Reverse Heat Giemsa (RHG) banded karyotype was performed on metaphase chromosome preparations obtained from peripheral blood lymphocytes of both patients and parents according to standard protocol (450–550 band level). A minimum of 20 R-banded metaphase chromosomes were analyzed using Cytovision® Karyotyping software version 4.0. Karyotypes were classified according to the International System of Human Cytogenetic Nomenclature (ISCN 2020) [11 ]. Fluorescent in situ Hybridization (FISH) was carried out on metaphase chromosomes of the patients according to the standard protocol, using commercial probes. Array Comparative genomic hybridization (aCGH) 4 × 44 K micro-arrays was performed using the Agilent platform according to the manufacturer’s instructions (Feature Extraction 9.1, CGH Analytics 4.5, Santa Clara, California, United States). An abnormal ratio greater than + 0.58 or lower than − 0.75 was considered as an alteration. An in silico analysis of the unbalanced regions was executed using UCSC Genome Browser (https://genome.ucsc.edu/), the Database of Chromosome Imbalance and Phenotype in Humans using Ensemble Resources (DECIPHER: https://decipher.sanger.ac.uk/), the Database of Genomic Variants (DGV: http://dgv.tcag.ca/dgv/app/home) and the Online Mendelian Inheritance in Man database (OMIM: https://omim.org/).
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