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Best S, Vidic N, An K, Collins F, White SM. A systematic review of geographical inequities for accessing clinical genomic and genetic services for non-cancer related rare disease. Eur J Hum Genet 2022; 30:645-652. [PMID: 35046503 DOI: 10.1038/s41431-021-01022-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/28/2021] [Accepted: 12/02/2021] [Indexed: 11/09/2022] Open
Abstract
Place plays a significant role in our health. As genetic/genomic services evolve and are increasingly seen as mainstream, especially within the field of rare disease, it is important to ensure that where one lives does not impede access to genetic/genomic services. Our aim was to identify barriers and enablers of geographical equity in accessing clinical genomic or genetic services. We undertook a systematic review searching for articles relating to geographical access to genetic/genomic services for rare disease. Searching the databases Medline, EMBASE and PubMed returned 1803 papers. Screening led to the inclusion of 20 articles for data extraction. Using inductive thematic analysis, we identified four themes (i) Current service model design, (ii) Logistical issues facing clinicians and communities, (iii) Workforce capacity and capability and iv) Rural culture and consumer beliefs. Several themes were common to both rural and urban communities. However, many themes were exacerbated for rural populations due to a lack of clinician access to/relationships with genetic specialist staff, the need to provide more generalist services and a lack of genetic/genomic knowledge and skill. Additional barriers included long standing systemic service designs that are not fit for purpose due to historically ad hoc approaches to delivery of care. There were calls for needs assessments to clarify community needs. Enablers of geographically equitable care included the uptake of new innovative models of care and a call to raise both community and clinician knowledge and awareness to demystify the clinical offer from genetics/genomics services.
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Affiliation(s)
- Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia. .,Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Nada Vidic
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Kim An
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Felicity Collins
- Clinical Genetics Service, Institute of Precision Medicine and Bioinformatics, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Divisions of Genomic Medicine, Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Susan M White
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Victorian Clinical Genetics Services, Melbourne, VIC, Australia
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2
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Gil-da-Silva-Lopes VL, Tacla MA, Sgardioli IC, Vieira TP, Monlleó IL. Brazil's Craniofacial Project: Different approaches on orofacial clefts and 22q11.2 deletion syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:912-927. [PMID: 33166033 DOI: 10.1002/ajmg.c.31852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022]
Abstract
This article reports the present situation of Brazilian health care in genetics for Orofacial Cleft (OFC) and 22q11.2 Deletions Syndrome (22q11.2 DS) based on research conducted by Brazil's Craniofacial Project (BCFP). Established in 2003, BCFP is a voluntary and cooperative network aiming to investigate the health care of people with these diseases and other craniofacial anomalies. The initiatives and research results are presented in four sections: (a) a comprehensive report of the Brazilian public health system in craniofacial genetics; (b) multicentric studies developed on OFC and 22q11.2 DS; (c) education strategies focused on addressing these conditions for both population and health-care professionals; and (d) the nosology through the Brazilian Database on Craniofacial Anomalies (BDCA). Since 2006, BDCA uses a standardized method with detailed clinical data collection, which allows for conducting studies on nosology, genotype-phenotype correlations, and natural history; data can also contribute to public policies. Currently, the BDCA stores data on 1,724 individuals, including 1,351 (78.36%) who were primarily admitted due to OFC and 373 (21.63%) with clinical suspicion of 22q11.2 DS. Chromosomal abnormalities/genomic imbalances were represented by 92/213 (43.19%) individuals with syndromic OFC, including 43 with 22q11.2 DS, which indicates the need for chromosomal microarray analysis in this group. The nosologic diversity reinforces that monitoring clinical is the best strategy for etiological investigation. BCFP's methodology has introduced the possibility of increasing scientific knowledge and genetic diagnosis of OFC and 22q11.2 DS to in turn improve health care and policies for this group of diseases.
