Characteristics of the treatment received by children with cleft lip and palate in Argentina

INTRODUCTION

Cleft lip and palate (CLP) are congenital abnormalities that affect anatomically and functionally the face and mouth, involving lip (CL), palate (CP), or both (CL/CP).

OBJECTIVE

to characterize the treatment of children with CLP in public institutions in Argentina.

PATIENTS AND METHOD

Cross sectional study in a random sample of 100 children from the Flap Network. We included children with isolated CL, CP, and CL/CP, of both sexes, with birth weight of 2500 grams or more and ges tational age over 36 weeks. The following data were recorded date of birth, hospital of birth, birth weight, gestational age, sex, specific diagnosis of the cleft, and initial surgery data. A telephone survey was conducted with the children's parents. To characterize the treatment, three indicators were cons tructed: interdisciplinary, opportunity, and integrality. These indicators were composed of different variables, and according to the sum of the score attributed to each one, the treatment was categorized as high, medium or low based on the treatment guidelines used by the Sumar Program.

RESULTS

30% of the patients started early treatment, 58% underwent timely surgery, and 29% of the children were in follow-up with basic specialties. The mother's high educational level was associated with higher probability of having interdisciplinary (OR2.9; 95%CI 1.3-6.8), comprehensive (OR3.7; 95%CI 1.6 8.7), and timely treatment (OR2.9; 95%CI 1.3-6.7).

CONCLUSIONS

There are barriers to accessing care, such as long distances or shift management. Less social vulnerability of families was associated with greater likelihood of receiving treatment close to standards.

National Health Care Network for children with oral clefts: organization, functioning, and preliminary outcomes

INTRODUCTION

Oral clefts are major congenital anomalies that may affect the lip and/or palate, and that may also involve the nose and nostrils. In Argentina, their prevalence is approximately 15 per 10 000 births. In 2015, the Ministry of Health of Argentina created a national health care network for children with oral clefts in Argentina through the joint work with the National Registry of Congenital Anomalies (Red Nacional de Anomalías Congénitas, RENAC) (coordinating center for the national network) and the SUMAR Program. The objective of this study was to describe the health care network and its preliminary outcomes.

POPULATION AND METHODS

A total of 61 centers that provided a comprehensive treatment for oral clefts or in collaboration with other centers were identified and accredited. Maternity centers were connected with treating centers grouped in health care network nodes.

RESULTS

In the period between March 2015 and February 2016, 550 newborn infants who were exclusively covered by the public health care system were identified. Among these, 18% had a cleft lip; 62%, cleft lip and palate; and 20%, cleft palate only; 75% were isolated cases and 25%, in association with other congenital anomalies.

CONCLUSION

Approximately 70% of children were assessed by a certified treating institution and are receiving treatment. The network seeks to improve data systematization, include the largest number of centers possible, strengthen interdisciplinary team work, and promote high-quality standards for treatments.

[Lumbocostovertebral syndrome: first case report in Argentina]

Lumbocostovertebral syndrome is defined by the presence of lumbar hernia, hemivertebrae and costal anomalies. Our aim was to describe the first case reported in Argentina. The patient was reported to the National Registry of Congenital Anomalies of Argentina. The clinical picture, differential diagnoses and possible pathogenic mechanisms involved are described. We suggest considering this as a lumbocostovertebral association. Lumbar hernia in a newborn is an infrequent finding and other associated anomalies should be evaluated.

[Prevalence of neural tube defects and estimation of cases averted in the post-fortification period in Argentina]

Periconceptional intake of folic acid has demonstrated to be effective to reduce the frequency of neural tube defects, and food fortification has been one of the strategies implemented to increase it. An update is herein presented on the reduced prevalence of neural tube defect cases in the post-fortification period in Argentina and an estimation of cases averted in the 2005-2013 period as a result of this intervention. When comparing the prevalence observed in the post-fortification period to that reported in the pre-fortification period, anencephaly and encephalocele decreased by 66%, and spina bifida, by 47%, which were significant reductions. The estimated number of cases averted was higher for anencephaly, followed by spina bifida; encephalocele showed the lowest number of cases averted given that the prevalence of this defect was smaller. The decrease observed in the prevalence supports findings from previous studies on the impact of fortification.

[Acheiropodia: first case report in Argentina]

Acheiropodia is a very rare disease with autosomal recessive inheritance characterized by limb reduction defects. It has been described mainly in Brazil. The aim of this report is to describe the first reported cases in Argentina in two affected twins. Patients were reported to the National Registry of Congenital Anomalies of Argentina (RENAC). Both twins had limb reduction defect including hands, forearms, feet and fibulae. These patients are the first reported cases of acheiropodia syndrome in Argentina. Immigration from Brazil could explain this case in our population.

CHACO outreach project: the development of a primary health care-based medical genetic service in an Argentinean province

Dissemination of knowledge in genetics to be applied in medicine has created a growing need for capacity building in health care workers. The CAPABILITY ARGENTINA outreach project protocol was designed as a model to introduce genetics in areas without genetic services. Our aim was for genetic health care to become part of primary care in an Argentine province lacking genetic services. The program was innovative as professionals from the referral center (Garrahan Hospital S.A.M.I.C.) traveled to remote areas to train professionals through problem-based education. A logical framework was designed for a local needs assessment. Teaching materials (Powerpoint presentations, printed syllabus, and CD) and a web page were developed. A demonstration project was carried out in the Province of Chaco, Argentina. A total of 485 health workers were trained. The number of consultations increased significantly in participating areas comparing before and after the training period. To support this increase, a complementary project was set up from a public hospital sponsored from within Argentina to build a cytogenetic laboratory in the capital of the Province of Chaco. The model was improved for reproduction in other areas in Argentina. CAPABILITY ARGENTINA is a capacity building model for training of primary care professionals in genetics that may be applied to other medical specialties. The outcomes of the programme have a direct impact on clinical practice.

[Complete androgen insensitivity syndrome: diagnosis and clinical characteristics]

Complete androgen insensitivity syndrome (CAIS) is a genetic disease caused by mutations in the androgen receptor gene. CAIS patients are individuals with a 46, XY karyotype. The phenotype consists in female external genitalia, short vagina, absent mullerian structures, and abdominal, inguinal or intralabial testes. Our aim is to describe a group of CAIS patients in our centre and identify the difficulties in the diagnosis. The amount of patients with inguinal hernia in childhood was remarkable (83%). Interestingly, the diagnosis was suspected later when patients presented primary amenorrhea. CAIS must be suspected every time a female child shows inguinal hernia. Early diagnosis is very important for a correct genetic counseling.