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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2023.tde-08052023-151411
Document
Author
Full name
Talita Vasconcelos Moura Araujo
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2023
Supervisor
Committee
Júnior, Pérsio Roxo (President)
Leitão, Mônica de Freitas
Silva, Marcos Tadeu Nolasco da
Title in Portuguese
Aspectos clínicos e laboratoriais sugestivos de síndrome de DiGeorge em pacientes com cardiopatias congênitas conotruncais e CIV
Keywords in Portuguese
Cardiopatias congênitas
Deleção cromossômica
Doenças da imunodeficiência primária
Síndrome de DiGeorge
Abstract in Portuguese
A Síndrome de DiGeorge (SDG) é considerada uma das síndromes genéticas de microdeleção mais frequentes, afetando, aproximadamente, 1 em cada 4.000 ou 6.000 indivíduos e acometendo, igualmente, ambos os sexos. Resulta da migração anormal das células embrionárias da terceira e quarta bolsas faríngeas, levando à hipoplasia ou aplasia do timo, defeitos da paratireoide, da tireoide e do arco aórtico/fluxo de saída cardíaco, além de dismorfismos faciais. Aproximadamente 90% dos pacientes apresentam deleção heterozigótica no cromossomo 22q11.2. A tríade clássica da SDG é caracterizada por: hipoplasia do timo, hipocalcemia e cardiopatia conotruncal. No entanto, ocorre ampla variabilidade fenotípica, dificultando sua suspeição, tornando-a um desafio diagnóstico. As cardiopatias congênitas apresentam alta incidência em pacientes com SDG (65 a 76%), representando a manifestação mais precoce nos períodos fetal e neonatal. Aproximadamente 75% das crianças apresentam acometimento imunológico, podendo se manifestar como infecções recorrentes, autoimunidade, alergia e asma. Objetivo: Caracterizar as manifestações clínicas e alterações laboratoriais sugestivas de SDG em crianças com cardiopatias conotruncais e comunicação interventricular (CIV). Metodologia: Estudo transversal, observacional e descritivo. Resultados: Foram avaliados 60 pacientes, sendo 24 (40%) enquadrados como casos sugestivos para SDG. Constatou-se a seguinte diversidade clínica no grupo sugestivo de SDG: comorbidades (79%), imunodeficiência (79%), dismorfismo (67%), alterações do timo (50%), hipocalcemia (42%) e tríade clássica (17%). Conclusão: A frequência de pacientes com características clínicas e laboratoriais sugestivas de SDG foi de 40% na amostra de pacientes com cardiopatias conotruncais e CIV. O presente estudo destaca a importância de critérios clínicos para a triagem de casos suspeitos de SDG, possibilitando a confirmação precoce do diagnóstico.
Title in English
Clinical and laboratory aspects suggestive of DiGeorge syndrome in patients with conotruncal congenital heart disease and VSD
Keywords in English
Chromosome deletion
Congenital heart disease
DiGeorge syndrome
Primary immunodeficiency diseases
Abstract in English
DiGeorge Syndrome (GDS) is considered one of the most frequent genetic microdeletion syndromes, affecting approximately 1 in 4,000 or 6,000 individuals and equally affecting both sexes. It results from abnormal migration of embryonic cells from the third and fourth pharyngeal pouches, leading to thymus hypoplasia or aplasia, parathyroid, thyroid, and aortic arch/cardiac outflow defects, and facial dysmorphisms. Approximately 90% of patients have a heterozygous deletion on chromosome 22q11.2. The classic triad of SDG is characterized by thymic hypoplasia, hypocalcemia, and conotruncal heart disease. However, there is wide phenotypic variability, making it difficult to suspect, making it a diagnostic challenge. Congenital heart diseases have a high incidence in patients with SDG (65 to 76%), representing the earliest manifestation in the fetal and neonatal periods. Approximately 75% of children have immunological impairment, which may manifest as recurrent infections, autoimmunity, allergy and asthma. Objective: To characterize the clinical manifestations and laboratory alterations suggestive of SDG in children with conotruncal heart diseases and interventricular communication (IVC). Methodology: Cross-sectional, observational and descriptive study. Results: Sixty patients were evaluated, of which 24 (40%) were classified as cases suggestive of SDG. The following clinical diversity was observed in the group suggestive of SDG: comorbidities (79%), immunodeficiency (79%), dysmorphism (67%), thymic alterations (50%), hypocalcemia (42%) and classic triad (17% ). Conclusion: The frequency of patients with clinical and laboratory characteristics suggestive of SDG was 40% in the sample of patients with conotruncal heart diseases and VSD. The present study highlights the importance of clinical criteria for screening cases suggestive of SDG, enabling early confirmation of the diagnosis.
 
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Publishing Date
2023-05-30
 
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