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Affiliation(s)
- Vera Lúcia Gil-da-Silva-Lopes
- Faculty of Medical Sciences, Department of Medical Genetics and Genomic Medicine, University of Campinas (Unicamp), Campinas, Sao Paulo, Brazil
| | - Milena Atique Tacla
- Faculty of Medical Sciences, Department of Medical Genetics and Genomic Medicine, University of Campinas (Unicamp), Sao Paulo, Brazil
| | - Ilária Cristina Sgardioli
- Faculty of Medical Sciences, Department of Medical Genetics and Genomic Medicine, University of Campinas (Unicamp), Campinas, Sao Paulo, Brazil
| | - Társis Paiva Vieira
- Faculty of Medical Sciences, Department of Medical Genetics and Genomic Medicine, University of Campinas (Unicamp), Campinas, Sao Paulo, Brazil
| | - Isabella Lopes Monlleó
- Faculty of Medicine, Clinical Genetics Service, University Hospital, Medical Genetics Sector, Federal University of Alagoas-UFAL, Maceió, Alagoas, Brazil
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3
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Gil-da-Silva-Lopes V, Fontes M, dos Santos A, Appenzeller S, Fett-Conte A, Francisquetti M, Monlleó I. Syndromic Oral Clefts: Challenges of Genetic Assessment in Brazil and Suggestions to Improve Health Policies. Public Health Genomics 2019; 22:69-76. [DOI: 10.1159/000501973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 07/07/2019] [Indexed: 11/19/2022] Open
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Sgardioli IC, Paoli Monteiro F, Fanti P, Paiva Vieira T, Gil-da-Silva-Lopes VL. Testing criteria for 22q11.2 deletion syndrome: preliminary results of a low cost strategy for public health. Orphanet J Rare Dis 2019; 14:123. [PMID: 31159889 PMCID: PMC6547599 DOI: 10.1186/s13023-019-1098-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/19/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The clinical heterogeneity of the 22q11.2 Deletion Syndrome (22q11.2DS - OMIM, #188400 and #192430) is a universal challenge leading to diagnostic delay. The aim of this study was to evaluate a low cost strategy for the diagnosis of this condition based upon clinical criteria previously reported. Health professionals, who collected clinical data, from twelve centers were trained in those criteria, which were summed through an online application (CranFlow). RESULTS Clinical and laboratorial data of 347 individuals registered from 2008 to 2017 in the Brazilian Database on Craniofacial Anomalies/22q11.2 Deletion Syndrome, were reviewed. They were divided in two groups: (I) 168 individuals investigated before the definition of the criteria and (II) 179 individuals investigated after the criteria application. All of them were investigated for 22q11.2DS by Fluorescent in situ Hybridization (FISH) and/or Multiplex Ligation Probe-dependent Amplification (MLPA), detecting 98 cases with 22q11.2DS. Among the individuals with 22q11.2DS in Group II, 42/53 (79.25%) fulfilled the proposed criteria against 11/53 (20.75%) who did not fulfill them (p < .0001). The association of congenital heart diseases with high predictive value for 22q11.2DS and hypernasal voice were significantly associated to the presence of 22q11.2DS (p = 0.0172 and p < .0001, respectively). In addition, 22q11.2DS was confirmed 3.82 more times when the individuals fulfilled the proposed criteria. Of the 249 cases negative for the typical deletion in 22q11.2, Chromosomal Microarray Analysis (CMA) was performed in 132 individuals and detected pathogenic alterations at other genomic regions in 19 individuals, and variants of uncertain clinical significance in 31 cases. CONCLUSIONS Therefore, a locus-specific approach could be used to individuals with positive criteria as a cost-effective alternative for 22q11.2DS diagnosis. The authors discuss advantages and suggest ways of implementing this approach to investigate 22q11.2DS in a public health system.
