Thesis (M.D.)—Boston University

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Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 6 uppsatser.

Thesis (M.P.H.)--University of Michigan, 1945.

Thesis (M.P.H.)--University of Michigan, 1945.

Orientador: Denise Pontes Cavalcanti / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T09:53:23Z (GMT). No. of bitstreams: 1 Moreno_CarolinaAraujo_M.pdf: 4072523 bytes, checksum: 09921eee06d7c1098048c98a3f891b33 (MD5) Previous issue date: 2013 / Resumo: A hidropisia fetal não-imune (HFNI) é causada por um grupo heterogêneo de condições e atualmente corresponde à maior parte dos casos de hidropisia fetal. Em função da ampla diversidade etiopatogênica, a investigação dos casos de HFNI constitui um desafio diagnóstico. Esse estudo teve como objetivo a avaliação prospectiva e sistemática de uma série de casos de HFNI a partir de um protocolo de investigação ampliado, que incluiu a pesquisa de doenças metabólicas. O presente estudo também incluiu a revisão dos casos de HFNI registrados previamente pelo Programa de Genética Perinatal na maternidade da Unicamp. Durante aproximadamente dois anos (2010-2012), foram identificados 53 casos de HFNI. Nesse período, ocorreram 6.129 nascimentos na maternidade local, com registro de HFNI em 37 recém-nascidos, conferindo uma prevalência de 60 por 10.000 nascimentos, valor maior do que o observado no período anterior ao estudo (1987 a 2009). Para o restante da análise, quatro casos foram excluídos devido à impossibilidade de estudá-los adequadamente. A maioria dos hidrópicos nasceu pré-termo (43 - 73,5%). Houve registro de 23 nativivos (47%), 10 óbitos no período neonatal e 26 óbitos durante a gestação (53%), resultado em uma mortalidade geral (pré-natal e neonatal) de 73,4%. A hidropisia foi identificada no pré-natal na maioria dos casos (44 - 89,8%) e, apesar da condição ser comumente associada a mau prognóstico, em três pacientes (6,1%) houve resolução completa e espontânea da hidropisia durante a gestação. Os principais grupos diagnósticos encontrados foram: anomalias cromossômicas (17 casos - 34,7%), quadros sindrômicos (16,4% - oito casos), cardiopatias e infecções congênitas (8,2% - quatro casos cada). Os erros inatos do metabolismo (EIM) corresponderam a 6,1% da amostra (três casos de doenças de depósito lisossômico). Três casos (6,1%) foram classificados como idiopáticos. Comparando os diagnósticos da casuística prospectiva com aqueles observados no período 1987-2009, observou-se que os grupos diagnósticos mais frequentes, ou seja, anomalias cromossômicas, quadros sindrômicos e cardiopatias, foram os mesmos. No entanto, algumas diferenças foram observadas na casuística prospectiva, como a frequência maior de anomalias cromossômicas e de EIM, que podem ser explicadas respectivamente pela inclusão de abortos e pesquisa sistemática de doenças metabólicas. Por outro lado, a menor frequência do grupo de idiopáticos foi decorrente da ampliação do protocolo de investigação e da eliminação de casos inadequadamente estudados. Ressalta-se também que a frequência de EIM registrada no trabalho prospectivo (6%) foi superior à usualmente descrita na literatura e provavelmente aproxima-se da frequência real das doenças metabólicas em HFNI, justificando desse modo a pesquisa das mesmas na investigação de hidrópicos de causa não-imune após exclusão das condições mais comuns, como as anomalias cromossômicas, cardiopatias isoladas, infecções congênitas e síndromes conhecidas. Sendo assim, observou-se que o protocolo de investigação proposto permitiu o diagnóstico clínico-etiológico ou patogênico de mais de 90% dos casos, evidenciando que uma avaliação ampla e sistemática é capaz de identificar a maior parte dos fatores etiopatogênicos envolvidos na HFNI / Abstract: Non-immune hydrops fetalis (NIHF) is caused by a hetereogenous group of conditions, currently accounting for the most cases of hydrops fetalis. Because of the wide etiopathogenic diversity, the investigation of NIHF cases constitutes a real diagnostic challenge. This study aimed to evaluate prospectively and systematically a series of NIHF cases from an expanded research protocol including the investigation of metabolic diseases. The present study also aimed to revise the NIHF cases previously recorded by Perinatal Genetics Program (PGP) in the maternity hospital of Unicamp. During approximately two years (2010-2012), 53 cases were identified. In this period, among 6,129 births that occurred in our hospital, NIHF was identified in 37 newborns, given a birth prevalence of 60 per 10,000, higher than that was observed in the previous period - 23:10,000 (1987-2009). For purpose of all other analysis, four of the 53 cases evaluated had to be excluded due to inability to assess them correctly. Most hydropic individuals were born preterm (43 - 73.5%). Twenty-three patients (47%) were live births, 10 of them died before hospital discharge; and 26 (53%) died in the prenatal period, given an overall mortality of 73.4%. The hydrops were identified in prenatal period in most cases (44 - 89.8%), and despite being commonly associated with poor prognosis, three cases (6.1%) had complete and spontaneous resolution of hydrops during pregnancy. The main diagnostic groups were chromosomal abnormalities (17 - 34.7%), syndromic (8 - 16.4%), isolated heart defects (4 - 8.2%), and congenital infections (4 - 8.2%). Inborn errors of metabolism (IEM) occurred in three cases (6.1%), all represented by lysosomal storage diseases. Three cases (6.1%) were classified as idiopathic. The comparison of these diagnostic groups with those found during the retrospective period (1987-2009) showed that the most frequent groups, i.e. chromosomal abnormalities, syndromic and isolated cardiopathy, were the same. However, some differences were observed in the prospective series. For instance, the higher frequency of chromosomal abnormalities and IEM can be respectively explained because of the inclusion of abortions and due to systematic investigation of metabolic diseases. The lower frequency of idiopathic group, by the other hand, can be regarded as close related, first, to the expanded investigation and, second, to the exclusion of cases poorly studied. It is noteworthy that the recorded IEM frequency in the present prospective series (6%) was higher than the usually reported in the literature and seems to be more realistic, thus, justifying the inclusion of a systematic approach of these conditions in NIHF. This investigation, however, should be initiated after the exclusion of the more common causes, i.e., chromosomal abnormalities, isolated cardiopathy, congenital infections and known syndromes. In conclusion, the proposed investigation protocol allowed the clinical-etiological or pathogenic diagnosis in more than 90% of the cases, suggesting that the most etiopathogenic factors related to NIHF can be identified if a wide and systematic evaluation is performed / Mestrado / Genetica Medica / Mestra em Ciências Médicas

