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Abstract The mainstay of management of phenylketonuria (PKU) is restriction of dietary phenylalanine (Phe) intake. The present study sought to assess the perception and understanding of health care providers and lay users (patients/family members/caregivers) regarding the national reference database for checking the Phe content of foods, provided by the Brazilian Health Regulatory Agency (Anvisa), whose data are presented in the Table of Phenylalanine Content of Foods (TCFA-Anvisa) and recently in the Phenylalanine Content of Foods Dashboard (PCCFA-Anvisa); and to identify factors which interfere with the usability of these resources. Two online questionnaires, one for providers (n=33) and another for lay users (n=194), were used to collect sociodemographic information, knowledge about dietary management of PKU, sources of information about the Phe content of foods, and perception and understanding of the Anvisa tools. TCFA-Anvisa and PCCFA-Anvisa were not used as main sources of information by either group. Among the participants who had used these tools (15 providers;35 lay users), most considered the PCCFA-Anvisa to be superior or partially superior to the TCFA-Anvisa. The main limitations reported were related to layout and limited variety of foods. We suggest that the limitations identified in this study be considered for future improvement of these resources.

https://doi.org/10.1590/2326-4594-jiems-2022-0002

A decade of molecular diagnosis of Mucolipidosis II and III in Brazil: a pooled analysis of 32 patients
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Ludwig, Nataniel F

; Sperb-Ludwig, Fernanda

; Randon, Dévora N

; Bernardi, Pricila

; Giuliani, Liane R

; Moreno, Carolina A

; Cavalcanti, Denise P

; Silva, Luiz CS da

; Schwartz, Ida V D

Journal of Inborn Errors of Metabolism and Screening

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2021, Volume 9 elocation e20200029

Resumo: En | Texto: En | PDF: En

Abstract GlcNAc-1-phosphotransferase is a hexameric complex formed by subunits α, β, and γ, where the first two are encoded by the GNPTAB gene and the third by the GNPTG gene. Pathogenic variants identified in the GNPTAB gene cause the diseases Mucolipidosis II and III alpha/beta, which are severe and characterized by an overflow of lysosomal hydrolases into the extracellular environment, and their absence in lysosomal compartments causes an accumulation of non-degraded macromolecules. Methodology: a retrospective study that included 32 unrelated Brazilian patients with a clinical and genetic diagnosis of Mucolipidosis II/III alpha/beta. The regional frequency of the altered alleles was determined. Results: The patients were from all regions of Brazil. The most prevalent variants were c.3503_3504del, associated with the severe form of the disease, and c.1208T>C, associated with the milder form. Variant c.3503_3504del is the most frequently found in the Midwest, Northeast, and Southeast regions of Brazil. In the South, 42.8% of the alleles present the c.1196C>T variant. Conclusions: From the perspective of all patients diagnosed with Mucolipidosis II/III in Brazil, it is possible to conclude that different regions present allelic frequencies of specific pathogenic variants, which can be explained by the occurrence of a founding effect or high inbreeding rates.

https://doi.org/10.1590/2326-4594-jiems-2020-0029 225 downloads

Website www.emergencyprotocol.net to Support Prevention of Metabolic Emergencies in Patients with Hepatic Glycogen Storage Diseases and Fatty Acid Oxidation Disorders
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Souza, Carolina F. Moura de

; Oliveira, Bibiana M. de

; Schwartz, Ida V D.

; Derks, Terry

Journal of Inborn Errors of Metabolism and Screening

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2021, Volume 9 elocation e20210025

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/2326-4594-jiems-2021-0025 86 downloads

Prevalence of the most common pathogenic variants in three genes for inborn errors of metabolism associated with sudden unexpected death in infancy: a population-based study in south Brazil
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Randon, Dévora N.

; Sperb-Ludwig, Fernanda

; Vianna, Fernanda S. L.

; Becker, Ana P. P.

; Vargas, Carmen R.

; Sitta, Angela

; Sant’Ana, Alexia N.

; Schwartz, Ida V. D.