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Affiliation(s)
- Ilária Cristina Sgardioli
- Department of Medical Genetics and Genomic Medicine, Faculty of Medical Science, State University of Campinas (Unicamp), Tessália Vieira de Camargo Street, 126, Campinas, SP, 13083-887, Brazil
| | - Fabíola Paoli Monteiro
- Department of Medical Genetics and Genomic Medicine, Faculty of Medical Science, State University of Campinas (Unicamp), Tessália Vieira de Camargo Street, 126, Campinas, SP, 13083-887, Brazil.,Association of Parents and Friends of the Exceptional from Sao Paulo (Associação de Pais e Amigos dos Excepcionais de São Paulo - APAE-SP), Campinas, SP, Brazil
| | - Paulo Fanti
- Department of Statistics, Faculty of Medical Science, State University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Társis Paiva Vieira
- Department of Medical Genetics and Genomic Medicine, Faculty of Medical Science, State University of Campinas (Unicamp), Tessália Vieira de Camargo Street, 126, Campinas, SP, 13083-887, Brazil
| | - Vera Lúcia Gil-da-Silva-Lopes
- Department of Medical Genetics and Genomic Medicine, Faculty of Medical Science, State University of Campinas (Unicamp), Tessália Vieira de Camargo Street, 126, Campinas, SP, 13083-887, Brazil.
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Zhong A, Darren B, Loiseau B, He LQB, Chang T, Hill J, Dimaras H. Ethical, social, and cultural issues related to clinical genetic testing and counseling in low- and middle-income countries: a systematic review. Genet Med 2018; 23:2270-2280. [PMID: 30072741 DOI: 10.1038/s41436-018-0090-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/04/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE We performed a systematic review of the ethical, social, and cultural issues associated with delivery of genetic services in low- and middle-income countries (LMICs). METHODS We searched 11 databases for studies addressing ethical, social, and/or cultural issues associated with clinical genetic testing and/or counselling performed in LMICs. Narrative synthesis was employed to analyze findings, and resultant themes were mapped onto the social ecological model (PROSPERO #CRD42016042894). RESULTS After reviewing 13,308 articles, 192 met inclusion criteria. Nine themes emerged: (1) genetic counseling has a tendency of being directive, (2) genetic services have psychosocial consequences that require improved support, (3) medical genetics training is inadequate, (4) genetic services are difficult to access, (5) social determinants affect uptake and understanding of genetic services, (6) social stigma is often associated with genetic disease, (7) family values are at risk of disruption by genetic services, (8) religious principles pose barriers to acceptability and utilization of genetic services, and (9) cultural beliefs and practices influence uptake of information and understanding of genetic disease. CONCLUSION We identified a number of complex and interrelated ethical, cultural, and social issues with implications implications for further development of genetic services in LMICs.
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Affiliation(s)
- Adrina Zhong
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Schulich School of Medicine & Dentistry, Western University, Canada
| | - Benedict Darren
- Human Biology Program, Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bethina Loiseau
- Human Biology Program, Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada
| | - Li Qun Betty He
- Human Biology Program, Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada.,Michael G. DeGroote Medical School, McMaster University, Hamilton, ON, Canada
| | - Trillium Chang
- Human Biology Program, Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada
| | - Jessica Hill
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Helen Dimaras
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Department of Ophthalmology & Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada. .,Child Health Evaluative Sciences Program & The Centre for Global Child Health, SickKids Research Institute, Toronto, ON, Canada. .,Department of Human Pathology, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
