were reported; the initial and final MASI score were 15.5 ± 8.4 and 9.5 ± 7.2 (p = 0.001), respectively. The dermatoscopy examination revealed a decrease in pigmentation after intervention (p = 0.001). Histopathologic improvement was detected in reductions in cutaneous atrophy (14 [70%] vs. 11 [55%]), solar elastosis (15 [75%] vs.11 [55%]), and inflammatory infiltrate (9 [45%] vs. 6 [30%]), before and after treatment, respectively. The intervention was associated with decreased intensity of the melasma patch and improved skin quality, shown by the MELASQOL and MASI scores.

Bases moleculares de la deficiencia de la hmg-coa sintasa mtocondrial / Molecular basis of hmg-coa synthase mitocondrial deficiency

La deficiencia de la HMG-CoA sintasa mitocondrial (mHS) (MIM600234) es un error innato del metabolismo de tipo autosómico recesivo que está causada por mutaciones en el gen HMGCS2. La mHS es una enzima mitocondrial que cataliza el paso de condensación de acetil-CoA con acetoacetil-CoA para forma 3-hidroxi-2-metilgutaril CoA en la ruta de síntesis de los cuerpos cetónicos. Esta deficiencia suele aparecer en la primara infancia en situaciones de ayuno y alto consumo energético. Las manifestaciones clínicas son inespecíficas e incluyen vómitos, letargia y a veces coma. Hasta la fecha, sólo se han diagnosticado a nivel clínico y genético ocho pacientes en todo el mundo (AU)

The HMG-CoA synthase mitocondrial (mHS) deficiency (OMIM 600234) is an autosomal recessive inborn error of metabolism caused by mutations in the HMGCS2 gene. mHS is a mitochondrial enzyme that cathalyzes the condensation step of acetyl-CoA with acetoacetyl-CoA to form 3-hydroxy-3-methylglutaryl CoA in the synthesis pathway of the ketone bodies. This deficiency frequently appears during childhood under fasting and/or high energy consumption situations. Clinical manifestations are rather inespecific and include vomiting, lethargy and, in some cases, coma. To date, only eight patients have been clinically and genetically characterized around the word (AU)