Congenital disorders

先天性疾病
  • 文章类型: Systematic Review
    背景与目的:戈谢病(GD)是一种常染色体隐性遗传传递的溶酶体贮积症。骨受累是戈谢病的普遍发现。它会导致畸形并限制日常活动和生活质量。在75%的患者中,有骨头受累。这篇综述旨在通过锥形束计算机断层扫描(CBTC)和X射线矫形器造影术评估颌骨的主要发现;材料和方法:PubMed,WebofScience,对丁香花和Scopus进行了系统搜索,直到2022年12月31日。此外,使用选定文章的参考书目和Google学者搜索进行了手动搜索。选择的临床研究考虑了一组受GD影响的患者的X线摄影中的主要X线摄影结果。结果:在5079篇论文中,纳入四项研究。主要发现是广义稀疏和扩大的狭窄空间,牙齿缺失症.结论:骨表现的确切机制可能是由于骨髓中Gaucher细胞的浸润,因此,骨骼结构的破坏。所有长骨都是骨骼表现的潜在手段。颌骨比上颌骨受影响更大,主要特征是皮质变薄,骨硬化,假性囊肿病变,精神脱矿,在髁的头部变平,解剖结构的消失,上颌窦粘膜增厚。牙医在诊断和治疗这些患者中起着至关重要的作用。有时可以通过简单的全景X光片进行诊断。所有的长骨都受到影响,尤其是下颌骨。
    Background and Objectives: Gaucher disease (GD) is a lysosomal storage disorder with the genetic autosomal recessive transmission. Bone involvement is a prevalent finding in Gaucher disease. It causes deformity and limits daily activities and the quality of life. In 75% of patients, there is bone involvement. This review aims to evaluate the principal findings in the jaw by a Cone-beam computed tomography (CBTC) and X-ray orthopantomography; Materials and Methods: PubMed, Web of Science, Lilacs and Scopus were systematically searched until 31 December 2022. In addition, a manual search was performed using the bibliography of selected articles and a Google Scholar search. Clinical studies were selected that considered principal radiographic findings in radiography in a group of patients affected by GD. Results: Out of 5079 papers, four studies were included. The main findings are generalized rarefaction and enlarged narrow space, anodontia. Conclusions: The exact mechanism of bone manifestation is probably due to the infiltration of Gaucher cells in the bone marrow and, consequently, the destruction of bone architecture. All long bones are a potential means of skeletal manifestation. The jaw is more affected than the maxilla, and the principal features are cortical thinning, osteosclerosis, pseudocystic lesions, mental demineralization, flattening in the head of the condyle, effacement of anatomical structures, thickening of maxillary sinus mucosa. The dentist plays a crucial role in diagnosing and treating these patients. Sometimes the diagnosis can be made by a simple panoramic radiograph. All long bones are affected, and the mandible is particularly involved.
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  • 文章类型: Journal Article
    出生缺陷,也被称为先天性疾病,是一个重大的健康问题,每年影响全球至少500万新生儿。对于决策者来说,要采取相关的医疗保健对策来照顾受影响的人,这些疾病的负担必须量化。出生缺陷对5岁以下儿童死亡率和发病率的贡献的估计是由全球几个群体得出的。这些估计往往不同,给决策者带来困惑。虽然一些差异可能归因于使用的数据源和方法,很大程度上是由于被归类为“先天性”的疾病组的术语缺乏明确性。这项研究旨在深入了解出生缺陷的术语和定义的多样性,包括相关国际/国家组织和同行评审文献中常规使用的那些。这项由两部分组成的研究包括(1)对同行评审的文献进行范围审查,以确定用于出生缺陷的术语和定义,以及(2)对关键网站和灰色文献进行审查,以确定使用的术语和定义。这项研究的结果表明,使用了各种各样的术语,通常可以互换和未定义,在同行评审的出版物中,在机构网站和相关文献上。这表明缺乏与术语相关的清晰度,并为进一步讨论奠定了基础。建议从事出生缺陷工作的实践社区就全球吸收和实施的标准术语和定义达成共识。这种标准化将有助于在全球范围内共同理解这些疾病的负担,区域和国家内部,以便采取行动支持受影响的儿童及其家庭。
    Birth defects, also known as congenital disorders, are a significant health issue impacting at least five million births annually worldwide. For policymakers to mount a relevant healthcare response to care for those affected, the burden of disease of these conditions must be quantified. Estimates of the contribution of birth defects to under-5 child mortality and morbidity are generated by several groups globally. These estimates often differ, causing confusion for policymakers. While some differences may be attributed to the data sources and methods used, much is due to a lack of clarity in the terminology used for the group of disorders classed as \"congenital\". This study aimed to gain insight into the diversity of terms and definitions for birth defects, including those used routinely by relevant international/national organisations and in the peer-reviewed literature. This two-part study included (1) scoping review of peer-reviewed literature to identify terms and definitions in use for birth defects and (2) review of key websites and grey literature to identify terms and definitions used. The results of this study indicate a wide variety of terms being used, often interchangeably and undefined, in peer-reviewed publications, on institutional websites and related literature. This suggests a lack of clarity related to terminology and sets the scene for further discussion, recommending that the community of practice working on birth defects comes to a consensus on standard terminology and definitions for global uptake and implementation. Such standardisation will facilitate a common understanding of the burden of these disorders globally, regionally and within countries so that action can be taken to support affected children and their families.