; Bitencourt, Fernanda H. de

Genetics and Molecular Biology

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2020, Volume 43 Nº 3 elocation 20190298

Resumo: En | Texto: En | PDF: En

Abstract Citrullinemia type 1 (CTLNI), long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD), and mut0 methylmalonic acidemia (mut0 MMA) are inborn errors of metabolism (IEMs) associated with sudden unexpected death in infancy (SUDI). Its most common pathogenic variants are: c.1168G>A (CTLNI, ASS1 gene), c.1528G>C (LCHADD, HADHA gene), c.655A>T and c.1106G>A (mut0 MMA, MUT gene). Considering the absence of estimates regarding the incidence of these diseases in Brazil, this study sought to investigate the prevalence of its main pathogenic variants in a healthy population in the southern region of the country. A total of 1,000 healthy subjects from Rio Grande do Sul were included. Genotyping was performed by real-time PCR. Individuals found to be heterozygous for c.1528G>C underwent further acylcarnitine profile analysis by tandem mass spectrophotometry. Allele and genotype frequencies were calculated considering Hardy-Weinberg equilibrium. The c.1528G>C variant was detected in heterozygosity in two subjects (carrier frequency = 1:500; allele frequency = 0.001; minimum prevalence of LCHADD = 1: 1,000,000), whose acylcarnitine profiles were normal. Variants c.1168G>A, c.655A>T, and c.1106G>A were not identified. These results denote the rarity of these IEMs in Southern Brazil, highlighting the need to expand the investigation of IEMs in relation to infant morbidity and mortality within the country.

https://doi.org/10.1590/1678-4685-gmb-2019-0298 803 downloads

Humoral immune response in adult Brazilian patients with Mucolipidosis III gamma
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Sperb-Ludwig, Fernanda

; Alegra, Taciane

; Velho, Renata Voltolini

; Ludwig, Nataniel

; Siebert, Marina

; Jobim, Mariana

; Vairo, Filippo

; Schwartz, Ida V. D.

Genetics and Molecular Biology

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Set 2019, Volume 42 Nº 3 Páginas 571 - 573

Resumo: En | Texto: En | PDF: En

Abstract Mucolipidosis II and III (ML II and III) alpha/beta and ML III gamma are lysosomal diseases caused by GlcNAc-1-phosphotransferase deficiency. Previous data indicate that MLII patients have functionally impaired immune system that contributes to predisposition to infections.We evaluated the immunological phenotype of three Brazilian patients with ML III gamma. Our data suggest that the residual activity of GlcNAc-1-phosphotransferase in patients with ML III gamma is enough to allow the targeting of the lysosomal enzymes required for B-cell functions maintenance.

https://doi.org/10.1590/1678-4685-gmb-2018-0246 589 downloads

Diagnosis and Management of Classica Homocystinuria in Brazil: A Summary of 72 Late-Diagnosed Patients
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Poloni, Soraia

; Hoss, Giovana W.

; Sperb-Ludwig, Fernanda

; Borsatto, Taciane

; Doriqui, Maria Juliana R.

; Leão, Emília K.E.A

; Boa-Sorte, Ney

; Lourenço, Charles M.

; Kim, Chong A.

; Souza, Carolina F. M. de

; Rocha, Helio

; Ribeiro, Marcia

; Steiner, Carlos E.

; Moreno, Carolina A.

; Bernardi, Pricila

; Valadares, Eugenia

; Artigalas, Osvaldo

; Carvalho, Gerson

; Wanderley, Hector Y. C.

; D’Almeida, Vânia

; Santana-da-Silva, Luiz C.

; Blom, Henk J.

; Schwartz, Ida V. D.

Journal of Inborn Errors of Metabolism and Screening

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2018, Volume 6 elocation e180007

Resumo: En | Texto: En | PDF: En

Abstract This study described a broad clinical characterization of classical homocystinuria (HCU) in Brazil. This was a cross-sectional, observational study including clinical and biochemical data from 72 patients (60 families) from Brazil (South, n = 13; Southeast, n = 37; Northeast, n = 8; North, n = 1; and Midwest, n = 1). Parental consanguinity was reported in 42% of families. Ocular manifestations were the earliest detected symptom (53% of cases), the main reason for diagnostic suspicion (63% of cases), and the most prevalent manifestation at diagnosis (67% of cases). Pyridoxine responsiveness was observed in 14% of patients. Only 22% of nonresponsive patients on treatment had total homocysteine levels <100 mmol/L. Most commonly used treatment strategies were pyridoxine (93% of patients), folic acid (90%), betaine (74%), vitamin B12 (27%), and low-methionine diet + metabolic formula (17%). Most patients diagnosed with HCU in Brazil are late diagnosed, express a severe phenotype, and poor metabolic control. Milder forms of HCU are likely underrepresented due to underdiagnosis.

https://doi.org/10.1177/2326409818788900 1352 downloads

Nutritional Status and Body Composition in Patients With Hepatic Glycogen Storage Diseases Treated With Uncooked Cornstarch—A Controlled Study
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Santos, Bruna B. dos

; Nalin, Tatiéle

; Grokoski, Kamila C.

