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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.
[achondroplasia]
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
FGFR
3
(
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
.
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