RESUMO
As the characteristics of preterm infants with retinopathy of prematurity (ROP) vary, depending on the quality of neonatal care they received, universal screening criteria for ROP are not possible. The purpose of this study was to compare ROP guidelines for those planning to develop guidelines, particularly in resource-poor settings.A systematic review was undertaken of PubMed, Embase and guidelines registers to identify national or international policy statements or guidelines in English, issued or operational in 2010-2021. Bibliographies of two publications were also reviewed. The searches identified 633, 1081 and 317 records, respectively, and 157 records were retrieved from other sources. 23 publications were included in the analysis.Most included documents defined cut-offs for screening as <32 weeks gestational age (GA) or ≤1500g birth weight (BW). The highest values were in the Philippines (<35 weeks GA; <2000g) and India (≤34 weeks GA; <2000g). The lowest were in high-income countries, i.e. the United States of America (≤32 weeks for GA) and New Zealand (<1250g for BW). Most guidelines included additional risk factors to consider. The most frequent indication for when screening should start was a combination of GA and chronological age. All but one document defined when screening could stop. There was general consensus on the indications, timing and methods of treatment. Indications for anti-VEGF therapy varied between countries.Guidelines were identified for a limited number of countries with none from low-income settings. Variation in the indications for screening reflects the varying exposure to risk factors in different settings.
RESUMO
Atypical hemolytic-uremic syndrome (aHUS) results from excessive, uncontrolled activation of the alternative pathway of the complement system. It is important to distinguish aHUS from other thrombotic microangiopathies. The aim of this paper is to discuss the complexity and relevance of the genetic background of aHUS patients. The review discusses the genetic variants that are important for diagnosis, treatment and prognosis of patients, which is inevitably important for the qualification of patients for treatment with eculizumab. These variants are not only found in the genes involved in the control of complement system but are also related to the coagulation system. The paper emphasizes the diagnostic difficulties resulting from the extremely diverse genetic background of the patients. It is important to conduct further genetic studies of aHUS patients, also paying attention to genes unrelated to the complement system. The paper contains information on the role of genetic predisposition in tailoring the risk for aHUS and determining its clinical outcome, including qualification for eculizumab therapy.