; Perry, Ingrid D. S.

; Refosco, Lilia F.

; Vairo, Filippo P.

; Souza, Carolina F. M.

; Schwartz, Ida V. D.

Journal of Inborn Errors of Metabolism and Screening

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2017, Volume 5 elocation e170012

Resumo: En | Texto: En | PDF: En

Abstract Hepatic glycogen storage diseases (GSDs) are genetic diseases associated with fasting hypoglycemia. Periodic intake of uncooked cornstarch is one of the treatment strategies available for those disorders. For reasons that are still not clear, patients with hepatic GSDs may be overweight. Aims: To assess nutritional status and body composition in patients with hepatic GSDs receiving uncooked cornstarch. Methods: The sample included 25 patients with hepatic GSD (type Ia = 14; Ib = 6; III = 3; IX? = 1; IX? = 1), with a median age of 11.0 years (interquartile range [IQR] = 9.0-17.5), matched by age and gender with 25 healthy controls (median age = 12.0 years, IQR = 10.0-17.5). Clinical, biochemical, and treatment-related variables were obtained from medical records. Nutritional status and body composition were prospectively evaluated by bioelectrical impedance. Results: Patients and controls did not differ with regard to age and gender. Height was significantly reduced in patients (median = 1.43 m, IQR = 1.25-1.54) in comparison to controls (median = 1.54 m, IQR = 1.42-1.61; P = .04). Body mass index for age z-score and fat mass percentage were higher in patients (median = 1.84, IQR = 0.55-3.06; and 27.5%, IQR = 22.6-32.0, respectively) than in controls (median = 0.86, IQR = ?0.55 to 1.82; P = .04 and 21.1%, IQR = 13.0-28.3; P = .01, respectively). When patients were stratified by type, those with GSD Ia had significantly higher adiposity (median fat mass = 28.7%, IQR = 25.3-32.9) than those with GSD III and GSD IX?/? (median fat mass = 20.9%, IQR = 14.9-22.6; P = .02). Conclusions: Our findings suggest that patients with hepatic GSD on treatment with cornstarch, especially those with GSD Ia, exhibit abnormalities in nutritional status and body composition, such as short stature and a trend toward overweight and obesity.

https://doi.org/10.1177/2326409817733014 561 downloads

Orthotopic Liver Transplantation in Glycogen Storage Disease Type 1a: Perioperative Glucose and Lactate Homeostasis
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Wilke, Matheus V. M. B.

; Kleine, Ruben H. de

; Wietasch, J. K. G.

; Amerongen, Cynthia C. A. van

; Blokzijl, Hans

; Spronsen, Francjan J. van

; Schwartz, Ida V. D.

; Derks, Terry G. J.

Journal of Inborn Errors of Metabolism and Screening

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2016, Volume 4 elocation e150014

Resumo: En | Texto: En | PDF: En

Abstract Glycogen storage disease type 1a (GSD 1a) is a rare inborn error of metabolism. It causes severe fasting intolerance and lactic acidosis due to the deficiency of glucose-6-phosphatase enzyme. Blood glucose and lactate concentrations from 2 patients with GSD 1a were retrospectively compared to a control group of patients with familial amyloid polyneuropathy. Carbohydrate intake and infusions were compared to experimental data based on stable isotope studies. Perioperative lactate concentrations were significantly higher in our 2 patients with GSD 1a (median 15.0 mmol/L; range 9.9-22.0 mmol/L) versus 8 controls. In one patient, despite normal blood glucose concentrations, lactate acidosis was probably caused by a combination of the disease itself, insufficient (par)enteral carbohydrate intake, Ringer lactate infusions, and circulatory insufficiency. Patients with GSD 1a carry an increased risk of lactic acidosis during orthotopic liver transplantation compared to non-GSD patients. Multidisciplinary perioperative care is essential to prevent significant complications.

https://doi.org/10.1177/2326409816649599 361 downloads

Mucopolissacaridose tipo VI (síndrome de Maroteaux-Lamy): avaliação da mobilidade articular e das forças de garra e de pinça
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Cardoso-Santos, Antonio

; Azevedo, Ana C. M. M.