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6
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Leite GC, Ururahy MA, Bezerra JF, Lima VM, Costa MI, Freire SS, Luchessi AD, Maia JM, Brito ME, Gil-da-Silva-Lopes VL, Rezende AA. Cardiovascular abnormalities in patients with oral cleft: a clinical-electrocardiographic-echocardiographic study. Clinics (Sao Paulo) 2018; 73:e108. [PMID: 29694606 PMCID: PMC5890169 DOI: 10.6061/clinics/2018/e108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/16/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The present study aims to describe the clinical, electrocardiographic, and echocardiographic cardiological findings in a group of patients with oral clefts. METHODS This is a prospective cross-sectional study on 70 children (age range from 13 days to 19 years) with oral clefts who attended the multidisciplinary program of a university hospital from March 2013 to September 2014. The patients were evaluated by a pediatric cardiologist and underwent detailed anamnesis, physical examination, electrocardiogram, and echocardiogram. RESULTS Sixty percent of the patients were male; 55.7% presented with cleft lip and palate, and 40.0% presented with health complaints. Comorbidities were found in 44.3%. Relevant pregnancy, neonatal, family and personal antecedents were present in 55.7%, 27.1%, 67.2%, and 24.3% of the patients, respectively. Regarding the antecedents, 15.2% of the patients presented with a cardiac murmur, 49.0% with a familial risk of developing plurimetabolic syndrome, and 6% with family antecedents of rheumatic fever. Electrocardiographic evaluation showed one case of atrioventricular block. Echocardiograms were abnormal in 35.7% of the exams, including 5 cases of mitral valve prolapse - one of which was diagnosed with rheumatic heart disease. CONCLUSION The finding of a family risk of developing plurimetabolic syndrome and a diagnosis of rheumatic heart disease indicates that patients with oral clefts may be more prone to developing acquired heart disease. Thus, our findings highlight the importance of anamnesis and methodological triangulation (clinical-electrocardiographic-echocardiographic) in the investigation of patients with oral clefts and emphasize that cardiological follow-up to evaluate acquired and/or rhythm heart diseases is necessary. This strategy permits comorbidity prevention and individualized planned treatment.
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Affiliation(s)
- Gisele C.P. Leite
- Departamento de Pediatria, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Marcela A.G. Ururahy
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - João F. Bezerra
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Valéria M.G.D.M. Lima
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Maria I.F. Costa
- Departamento de Pediatria, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Sandra S.C. Freire
- Departamento de Pediatria, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - André D. Luchessi
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Jussara M.C. Maia
- Departamento de Pediatria, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Maria E.F. Brito
- Departamento de Pediatria, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | | | - Adriana A. Rezende
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
- Corresponding author. E-mail:
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7
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Volpe-Aquino RM, Monlleó IL, Lustosa-Mendes E, Mora AF, Fett-Conte AC, Félix TM, Xavier AC, Tonocchi R, Ribeiro EM, Pereira R, Boy da Silva RT, de Rezende AA, Cavalcanti DP, Gil-da-Silva-Lopes VL. CranFlow
: An Application for Record-Taking and Management Through the Brazilian Database on Craniofacial Anomalies. Birth Defects Res 2017; 110:72-80. [DOI: 10.1002/bdr2.1123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/23/2017] [Accepted: 08/09/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Roberta M. Volpe-Aquino
- Department of Medical Genetics; School of Medical Sciences, State University of Campinas - Unicamp; Campinas SP Brazil
