title: Eight years experience from a skeletal dysplasia referral center in a tertiary hospital in Southern India: a model for the diagnosis and treatment of rare diseases in a developing country.
abstract: We report on a series of 514 consecutive diagnoses of skeletal dysplasia made over an 8-year period at a tertiary hospital in Kerala, India. The most common diagnostic groups were dysostosis multiplex group (n = 73) followed by FGFR3 (n = 49) and osteogenesis imperfecta and decreased bone density group (n = 41). Molecular confirmation was obtained in 109 cases. Clinical and radiographic evaluation was obtained in close diagnostic collaboration with expert groups abroad through Internet communication for difficult cases. This has allowed for targeted biochemical and molecular studies leading to the correct identification of rare or novel conditions, which has not only helped affected families by allowing for improved genetic counseling and prenatal diagnosis but also resulted in several scientific contributions. We conclude that (1) the spectrum of genetic bone disease in Kerala, India, is similar to that of other parts of the world, but recessive entities may be more frequent because of widespread consanguinity; (2) prenatal detection of skeletal dysplasias remains relatively rare because of limited access to expert prenatal ultrasound facilities; (3) because of the low accessibility to molecular tests, precise clinical-radiographic phenotyping remains the mainstay of diagnosis and counseling and of gatekeeping to efficient laboratory testing; (4) good phenotyping allows, a significant contribution to the recognition and characterization of novel entities. We suggest that the tight collaboration between a local reference center with dedicated personnel and expert diagnostic networks may be a proficient model to bring current diagnostics to developing countries.
authors.affiliation: Department of Pediatric Genetics, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India.
authors.forename: Sheela
authors.initials: S
authors.lastname: Nampoothiri
authors.forename: Dhanya
authors.initials: D
authors.lastname: Yesodharan
authors.forename: Gazel
authors.initials: G
authors.lastname: Sainulabdin
authors.forename: Dhanyalakshmi
authors.initials: D
authors.lastname: Narayanan
authors.forename: Laxmi
authors.initials: L
authors.lastname: Padmanabhan
authors.forename: Katta Mohan
authors.initials: KM
authors.lastname: Girisha
authors.forename: Sara S
authors.initials: SS
authors.lastname: Cathey
authors.forename: Anne
authors.initials: A
authors.lastname: De Paepe
authors.forename: Fransiska
authors.initials: F
authors.lastname: Malfait
authors.forename: Delfien
authors.initials: D
authors.lastname: Syx
authors.forename: Raoul C
authors.initials: RC
authors.lastname: Hennekam
authors.forename: Luisa
authors.initials: L
authors.lastname: Bonafe
authors.forename: Sheila
authors.initials: S
authors.lastname: Unger
authors.forename: Andrea
authors.initials: A
authors.lastname: Superti-Furga
mesh_terms: D001848:Bone Diseases, Developmental / Q000175:diagnosis* / Q000628:therapy*; D003906:Developing Countries; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D035583:Rare Diseases / Q000175:diagnosis* / Q000628:therapy*; D012017:Referral and Consultation; D062606:Tertiary Care Centers; D013997:Time Factors
keywords: Morquio syndrome; achondroplasia; lethal dysplasia; mucolipidosis type 3; mucopolysaccharidosis; osteogenesis imperfecta; skeletal dysplasia; ultrasonography