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  • 文章类型: Case Reports
    一名50多岁患有特纳综合征的妇女被转诊到内分泌诊所,在COVID-19大流行期间,她一直不知道自己的诊断,直到她收到英国政府的屏蔽信。尽管在她的全科医生记录中诊断为特纳综合征,并且尽管接受了18岁的青春期缺失和原发性闭经的腹腔镜检查,她之前没有接受过任何激素治疗或心血管筛查.虽然特纳综合症很罕见,英国生物银行的最新数据表明,它可能被诊断不足。临床医生应了解特纳综合征的临床特征和相关并发症,以避免延误诊断和错过治疗机会。在这份报告中,我们讨论了这种罕见综合征的临床特征以及目前的筛查和治疗指南.我们强调通过患者主导的团体进行点对点支持和信息共享的重要性,比如特纳综合症支持协会。
    A woman in her 50s with Turner syndrome was referred to the endocrine clinic, having been unaware of her diagnosis until she received a shielding letter from the UK government during the COVID-19 pandemic. Despite a neonatal diagnosis of Turner syndrome on her general practitioner record and despite having undergone laparoscopic examination for absent puberty and primary amenorrhoea aged 18 years, she had not received any prior hormone treatment or cardiovascular screening.Though Turner syndrome is rare, recent data from the UK Biobank suggest that it may be underdiagnosed. Clinicians should be aware of the clinical features and associated complications of Turner syndrome to avoid delayed diagnosis and missed opportunities for treatment.In this report, we discuss the clinical features of this rare syndrome and current guidelines for screening and treatment. We stress the importance of peer-to-peer support and information sharing through patient-led groups, such as the Turner Syndrome Support Society.
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  • 文章类型: Journal Article
    这项荟萃分析的目的是确定母体暴露于他汀类药物是否与主要先天性畸形和其他不良妊娠结局的发生率增加有关。
    PubMed/Medline,搜索了WebofScience和Reprotox®数据库。包括产前暴露于他汀类药物的队列和病例对照研究。
    对5项队列研究和1项病例对照研究的分析表明,当暴露组与对照组相比时,主要先天性畸形的发生率没有显着增加([OR1.27;95%CI0.80-2.04],[aOR1.05;95%CI0.84-1.31])。在他汀类药物暴露组中,当合并未调整的OR时,心脏缺陷风险显着增加(OR2.47;95%CI1.36-4.49)。使用校正OR对相同结果进行的进一步分析显示,与对照组相比,他汀类药物暴露组的心脏缺陷风险没有显着增加(aOR1.24;95%CI0.93-1.66)。在他汀类药物暴露组中,活产率显着降低(OR0.60,95%CI0.49-0.75)和自然流产率更高(OR1.36;95%Cl1.06-1.75)。
    妊娠他汀类药物暴露与重大先天性畸形风险的显著增加无关。心脏缺陷和其他不良妊娠结局,除了自然流产和活产率,这可能与孕产妇合并症和其他未经调整的危险因素有关。需要针对特定他汀类药物进行进一步研究,以得出更明确的结论。
    The objective of this meta-analysis was to determine whether maternal exposure to statins is associated with increased rates of major congenital malformations and other adverse pregnancy outcomes.
    PubMed/Medline, Web of Science and Reprotox® databases were searched. Cohort and case control studies with prenatal exposure to statins were included.