; Fagondes, Simone

; Burin, Maira G.

; Giugliani, Roberto

; Schwartz, Ida V. D.

Jornal de Pediatria

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Abr 2008, Volume 84 Nº 2 Páginas 130 - 135

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

OBJETIVO: Descrever o perfil de mobilidade articular e das forças de garra e de pinça de indivíduos com MPS VI, além de sua correlação com a excreção urinária de glicosaminoglicanos, atividade da ARSB e distância percorrida no teste de caminhada de 6 minutos. MÉTODOS: Estudo observacional de 28 pacientes com MPS VI, não submetidos a tratamento específico. Todos os pacientes foram avaliados em relação à amplitude da mobilidade articular, forças de garra e de pinça, excreção urinária de glicosaminoglicanos, atividade da ARSB e teste de caminhada de 6 minutos. RESULTADOS: Demonstrou-se maior comprometimento de flexão de ombro, sem correlação com a idade, e da extensão de joelho e flexão de cotovelo, estas últimas correlacionadas negativamente com a idade. A força de garra mostrou-se comprometida em todos os pacientes, e a força de pinça apresentou correlação positiva com idade. CONCLUSÕES: A restrição da flexão de ombro, sem correlação com a idade, sugere que este achado esteja presente precocemente na MPS VI e se constitua em sinal clínico importante para suspeita diagnóstica desta doença. A amplitude da extensão de joelho e da flexão de cotovelo, por sua vez, por apresentarem correlação negativa com a idade, são possíveis marcadores da evolução da doença. Estudos adicionais são necessários para confirmação dessas hipóteses.

OBJECTIVE: To describe the profile of joint mobility and grip and pinch strength of MPS VI patients and to correlate this with urinary excretion of glycosaminoglycans (GAGs), ARSB activity, and the distance covered in a 6-minute walking test (6MWT). METHODS: This was an observational study of 28 patients with MPS VI, who had not undergone specific treatment. All patients were assessed for amplitude of joint mobility (shoulder, elbow, and knee), grip and pinch strength and urinary GAG excretion and also performed the 6MWT. RESULTS: Shoulder flexion exhibited the greatest limitation, with no correlation with age, followed by knee extension and elbow flexion, both of which were correlated inversely with age. Hand grip strength was compromised in all patients, and pinch strength exhibited a positive correlation with age. CONCLUSIONS: The fact that restricted shoulder flexion was not correlated with age suggests that this finding is present early on in MPS VI and that it constitutes an important clinical sign that should arouse diagnostic suspicion of this disease. The amplitude of knee extension and elbow flexion, in turn, are possible markers of disease progression since they have a negative correlation with age. Further studies are needed to confirm these hypotheses.

11171 downloads Citado 1 vez em SciELO

10.

Avaliação prospectiva de 11 pacientes brasileiros com mucopolissacaridose II
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Pinto, Louise L. C.

; Schwartz, Ida V. D.

; Puga, Ana C. S.

; Vieira, Taiane A.

; Munoz, Maria Verônica R.

; Giugliani, Roberto

Jornal de Pediatria

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Ago 2006, Volume 82 Nº 4 Páginas 273 - 278

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

OBJETIVO: Avaliar a progressão da mucopolissacaridose II, durante um período de 12 meses, em 11 pacientes brasileiros. MÉTODOS: Onze pacientes brasileiros com mucopolissacaridose II foram avaliados prospectivamente no Serviço de Genética Médica do Hospital de Clínicas de Porto Alegre. As avaliações realizadas na visita inicial e na de 12 meses foram: anamnese, exame físico, ressonância nuclear magnética abdominal, ecocardiograma, teste da caminhada em 6 minutos, audiometria, exames bioquímicos séricos e dosagem uriná- ria de glicosaminoglicanos. RESULTADOS: Os principais achados relativos à comparação entre as duas visitas foram: 1) dois pacientes apresentaram retardo de crescimento; 2) dois pacientes apresentaram variação negativa em relação ao peso; 3) um paciente apresentou variação de obesidade para sobrepeso; 4) três pacientes desenvolveram alargamento do ventrículo esquerdo; destes, dois aumentaram o número de lesões nas valvas cardíacas; 5) não foi encontrada diferença estatística significativa entre a média das distâncias percorridas no teste da caminhada em 6 minutos; 6) houve aumento do volume esplênico; 7) ocorreu aumento dos níveis de gamaglutamiltransferase; 8) não houve alteração dos níveis urinários de glicosaminoglicanos. CONCLUSÕES: De uma maneira geral, a única variável que apresentou, no período estudado, piora com potencial repercussão clínica imediata foram os achados ecocardiográficos. Embora o período de 12 meses seja curto para medir alterações na maioria dos parâmetros comprometidos na mucopolissacaridose II, sua natureza progressiva deve ser levada em conta na avaliação da eficácia dos protocolos de tratamento para essa condição.