Submitted in fulfilment of the requirements of the Degree of Master of Technology: Biomedical Technology, Durban University of Technology, 2013. / The purpose of the study was to evaluate knowledge and effects of Haemolytic Disease of the Newborn (HDN) in postnatal women from the Umgungundlovu District. Although the prevalence of HDN has declined because of prophylaxis from 45 cases per 10,000 births to 10.2 cases per 10,000 births but it is still a cause of infant and neonatal morbidity and mortality. The effects of the disease range from jaundice, kernicterus and in severe cases death. Methodology : An interviewer-administered questionnaire was used to obtain information about the knowledge and effects of HDN amongst postnatal women. The incidence rate was calculated using the number of cases that were found divided by the total number of deliveries during the study period. A total of 300 women were interviewed. SPSS version 19.0 was used to analyse data. Findings : Fifteen (15) of the 300 women had babies with confirmed HDN and only four of the 15 (26%) women had knowledge of HDN. Two hundred and eighty five women had babies with jaundice but were not affected by HDN and, of these women, 12 (4.2%) of them knew what HDN was. Overall, only 16 (5.3%) knew what HDN was. All 15 women who had babies with HDN indicated financial and emotional effects because of HDN. The total incidence was 0.09% for the first 12 months of the study period. Conclusion : Postnatal women with jaundiced babies lack knowledge of HDN and HDN has financial and emotional effects on these women. Although the incidence rate of HDN was found to be even smaller than previously reported, it still exists and threatens the lives of infants and neonates.