| | - Isabella L. Monlleó
- Clinical Genetics Service; School of Medicine, University Hospital, Federal University of Alagoas - Ufal; Maceió AL Brazil
| | - Elaine Lustosa-Mendes
- Department of Medical Genetics; School of Medical Sciences, State University of Campinas - Unicamp; Campinas SP Brazil
- Assistance Center for Cleft Lip and Palate - CAIF-AFISSUR; Curitiba PR Brazil
| | - Amanda F. Mora
- Department of Medical Genetics; School of Medical Sciences, State University of Campinas - Unicamp; Campinas SP Brazil
| | - Agnes C. Fett-Conte
- Department of Molecular Biology; Medical School of São José do Rio Preto - FAMERP/FUNFARME; São José do Rio Preto SP Brazil
| | - Têmis M. Félix
- Medical Genetics Service; Clinical Hospital of Porto Alegre - HCPA; Porto Alegre RS Brazil
| | - Ana C. Xavier
- Center for Research and Rehabilitation of Lip and Palate Lesions - CRRLPL; Centrinho Prefeito Luiz Gomes; Joinville SC Brazil
| | - Rita Tonocchi
- Assistance Center for Cleft Lip and Palate - CAIF-AFISSUR; Curitiba PR Brazil
| | - Erlane M. Ribeiro
- Medical Genetics Service; Hospital Infantil Albert Sabin - HIAS; Fortaleza CE Brazil
| | - Rui Pereira
- Institute of Integral Medicine, Prof. Fernando Figueira - IMIP; Recife PE Brazil
| | | | - Adriana A. de Rezende
- Department of Clinical and Toxicological Analysis; School of Pharmaceutical Sciences; Hospital Onofre Lopes (HUOL), Federal University of Rio Grande do Norte (UFRN); Natal RN Brazil
| | - Denise P. Cavalcanti
- Perinatal Genetics Program; Department of Medical Genetics, Faculty of Medical Sciences, State University of Campinas; Campinas SP Brazil
| | - Vera L. Gil-da-Silva-Lopes
- Department of Medical Genetics; School of Medical Sciences, State University of Campinas - Unicamp; Campinas SP Brazil
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8
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Zhong A, Darren B, Dimaras H. Ethical, social, and cultural issues related to clinical genetic testing and counseling in low- and middle-income countries: protocol for a systematic review. Syst Rev 2017; 6:140. [PMID: 28697779 PMCID: PMC5505010 DOI: 10.1186/s13643-017-0535-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 06/28/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There has been little focus in the literature on how to build genetic testing and counseling services in low- and middle-income countries in a responsible, ethical, and culturally appropriate manner. It is unclear to what extent this area is being explored and what form further research should take. The proposed knowledge synthesis aims to fill this gap in knowledge and mine the existing data to determine the breadth of work in this area and identify ethical, social, and cultural issues that have emerged. METHODS/DESIGN An integrated knowledge translation approach will be undertaken by engaging knowledge users throughout the review to ensure relevance to their practice. Electronic databases encompassing various disciplines, such as healthcare, social sciences, and public health, will be searched. Studies that address clinical genetic testing and/or counseling and ethical, social, and/or cultural issues of these genetic services, and are performed in low- and middle-income countries as defined by World Bank will be considered for inclusion. Two independent reviewers will be involved in a two-stage literature screening process, data extraction, and quality appraisal. Studies included in the review will be analyzed by thematic analysis. A narrative synthesis guided by the social ecological model will be used to summarize findings. DISCUSSION This systematic review will provide a foundation of evidence regarding ethical, social, and cultural issues related to clinical genetic testing and counseling in low- and middle-income countries. Using the social ecological model as a conceptual framework will facilitate the understanding of broader influences of the sociocultural context on an individual's experience with clinical genetic testing and counseling, thereby informing interdisciplinary sectors in future recommendations for practice and policy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016042894.
