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Chronic foetal hypoxaemia does not cause elevation of serum markers of brain injury
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- Camilla Omann, Kendall M. Lawrence, Mallory L. Hunt, James K. Moon, Jamuna Buchanan, Daniel J. Licht, Richard F. Ittenbach, Patrick McGovern, Jonathan M. Chen, Marcus Davey, Vibeke E. Hjortdal, Alan W. Flake, J. William Gaynor
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- Journal:
- Cardiology in the Young / Volume 32 / Issue 5 / May 2022
- Published online by Cambridge University Press:
- 09 August 2021, pp. 732-737
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Objectives:
The objective of this study was to investigate changes in serum biomarkers of acute brain injury, including white matter and astrocyte injury during chronic foetal hypoxaemia. We have previously shown histopathological changes in myelination and neuronal density in fetuses with chronic foetal hypoxaemia at a level consistent with CHD.
Methods:Mid-gestation foetal sheep (110 ± 3 days gestation) were cannulated and attached to a pumpless, low-resistance oxygenator circuit, and incubated in a sterile fluid environment mimicking the intrauterine environment. Fetuses were maintained with an oxygen delivery of 20–25 ml/kg/min (normoxemia) or 14–16 ml/kg/min (hypoxaemia). Myelin Basic Protein and Glial Fibrillary Acidic Protein serum levels in the two groups were assessed by ELISA at baseline and at 7, 14, and 21 days of support.
Results:Based on overlapping 95% confidence intervals, there were no statistically significant differences in either Myelin Basic Protein or Glial Fibrillary Acidic Protein serum levels between the normoxemic and hypoxemic groups, at any time point. No statistically significant correlations were observed between oxygen delivery and levels of Myelin Basic Protein and Glial Fibrillary Acidic Protein.
Conclusion:Chronic foetal hypoxaemia during mid-gestation is not associated with elevated serum levels of acute white matter (Myelin Basic Protein) or astrocyte injury (Glial Fibrillary Acidic Protein), in this model. In conjunction with our previously reported findings, our data support the hypothesis that the brain dysmaturity with impaired myelination found in fetuses with chronic hypoxaemia is caused by disruption of normal developmental pathways rather than by direct cellular injury.
Medical comorbidities of patients presenting to an adult neurodevelopmental new case clinic in Singapore
- Ho Teck Tan, James Patrick Moon, Giles Ming Yee Tan
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S295
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Aims
To describe the occurrence of medical comorbity in patients with neurodevelopmental disorders presenting to the Adult Neurodevelopmental Service (ANDS) multi-disciplinary new case clinic at the Institute of Mental Health (IMH) in Singapore. We hypothesize that patients with neurodevelopmental disorders have higher rates of medical comorbidity compared to those without a diagnosis of neurodevelopmental disorder.
BackgroundMedical comorbidities are common in patients with neurodevelopmental disorders. They may have difficulties managing their medical conditions which could in turn affect their well being, quality of life and life expectancy.
MethodA retrospective cohort study was conducted amongst patients who presented to the clinic from January 2015 to December 2016. The electronic case records of the assessments were de-identified and the medical conditions of patients were collected and analysed.
Result319 patients attended the ANDS new case clinic in the 2-year study period. 87.1% (278/319) were diagnosed with a neurodevelopmental disorder while 12.9% (41/319) did not receive any diagnosis of a neurodevelopmental disorder.
58.3% (162/278) of patients with a neurodevelopmental disorder had at least 1 medical comorbidity while only 31.7% (13/41) of patients with no neurodevelopmental disorder had at least 1 medical condition.
Patients with neurodevelopmental disorders had higher rates of epilepsy (12.2% vs 4.9%), cerebral palsy (3.2% vs 0%) but lower rates of having other neurological conditions (1.4% vs 7.3%) compared to those with no neurodevelopmental disorders.
Patients with neurodevelopmental disorders had higher rates of diabetes (6.1% vs 2.4%), hypertension (6.1% vs 2.4%), hyperlipidaemia (7.1% vs 2.4%) and cardiovascular conditions (2.9% vs 0%) than those without a neurodevelopmental disorder.
In terms of other medical comorbidities, patients with neurodevelopmental disorders had higher rates of thyroid abnormalities (4.7% vs 2.4%), respiratory problems (7.6% vs 2.4%), musculoskeletal conditions (5.8% vs 0%), eye issues (5% vs 2.4%) and hearing problems (2.9% vs 0%) but similar rates of dermatological conditions (10.1% vs 9.8%) and gastrointestinal conditions (4.7% vs 4.9%) compared to those with no neurodevelopmental disorders.
ConclusionPatients with neurodevelopmental disorders have significantly highly rates of medical comorbidity than those without any neurodevelopmental disorders. This study highlights the need to raise awareness of the common medical comorbidities in patients with neurodevelopmental disorders and to ensure adequate screening and referral for follow-up medical care for them.
Contributors
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- By Alaa A. Abd-Elsayed, Basem Abdelmalak, Kalil G. Abdullah, Maged Argalious, Rafi Avitsian, Maria Bauer, Edward C. Benzel, Dani S. Bidros, William Bingaman, Jay B. Brodsky, David Brown, Patrick M. Callahan, Juan P. Cata, Chakorn Chansakul, Jianguo Cheng, Jeffrey G. Clark, Peter J. Davis, Stacie Deiner, Xiao Di, Karen B. Domino, D. John Doyle, Zeyd Ebrahim, Ehab Farag, Gordon Finlayson, Elizabeth A. M. Frost, Matthew Grosso, David P. Gurd, Rodolfo Hakim, Robert Helfand, Iain H. Kalfas, Rami Karroum, Michael Kelly, Stephen J. Kimatian, Christian Koopman, Ajit A. Krishnaney, Andrea Kurz, Lorri A. Lee, Brian P. Lemkuil, James K. C. Liu, Sara P. Lozano, Daniel Lubelski, Mark Luciano, Ramez Malaty, Mariel R. Manlapaz, Edward M. Manno, Virgilio Matheus, Robert F. McLain, Nagy Mekhail, Doksu Moon, Loran Soliman Mounir, Raghu Mudumbai, Thomas E. Mroz, Dileep R. Nair, Julie Niezgoda, R. Douglas Orr, Piyush M. Patel, Jason E. Pope, Manuel Saavedra, Kenneth J. Saliba, Richard Schlenk, John Seif, John H. Shin, Jeffrey Silverstein, Dmitri Souzdalnitski, Michael Steinmetz, Tunga Suresh, John E. Tetzlaff, Sherif Zaky
- Edited by Ehab Farag
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- Book:
- Anesthesia for Spine Surgery
- Published online:
- 05 June 2012
- Print publication:
- 17 May 2012, pp ix-xii
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