OBJECTIVE: To assess the progression of mucopolysaccharidosis II in 11 Brazilian patients over a 12-month period. METHODS: Eleven Brazilian patients with mucopolysaccharidosis II were prospectively studied at the Division of Medical Genetics of Hospital de Clínicas de Porto Alegre. The initial assessment and the assessment at 12 months included: anamnesis, physical examination, abdominal nuclear magnetic resonance, echocardiogram, 6-minute walk test, audiometry, serum biochemical tests and urinary glycosaminoglycan concentration. RESULTS: The major findings after comparing the assessments were: 1) two patients had growth retardation; 2) two patients showed negative weight change; 3) one patient went from obese to overweight; 4) three patients revealed left ventricle hypertrophy; of these, two increased the number of cardiac valve lesions; 5) there was no statistically significant difference between the mean distances obtained on the 6-minute walk test; 6) there was splenic enlargement; 7) there was an increase in gamma-glutamyltransferase levels; 8) the urinary concentration of glycosaminoglycans remained unchanged. CONCLUSIONS: In general, echocardiographic findings were the only variable with deterioration and possible immediate clinical consequences. Although a 12-month period is too short to detect changes in most variables related to mucopolysaccharidosis II, its progressive nature should be taken into account when evaluating the efficiency of treatment protocols.

5457 downloads

11.

O ENSINO DE GENÉTICA NA MEDICINA: COMO OS ALUNOS PERCEBEM A GENÉTICA CLÍNICA
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Souza, Carolina F.M

; Schwartz, Ida V. D.

; Ruschel, Sílvia P.

; Puga, Ana Cristina

; Reis, Alexandre M.

; Costa, Fabrício S.

; Dias, Ricardo P.

; Flores, Renato Z.

; Schuler, Lavínia

Revista Brasileira de Educação Médica

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Dez 1996, Volume 20 Nº 2-3 Páginas 33 - 40

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Considerando a genética como uma área de rápido avanço nas áreas biomédicas e de inclusão recente como disciplina nos currículos das faculdades de medicina, procura-se verificar o grau e o tipo de conhecimento por parte dos alunos de medicina da Universidade Federal do Rio Grande do Sul - Brasil sobre o papel do geneticista como especialista médico, bem como avaliar a influência da disciplina de genética médica na modificação dos conceitos prévios relativos à esta questão .Para tanto, foram aplicados dois questionários padronizados no primeiro e último dia de aula nos semestres de 1992/2 e 1993/1. Nos questionários PRÉ disciplina as principais funções atribuídas ao médico geneticista foram relacionadas a pesquisa e laboratório (32%). Nos questionários PÓS disciplina as atribuições passaram a ser estudo e diagnóstico de síndromes (29,1%). Aconselhamento genético (26,1%) e tratamento (17,2%). As diferenças foram estatisticamente significantes (P<0,01).

Summary Genetics has been advanced faster in the biomedical areas and recently had been included as a course in the curriculum of the medicine schools. Taking those facts into consideration, this study intends to verify the type and degree of knowledge of the students of medicine of the Federal University of Rio Grande do Sul (UFRGS) - Brazil in relation to the role of the geneticist as a medical specialist, before and after taking the Medical Genetics course, regularly offered at the Medical School Of UFRGS, and the influence of this course on the modifications of their previous notions on the subject. Two Types of standard questionnaires were applied on the first and the last day of two class semesters (92/2 and 93/1). In PRE questionnaires, the main functions attributed to the clinical geneticist were related to research and laboratory (32%); in POST questionnaires, emphasis was given to study diagnoses (29,1%), genetic counselling (26,1%) and treatment (17,2%). The differences were statistically significant (p<0.01)

https://doi.org/10.1590/1981-5271v20.2-3-006 312 downloads

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