    Analysis of five cohort studies and one case-control study showed no significant increase in rate of major congenital malformations when the exposed group was compared with the control ([OR 1.27; 95% CI 0.80-2.04], [aOR 1.05; 95% CI 0.84-1.31]). A significant increase in heart defect risk was detected in the statin-exposed group when unadjusted ORs were combined (OR 2.47; 95% CI 1.36-4.49). Further analysis of the same outcome by using adjusted ORs showed no significant increase in heart defect risk in the statin-exposed group compared with the controls (aOR 1.24; 95% CI 0.93-1.66). A significantly lower live birth rate (OR 0.60, 95% CI 0.49-0.75) and a higher spontaneous abortion rate (OR 1.36; 95% Cl 1.06-1.75) were detected in the statin-exposed group.
    Gestational statin exposure was not associated with a significant increase in risk of major congenital malformations, heart defects and other adverse pregnancy outcomes, except spontaneous abortion and live birth rate, which may be associated with maternal comorbidity and other unadjusted risk factors. Further research focusing on particular statins is needed to draw more definitive conclusions.
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  • 文章类型: Journal Article
    越来越多的人关注远程认知干预的实施,它允许在日常环境中进行练习,有利于康复的连续性。本研究概述了患有先天性脑畸形或影响中枢神经系统的遗传综合征的儿童的远程认知训练计划,包括在2011-2021年期间发表的论文中。共发现并讨论了13条记录,包括疗效研究,可行性研究和研究协议。许多研究都集中在特定的诊断上,比如脑瘫,唐氏综合症,脆性X综合征,虽然没有或几乎没有证据表明更罕见的疾病或大脑畸形。发现干预措施对某些认知功能产生益处,但是强调了依从性的问题,特别是由于训练或临床合并症带来的过度认知负荷。由于训练中的异质性,结论仍是暂时的,研究和患者特征,和研究方法的局限性。
    Increased attention is arising on the delivery of remote cognitive interventions, which allow performing exercises in everyday settings, favouring rehabilitation continuity. The present study offers an overview of remote cognitive training programs for children with congenital brain malformation or genetic syndrome affecting the central nervous system, included in papers published in the time period 2011-2021. A total of 13 records was found and discussed including efficacy studies, feasibility studies and study protocols. Many studies have focused on a specific diagnosis, such as cerebral palsy, Down Syndrome, Fragile X Syndrome, while no or little evidence has been gathered on more rare diseases or brain malformations. Interventions were found to generate benefits on some cognitive functions, but problems with adherence were highlighted, especially due to excessive cognitive load from the training or clinical comorbidities. Conclusions remain tentative due to heterogeneity in training, study and patients characteristics, and methodological limitations of studies.
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  • 文章类型: Case Reports
    继发于运动障碍或胃食管反流病(GERD)的食管憩室在成人中很常见,但真正的先天性食管憩室在婴儿和儿童中很少见。我们介绍了一个蹒跚学步的男孩,该男孩从6个月大开始尝试断奶后进食后出现吞咽困难和呕吐。钡食管造影显示胸腔内食道上部三分之一处存在憩室。这名儿童在其他地方接受了多次干预,没有进行明确的手术,这凸显了这种情况的罕见性。我们进行了开胸手术和修复,结果令人满意。对这种罕见疾病的临床表现和处理的文献进行了综述,强调类似的报告病例。
    Oesophageal diverticulum occurring secondary to motility disorders or gastro-oesophageal reflux disease (GERD) is common in adults but true congenital oesophageal diverticula are rare in infants and children. We present a case of a toddler boy who presented with dysphagia and vomiting after feeds after weaning was attempted starting at 6 months of age. Barium esophagogram revealed a diverticulum in the upper one-third of the oesophagus within the thoracic cavity. The child underwent multiple interventions elsewhere without definitive surgery that highlights the rarity of this condition. Thoracotomy and repair were performed by us with a satisfactory outcome. The review of the literature on the clinical presentation and management of this rare condition has been discussed, highlighting similar reported cases.
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  • 文章类型: Case Reports
    声带网是由于再通失败而发生的声带之间的异常软组织粘连。先天性声门网占喉部异常的5%。科恩根据气道闭塞的百分比将声门网分为四种类型。严重声门网III级和IV级患者出现呼吸窘迫,stridor,需要紧急干预的语音困难或反复呼吸道感染。我们正在介绍我们在管理两名患有严重先天性声门网的此类患者方面的经验。在麻醉监测下通过纤维喉镜检查证实了诊断。内镜下网状切除术与喉裂入路联合置入龙骨支架。在我们的两个病人身上,我们使用硅胶龙骨进行喉支架置入,以提供强度并防止重新织带。随访期间,两名患者均被发现有足够的发声和正常的气道,因此证明该方法是足够的发声和气道结局的安全选择.