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Affiliation(s)
- Adrina Zhong
- Division of Health Promotion, University of Toronto, Toronto, Ontario Canada
| | - Benedict Darren
- Human Biology Program, Faculty of Arts & Science, University of Toronto, Toronto, ON Canada
- Present Address: Michael G. DeGroote Medical School, McMaster University, Hamilton, Ontario Canada
| | - Helen Dimaras
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Ave, Room 7260, Toronto, Ontario M5G 1X8 Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario Canada
- Department of Human Pathology, College of Health Sciences, University of Nairobi, Nairobi, Kenya
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9
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Sgardioli IC, de Mello Copelli M, Monteiro FP, Dos Santos AP, Lustosa Mendes E, Paiva Vieira T, Gil-da-Silva-Lopes VL. Diagnostic Approach to Microdeletion Syndromes Based on 22q11.2 Investigation: Challenges in Four Cases. Mol Syndromol 2017; 8:244-252. [PMID: 28878608 DOI: 10.1159/000477598] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 01/18/2023] Open
Abstract
In the last few decades, different methods for the detection of genomic imbalances, such as the microdeletion syndromes, were developed. The 22q11.2 deletion syndrome (22q11.2DS) is the most common microdeletion syndrome and presents wide clinical heterogeneity. The aim of this study was to describe 4 unusual cases of genomic imbalances found in individuals with suspected microdeletion syndromes. Different methods were necessary to complete the diagnosis and to obtain information for genetic counseling. The study was retrospective and descriptive. From August 2014 to December 2015, 39 individuals were assessed using FISH and/or MLPA; in 15 cases, chromosomal microarray (CMA) analysis was carried out. Of 39 registered individuals, we found deletions in the 22q11.2 region in 10 individuals (8 individuals with 22q11.2DS and 2 individuals presenting with atypical deletions in the 22q11.2 region: 1 distal deletion and 1 central deletion). In one case with a typical 22q11.2 deletion, a familial balanced translocation was detected. In another case without a 22q11.2 deletion, a 6p duplication concomitant with a 9p deletion was detected by CMA. Clinical data are reported and diagnostic investigations are discussed. Essential aspects for the understanding of different diagnostic techniques of genomic imbalances are considered, and the 4 cases described underline the complexity and the difficulties involved in the diagnostic process. The approach is informative for clinical practice and may be applied in other contexts of genomic imbalance investigation in microdeletion syndromes.
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Affiliation(s)
- Ilária C Sgardioli
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Matheus de Mello Copelli
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Fabíola P Monteiro
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Ana P Dos Santos
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Elaine Lustosa Mendes
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Társis Paiva Vieira
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Vera L Gil-da-Silva-Lopes
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
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10
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Sgardioli IC, Vieira TP, Simioni M, Monteiro FP, Gil-da-Silva-Lopes VL. 22q11.2 Deletion Syndrome: Laboratory Diagnosis and TBX1 and FGF8 Mutation Screening. J Pediatr Genet 2016; 4:17-22. [PMID: 27617111 DOI: 10.1055/s-0035-1554976] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Velocardiofacial syndrome is one of the recognized forms of chromosome 22q11.2 deletion syndrome (22q11.2 DS) and has an incidence of 1 of 4,000 to 1 of 6,000 births. Nevertheless, the 22q11 deletion is not found in several patients with a 22q11.2 DS phenotype. In this situation, other chromosomal aberrations and/or mutations in the T-box 1 transcription factor C (TBX1) gene have been detected in some patients. A similar phenotype to that of the 22q11.2 DS has been reported in animal models with mutations in fibroblast growth factor 8 (Fgf8) gene. To date, FGF8 mutations have not been investigated in humans. We tested a strategy to perform laboratory testing to reduce costs in the investigation of patients presenting with the 22q11.2 DS phenotype. A total of 109 individuals with clinical suspicion were investigated using GTG-banding karyotype, fluorescence in situ hybridization, and/or multiplex ligation-dependent probe amplification. A conclusive diagnosis was achieved in 33 of 109 (30.2%) cases. In addition, mutations in the coding regions of TBX1 and FGF8 genes were investigated in selected cases where 22q11.2 deletion had been excluded, and no pathogenic mutations were detected in both genes. This study presents a strategy for molecular genetic characterization of patients presenting with the 22q11.2 DS using different laboratory techniques. This strategy could be useful in different countries, according to local resources. Also, to our knowledge, this is the first investigation of FGF8 gene in humans with this clinical suspicion.
