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Daich Varela M, Moya R, Schlottmann PG, Hufnagel RB, Arberas C, Fernández FM, Inga ME, Lores J, Pachajoa H, Prada CE, Sallum JMF. Ophthalmic genetics in South America. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:753-761. [PMID: 32856789 DOI: 10.1002/ajmg.c.31832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/14/2020] [Accepted: 07/28/2020] [Indexed: 12/13/2022]
Abstract
South America comprises of heterogeneous topographies, populations, and health care systems. Therefore, it is not surprising to see differences among the countries regarding expertise, education, and practices of ophthalmic genetics for patients with rare eye diseases. Nevertheless, common challenges such as limited genetics training in medical schools and among ophthalmologists, scarcity of diagnostic tools for phenotyping, and expensive genetic testing not covered by the public healthcare systems, are seen in all of them. Here, we provide a detailed report of the current status of ophthalmic genetics, described by the personal views of local ophthalmologists from Brazil, Colombia, Argentina, and Chile. By reporting our strengths and weaknesses as a region, we intend to highlight the need for guidelines on how to manage these patients aligned with public health policies. Our region contributes to research worldwide, with thousands of well diagnosed patients from a number of unique and genetically diverse populations. The constant expansion of ophthalmic genetics and molecular diagnostics requires us to join forces to collaborate across South America and with other countries to improve access to next-generation diagnostics and ultimately improve patient care.
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Affiliation(s)
- Malena Daich Varela
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA.,University of Buenos Aires, Buenos Aires, Argentina
| | - Rene Moya
- Departamento de Retina y Departamento de Genética Ocular, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | | | - Robert B Hufnagel
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Claudia Arberas
- Sección Genética Médica, Hospital de Niños "R. Gutiérrez", Buenos Aires, Argentina
| | | | | | - Juliana Lores
- Centro de Investigaciones en Anomalías Congénitas y Enfermedades Raras Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Cali, Colombia
| | - Harry Pachajoa
- Centro de Investigaciones en Anomalías Congénitas y Enfermedades Raras Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Cali, Colombia
| | - Carlos E Prada
- Hospital Internacional de Colombia, Bucaramanga, Colombia.,Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Juliana M Ferraz Sallum
- Department of Ophthalmology, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Instituto de Genética Ocular, Sao Paulo, Brazil
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Microcephaly in Colombia before the Zika outbreak: A systematic literature review. BIOMEDICA 2018; 38:127-134. [PMID: 30184373 DOI: 10.7705/biomedica.v38i0.4413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Microcephaly is characterized by a smaller than normal head circumference. Recently, Zika virus (ZV) has been associated with microcephaly. OBJECTIVE To describe the prevalence of microcephaly in Colombia taking as the baseline the information from the period before the Zika virus infection epidemics. MATERIALS AND METHODS We reviewed Medline, Scopus, Scielo, Lilacs and annual reports of congenital malformation monitoring systems across Latin America, among others sources, for articles published before April, 2015, reporting the prevalence of microcephaly in Colombia between 1982 and 2013. RESULTS We identified 32 non-duplicate articles; we selected 25 articles for revision of which 12 met the criteria for inclusion in the systematic review, including 2,808,308 births. CONCLUSIONS The prevalence of microcephaly in Colombia from 1982 to 2013, before the introduction of ZV, ranged from 0.3 to 3.1 per 10,000 births, with an average of 1.8 (95% CI 1.7-1.8) per 10,000 births. These findings are important to determine if the prevalence after the introduction of the Zika virus infection registered significant changes.
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Orioli IM, Dolk H, Lopez-Camelo JS, Mattos D, Poletta FA, Dutra MG, Carvalho FM, Castilla EE. Prevalence and clinical profile of microcephaly in South America pre-Zika, 2005-14: prevalence and case-control study. BMJ 2017; 359:j5018. [PMID: 29162597 PMCID: PMC5696624 DOI: 10.1136/bmj.j5018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective To describe the prevalence and clinical spectrum of microcephaly in South America for the period 2005-14, before the start of the Zika epidemic in 2015, as a baseline for future surveillance as the Zika epidemic spreads and as other infectious causes may emerge in future.Design Prevalence and case-control study.Data sources ECLAMC (Latin American Collaborative Study of Congenital Malformations) database derived from 107 hospitals in 10 South American countries, 2005 to 2014. Data on microcephaly cases, four non-malformed controls per case, and all hospital births (all births for hospital based prevalence, resident within municipality for population based prevalence). For 2010-14, head circumference data were available and compared with Intergrowth charts.Results 552 microcephaly cases were registered, giving a hospital based prevalence of 4.4 (95% confidence interval 4.1 to 4.9) per 10 000 births and a population based prevalence of 3.0 (2.7 to 3.4) per 10 000. Prevalence varied significantly between countries and between regions and hospitals within countries. Thirty two per cent (n=175) of cases were prenatally diagnosed; 29% (n=159) were perinatal deaths. Twenty three per cent (n=128) were associated with a diagnosed genetic syndrome, 34% (n=189) polymalformed without a syndrome diagnosis, 12% (n=65) with associated neural malformations, and 26% (n=145) microcephaly only. In addition, 3.8% (n=21) had a STORCH (syphilis, toxoplasmosis, other including HIV, rubella, cytomegalovirus, and herpes simplex) infection diagnosis and 2.0% (n=11) had consanguineous parents. Head circumference measurements available for 184/235 cases in 2010-14 showed 45% (n=82) more than 3 SD below the mean, 24% (n=44) between 3 SD and 2 SD below the mean, and 32% (n=58) larger than -2 SD.Conclusion Extrapolated to the nearly 7 million annual births in South America, an estimated 2000-2500 microcephaly cases were diagnosed among births each year before the Zika epidemic began in 2015. Clinicians are using more than simple metrics to make microcephaly diagnoses. Endemic infections are important enduring causes of microcephaly.
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Affiliation(s)
- Iêda M Orioli
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, 21944-001, Rio de Janeiro, Brazil
- National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
| | - Helen Dolk
- Maternal Fetal and Infant Research Centre, Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK
| | - Jorge S Lopez-Camelo
- National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
- ECLAMC at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Daniel Mattos
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, 21944-001, Rio de Janeiro, Brazil
- National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
| | - Fernando A Poletta
- National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
- ECLAMC at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Maria G Dutra
- National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
- ECLAMC at Laboratory of Congenital Malformations Epidemiology, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Flavia M Carvalho
- National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
- ECLAMC at Laboratory of Congenital Malformations Epidemiology, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Eduardo E Castilla
- National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
- ECLAMC at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
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