    Glottic web is an abnormal soft tissue adhesion between the vocal cords which occurs due to failure of recanalisation. Congenital glottic webs comprises 5% of laryngeal anomalies. Cohen classified glottic webs into four types based on percentage of airway obliteration. Patients with severe glottic web-grade III and grade IV present with respiratory distress, stridor, phonatory difficulties or recurrent respiratory infections warranting urgent intervention. We are presenting our experience in managing two such patients with severe congenital glottic web. Diagnosis was confirmed by fibreoptic laryngoscopy under monitored anaesthetic care. Combined endoscopic excision of web with laryngofissure approach for keel stenting. In both our patients, we have used a silicone based keel for laryngeal stenting to provide strength and prevent re-webbing. During follow-up, both patients were found to have adequate phonation and normal airway thus demonstrating this method as safe option for adequate phonatory and airway outcomes.
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  • 文章类型: Case Reports
    对一名12岁女孩因Chiari1.5畸形(CM)引起的全脊髓空洞症进行了4年的3TMRI连续成像。系列MRI显示注射器的尺寸减小,没有任何手术干预或CM改善,而是由于自发性脊髓撕裂.通过胸上水平的syrinx和蛛网膜下腔之间的撕裂处的血流信号的证据清楚地证明了撕裂。泪液在随访时表现为自发闭合。成人中的髓质撕裂已被描述为自发性脊髓空洞症减少的推定原因之一,但在儿科人群中尚未报道现代高分辨率MRI的清晰演示。此外,这是首例报道的儿科患者由于自发性裂隙而导致的syrinx减少病例.
    A holocord syringomyelia due to Chiari 1.5 malformation (CM) in a 12-year-old girl was serially imaged with 3 T MRI over 4 years. The serial MRI showed reduction in size of the syrinx, without any surgical intervention or CM improvement, but rather due to spontaneous spinal cord tear. The tear was clearly demonstrated by evidence of flow signal across the tear between syrinx and subarachnoid space at the upper thoracic level. The tear showed spontaneous closure at follow-up. A medullary tear has been described in the adult population as one of the putative causes of spontaneous syringomyelia reduction, but its clear demonstration with modern high-resolution MRI has not been reported in the paediatric population. Moreover, this is the first reported case of syrinx reduction due to spontaneous fissuration in a paediatric patient.
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  • 文章类型: Journal Article
    尼日利亚有大量的先天性疾病(CD)。例如,在尼日利亚出生的每100名儿童中有2名患有镰状细胞疾病(SCD)。使尼日利亚成为SCD发病率最高的国家。本文回顾了CD在尼日利亚的流行情况;重点是那些对该国造成沉重统计负担的人,尼日利亚社区遗传学服务的可用性以及为应对CD挑战所做的努力。通过文献检索对尼日利亚先天性畸形(CM)的出生患病率进行了系统评价,发布日期没有时间限制。仅包括包括CM出生患病率的研究。排除具有不正确或缺失数据的合格研究。这表明尼日利亚缺乏CD数据,就像大多数低收入和中等收入国家一样。在尼日利亚发现肌肉骨骼和胃肠道系统的CM占主导地位。然而,南南地区的CM模式更多是中枢神经系统。在政府援助不足的情况下,尼日利亚应对裁谈会挑战的资源匮乏。同时,通过实施良好的社区遗传学服务,可以预防和充分管理70%的CD。
    Nigeria has a large number of congenital disorders (CD). For instance, two out of every hundred children born in Nigeria have sickle cell disorders (SCD). Making Nigeria the country with the highest incidence of SCD. This article reviews the prevalence of CD in Nigeria; with emphasis on those having a heavy statistical burden on the country, the availability of community genetics services in Nigeria and the efforts being made to tackle the challenges of CD. A systematic review of birth prevalence of congenital malformations (CM) in Nigeria was done through a literature search, with no time restriction for publication dates. Only studies that included the birth prevalence of CM were included. Eligible studies with incorrect or missing data were excluded. This revealed a dearth of data on CD in Nigeria, as in most Low- and Middle-Income Countries. A predominance of CM of the musculoskeletal and gastrointestinal systems was found in Nigeria. However, the pattern of CM in the South-South region was more of the central nervous system. There is scarcity of resources to address the challenges of CD in Nigeria with feeble government assistance. Meanwhile, 70% of CD can be prevented and adequately managed by well implemented community genetics services.
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  • 文章类型: Case Reports
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