Galactosaemia in a Brazilian population: high incidence and cost-benefit analysis.

OBJECTIVES: To study the incidence of galactosaemia in the state of São Paulo and the benefit/cost (B/C) ratio of the introduction of neonatal screening for galactosaemia, comparing it with a selective approach. METHODS: An enzymatic-colorimetric assay was used for the screening of total galactose (TG) in a sample of 10% of the births in São Paulo in one year and positive cases were confirmed by the activity of galactose-1-phosphate uridyltransferase (GALT). Detected and referred cases were genotyped using enzyme restriction studies for Q188R, N314D and S135L mutations of the GALT gene. The economic analysis was determined by calculating the B/C ratio and by analysis of sensitivity as a function of the incidence of the disease detected and the variation of the interest rate in the economy. RESULTS: 59 953 newborns were screened for TG, with 3 cases of galactosaemia being identified (0.26% false positives), corresponding to a frequency of 1:19 984 liveborns (95% confidence interval: 1:7494 to 1:59 953). One classical case and one Duarte 2 variant referred to as a selective approach were confirmed. With an incidence of 1:19 984, the B/C ratio was 1.04 for the 11.75% interest rate in effect in Brazil, with values already decapitalized. With a maximum possible incidence of 1:7494, the B/C ratio was 2.79. DISCUSSION: There is an economic advantage in introducing neonatal screening for galactosaemia in the national neonatal screening programme. This advantage could increase with a reduction of the current interest rates in the economy.

[Screening for congenital hypothyroidism, phenylketonuria, galactosemia and biotinidase deficiency in a sample of mentally retarded patients in the city of Havana]. / Cribado de hipotiroidismo congénito, fenilcetonuria, galactosemia y deficiencia de biotinidasa en una muestra de retrasados mentales de Ciudad de La Habana.

INTRODUCTION: Congenital hypothyroidism (CH), phenylketonuria (PKU), galactosemia (GAL) and biotinidase deficiency (BD) are innate errors in metabolism that share varying degrees of mental retardation (MR) as a common characteristic. AIMS. The aim of our study was to screen individuals with MR of unknown origin for CH, PKU, GAL and BD. PATIENTS AND METHODS: Venous blood samples were collected on SS 903 specimen collection paper from 55 individuals with MR of unspecific origin born within the period 1977 1997. CH diagnosis was performed through determination of total thyroxine (T4) and thyroid stimulating hormone (TSH), using the UMELISA T4 and neonatal TSH reagent kits, respectively, and the detection of PKU, GAL and BD was conducted by determining phenylalanine (Phe), total galactose (Gal) and biotinidase enzyme activity (Biot) using UMTEST PKU, GAL and BIOTINIDASA. RESULTS: The mean values obtained for the analytes that were evaluated were: 0.8 mUI of TSH/L of total blood (EEM: 0.2), 113.1 nmol of T4/L of serum (EEM: 5.4), 67.7 mol of Phe/L of total blood (EEM: 0.1), 0.1 mmol of Gal/L of total blood (EEM: 0.01), and Biot activity was normal in all cases. CONCLUSIONS: This study enabled us to determine the T4, TSH, Phe and Gal levels in a sample from the Cuban population with MR of unknown causation. In addition, slightly higher levels of T4 were found in children who had hyperkinesis

Galactosemia: presentación de un caso clínico, revisión y actualización / Galactosemia: report of a clinical case, review and updating

Presentamos un caso de galactosemia en un recién nacido de pretérmino, treinta y seis semanas de edad gestacional por examen físico, que a partir del tercer día de vida comienza con sintomatología (Ictericia), recibiendo alimentación desde su ingreso con fórmula de inicio y posteriormente al pecho; hasta el 6º día de vida que debe ser ingresado en UTI en delicado estado clínico. Realizado el diagnóstico tras completar los estudios, con indicación de fórmula libre de lactosa egresa del hospital a los 33 días de vida, continuando su seguimiento por consultorio e

Galactosemia: presentación de un caso clínico, revisión y actualización / Galactosemia: report of a clinical case, review and updating

Presentamos un caso de galactosemia en un recién nacido de pretérmino, treinta y seis semanas de edad gestacional por examen físico, que a partir del tercer día de vida comienza con sintomatología (Ictericia), recibiendo alimentación desde su ingreso con fórmula de inicio y posteriormente al pecho; hasta el 6§ día de vida que debe ser ingresado en UTI en delicado estado clínico. Realizado el diagnóstico tras completar los estudios, con indicación de fórmula libre de lactosa egresa del hospital a los 33 días de vida, continuando su seguimiento por consultorio externo de clínica pediátrica y seguimiento de especialistas en metabolopatías.

[Identification of inborn errors of galactose metabolism in patients with cataracts]. / Identificación de errores innatos del metabolismo de la galactosa en pacientes con cataratas.

133 patients with congenital or idiopathic cataracts were studied (94 patients had ages between 1 month and 14 years; 10 patients had ages between 16 and 50 years and 29 patients did not have an age registry) along with 18 patients with a clinical diagnosis of classic galactosemia. The activity of galactokinase (GALAK) and that of erythrocyte galactose-1-phosphate uridyl transferase (GALT) was measured. There were no individuals with a total deficiency of GALK or GALT. The cataract patients of ages between 1 monthly and 14 years, 3 (3.19%) and 4 (4.25%) showed GALK and GALT levels in the range corresponding to the respective heterozygotes. As compared with the expected incidence of heterozygotes in the general population (0.2% for GALK and 0.8% for GALT) we found a significant rise of individuals with low levels of enzymes for the metabolism of galactose. The possibility that heterozygote galactosemic states contribute a risk factor in the development of cataracts and its therapeutic implications are discussed.