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Affiliation(s)
- Ilária C Sgardioli
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Társis P Vieira
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Milena Simioni
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Fabíola P Monteiro
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Vera L Gil-da-Silva-Lopes
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas-Unicamp, Campinas, São Paulo, Brazil
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11
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Schlatter RP, Matte U, Polanczyk CA, Koehler-Santos P, Ashton-Prolla P. Costs of genetic testing: Supporting Brazilian Public Policies for the incorporating of molecular diagnostic technologies. Genet Mol Biol 2015; 38:332-7. [PMID: 26500437 PMCID: PMC4612610 DOI: 10.1590/s1415-475738320140204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 04/23/2015] [Indexed: 01/03/2023] Open
Abstract
This study identifies and describes the operating costs associated with the molecular diagnosis of diseases, such as hereditary cancer. To approximate the costs associated with these tests, data informed by Standard Operating Procedures for various techniques was collected from hospital software and a survey of market prices. Costs were established for four scenarios of capacity utilization to represent the possibility of suboptimal use in research laboratories. Cost description was based on a single site. The results show that only one technique was not impacted by rising costs due to underutilized capacity. Several common techniques were considerably more expensive at 30% capacity, including polymerase chain reaction (180%), microsatellite instability analysis (181%), gene rearrangement analysis by multiplex ligation probe amplification (412%), non-labeled sequencing (173%), and quantitation of nucleic acids (169%). These findings should be relevant for the definition of public policies and suggest that investment of public funds in the establishment of centralized diagnostic research centers would reduce costs to the Public Health System.
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Affiliation(s)
- Rosane Paixão Schlatter
- Programa de Pós-Graduação em Ciências da Saúde Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. ; Instituto Nacional de Avaliação de Tecnologias em Saúde, CNPq, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ursula Matte
- Departamento de Genética e Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. ; Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, RS, Brazil
| | - Carisi Anne Polanczyk
- Programa de Pós-Graduação em Ciências da Saúde Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. ; Instituto Nacional de Avaliação de Tecnologias em Saúde, CNPq, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Patrícia Koehler-Santos
- Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, RS, Brazil
| | - Patricia Ashton-Prolla
- Departamento de Genética e Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. ; Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, RS, Brazil. ; Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Vieira TP, Monteiro FP, Sgardioli IC, Souza J, Fett-Conte AC, Monlleó IL, Fontes MB, Félix TM, Leal GF, Ribeiro EM, Gil-da-Silva-Lopes VL. Clinical Features in Patients With 22q11.2 Deletion Syndrome Ascertained by Palatal Abnormalities. Cleft Palate Craniofac J 2014; 52:411-6. [PMID: 24805874 DOI: 10.1597/13-233] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The aim of this study was to describe clinical features in subjects with palatal abnormalities and to assess the distribution of these features among those with and without 22q11.2 deletion. DESIGN Descriptive cohort. PATIENTS One hundred patients with palatal abnormalities and suspicion of 22q11.2 DS were included. METHODS All patients were evaluated by a clinical geneticist, who completed a standardized clinical protocol. The 22q11.2 deletion screening was performed with fluorescence in situ hybridization using the TUPLE1 probe and multiplex ligation-dependent probe amplification using the P250-A1 kit. RESULTS The 22q11.2 deletion was detected in 35 patients, in whom the most frequent clinical features were congenital heart disease (15/30 - 50%), developmental delay (19/35 - 54%), speech delay (20/35 - 57%), learning disabilities (27/35 - 77%), immunologic alterations (18/29 - 62%). In addition, the most common facial dysmorphisms in this group were long face (27/35 - 77%), typical nose (24/35 - 69%), and hooded eyelids (19/35 - 54%). Comparing features in patients with or without the deletion revealed significant differences (positively correlated with the deletion) for speech delay, learning disabilities, conductive hearing loss, number of dysmorphisms, long face, and hooded eyelids. Cleft lip and palate was negatively correlated with the deletion. CONCLUSIONS The presence of speech delay, learning disabilities, conductive hearing loss, long face, and hooded eyelids should reinforce the suspicion of 22q11.2 DS in patients with palatal abnormalities and would help professionals direct clinical follow-up of these patients.
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