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EN
The first three years of life (zero to three) are a period of great importance when discovering the congenital, as well as the acquired disorders and developmental delays. Recognizing milestones and manifestations of certain behaviors helps us identify developmental delays and disruptions. With this research we intended to determine the segments of developmental achievements and developmental discrepancies of psycho-motor development (general development achievements, motor functions, surrounding motor functions and communication) in infancy and early childhood (zero to three years old) in three groups of respondents. The research sample included 104 respondents. Sixty-three of them had been diagnosed with cerebral palsy (thirty-three were without comorbidity convulsions, and thirty were with comorbidity convulsions-epilepsy), and forty-one respondents were born with a risk factor for a developmental delay. The research was conducted using the standardized developmental instrument Chuturic Developmental Scale for evaluation of the psycho-motor development, which encompasses oculomotorics, emotional development, speech, hearing-motor reactions, communication, socialization and verbalization, of infants and small children. The analysis of results concluded that there is a discrepancy in the developmental achievements of the three groups of respondents. Based on analysis of the values of the Global Development Coefficient (GDC), we have determined that the most affected group is the group of children with cerebral palsy and comorbidity convulsions where the average value of GDC is 47.77. Early and precision diagnostics, as well as knowledge of the developmental characteristics of different categories of developmental delays will improve the prognosis and contribute to better utilization of the brain plasticity in children with cerebral damage and children born at risk. Early intervention and stimulation are more than necessary to maximize the child's full potential, reduce the primary effects of the damage or prevent secondary damages and difficulties.
EN
Zespół oczno-mózgowo-nerkowy, opisany po raz pierwszy przez Lowe’a w 1952 roku, jest rzadkim defektem gene-tycznym (częstość 1 : 500 000), wywołanym mutacją w genie OCRL kodującym enzym 5-fosfatazę 4,5-dwufosfo-fosfatydyloinozytolu. Jest on zlokalizowany na chromosomie X (Xq25-26), a choroba dziedziczy się w sposób recesywny sprzężony z płcią. Typowymi objawami są: wrodzona zaćma, upośledzenie rozwoju umysłowego i tubulopatia proksymalna (wtórny zespół Fanconiego bez glukozurii) z wolno postępującym upośledzeniem czynności nerek, aż do schyłkowej ich niewydolności w 2–4 dekadzie życia. Inne objawy to: zaburzenia wzrastania, jaskra, woloocze, hipotonia mięśniowa, opóźnienie rozwoju motorycznego, dziwne zachowania (napady agresji i złości, ruchy mimowolne), wentrykulomegalia, przykurcze, artropatie, osteopenia, wnętrostwo, dysplazja zębów, torbiele skórne i skaza krwotoczna. Rozpoznanie wstępne można postawić na podstawie obrazu klinicznego z typową sekwencją pojawiania się objawów, z których początkowymi są zaćma, hipotonia z brakiem odruchów głębokich i białkomocz cewkowy. Potwierdzenie diagnozy stanowi badanie genetyczne, w którym stwierdza się jeden z ponad 200 znanych wariantów genu OCRL lub mutację de novo. Przedstawiono przypadek 2-letniego chłopca z obrazem klinicznym zespołu Lowe’a (wrodzona zaćma, hipotonia, opóźnienie rozwoju psychofizycznego i tubulopatia), diagnozowanego i leczonego w wielu ośrodkach. Po przekazaniu chorego pod opiekę powiatowego oddziału pediatrycznego w Międzyrzeczu rozpoznanie potwierdzono badaniem genetycznym, w którym wykazano hemizygotyczną punktową mutację w eksonie 13 OCRL (c.1351G > A); badanie wykonano dzięki uprzejmości prof. Michaela Ludwiga w Laboratorium Biologii Molekularnej Uniwersytetu w Bonn. Zwrócono uwagę na celowość wczesnego zgłaszania chorych z podejrzeniem zespołu Lowe’a do krajowego rejestru POLtube, co ułatwia dostęp do diagnostyki molekularnej.
PL
The oculocerebrorenal syndrome described by C.U. Lowe in 1952 is a rare genetic defect (prevalence 1:500 000) caused by mutation of the OCRL gene which encodes phosphatidylinositol 4,5-bisphosphate 5-phosphatase. Its location on chromosome X (Xq25-26) leads to an X-linked recessive mode of inheritance. A typical clinical triad characterizing the disease consists of congenital cataract, mental retardation and proximal tubulopathy (secondary Fanconi syndrome without glycosuria) with slow progression to end stage kidney disease in the 2nd–4th decade. There are many other symptoms reported like: growth retardation, glaucoma, buphthalmos, muscle hypotonia, neuromotor retardation, behavioral abnormalities (aggression, temper tantrums, repetitive purposeless movements), ventriculomegaly, contractures, arthropathy, osteopenia, cryptorchidism, dental anomalies, skin cysts and bleeding disorders. Preliminary diagnosis may be based on the clinical picture with a typical sequence of symptoms starting from cataracts, hypotonia with a lack of deep tendon reflexes and tubular proteinuria. Final identification of the disease is confirmed by molecular testing with one out of more than 200 known mutations (or de novo variant) found. Here we reported a 2-year-old boy with the clinical picture of Lowe syndrome (congenital cataract, hypotonia, psychomotor development retardation and tubulopathy), examined and treated in many medical centers. The final diagnosis was confirmed by genetic testing planned in the regional hospital in Międzyrzecz and performed by prof. Michael Ludwig from the Laboratory of Molecular Biology at University of Bonn, Germany. A single hemizygous deviation in exon 13 (c.1351G > A) was found. Attention was paid to the purpose of early notification of such patients to the national registry POLtube which facilitates molecular diagnosis.
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