Rapid Weight Gain Research Articles

Rapid refeeding in anorexia nervosa: A dialectic balance.

ObjectiveTo examine the impact of our new rapid refeeding protocol on patients with anorexia nervosa (AN) in our Eating Disorders Program. We hypothesize that the new protocol would lead to a more rapid weight gain and a shorter length of stay, with no effect on medical complications or program completion.MethodThis cohort design included consecutive inpatients and day hospital patients admitted to the program with a BMI <18 kg/m2 and a diagnosis of AN between 2007 and 2020; N = 326 patients. Main outcomes measured were rate of weight gain and length of stay. Safety indicators included electrolyte disturbances and supplementation required, complications including refeeding syndrome and completion of the program. A p value <.05 was considered statistically significant.ResultsTotal length of stay was 21 days shorter for patients on the rapid refeeding protocol compared to the traditional refeeding protocol. Patients on the new protocol gained 0.21 more kg/week compared to patients on the old protocol. There was no difference in completion rates between programs. Electrolyte imbalances were mild to moderate and easily treated with oral electrolyte supplementation. There were no deaths or cases of refeeding syndrome with either protocol.DiscussionThis is the first Canadian study to assess the effectiveness and safety of rapid refeeding in an adult population. Rapid refeeding protocols can be safely administered and are cost effective. Shorter hospital admissions are desirable to minimize possible regression and dependency on inpatient services and positively impacts patients' quality of life.Public SignificanceThis study advances the idea that rapid refeeding in patients with anorexia nervosa can be administered safely and effectively with close medical monitoring. In addition, rapid refeeding leads to shorter hospital stays, with a cost‐savings to the health system. Shorter admissions are desirable to minimize possible regression and dependency on inpatient services and also positively impacts patients' quality of life.

The Epidemiology and Mechanisms of Lifetime Cardiopulmonary Morbidities Associated With Pre-Pregnancy Obesity and Excessive Gestational Weight Gain.

Obesity has reached pandemic proportions in the last few decades. The global increase in obesity has contributed to an increase in the number of pregnant women with pre-pregnancy obesity or with excessive gestational weight gain. Obesity during pregnancy is associated with higher incidence of maternal co-morbidities such as gestational diabetes and hypertension. Both obesity during pregnancy and its associated complications are not only associated with immediate adverse outcomes for the mother and their newborns during the perinatal period but, more importantly, are linked with long-term morbidities in the offsprings. Neonates born to women with obesity are at higher risk for cardiac complications including cardiac malformations, and non-structural cardiac issues such as changes in the microvasculature, e.g., elevated systolic blood pressure, and overt systemic hypertension. Pulmonary diseases associated with maternal obesity include respiratory distress syndrome, asthma during childhood and adolescence, and adulthood diseases, such as chronic obstructive pulmonary disease. Sequelae of short-term complications compound long-term outcomes such as long-term obesity, hypertension later in life, and metabolic complications including insulin resistance and dyslipidemia. Multiple mechanisms have been proposed to explain these adverse outcomes and are related to the emerging knowledge of pathophysiology of obesity in adults. The best investigated ones include the role of obesity-mediated metabolic alterations and systemic inflammation. There is emerging evidence linking metabolic and immune derangements to altered biome, and alteration in epigenetics as one of the intermediary mechanisms underlying the adverse outcomes. These are initiated as part of fetal adaptation to obesity during pregnancy which are compounded by rapid weight gain during infancy and early childhood, a known complication of obesity during pregnancy. This newer evidence points toward the role of specific nutrients and changes in biome that may potentially modify the adverse outcomes observed in the offsprings of women with obesity.

The Macronutrient Composition of Infant Formula Produces Differences in Gut Microbiota Maturation That Associate with Weight Gain Velocity and Weight Status.

This proof-of-principle study analyzed fecal samples from 30 infants who participated in a randomized controlled trial on the effects of the macronutrient composition of infant formula on growth and energy balance. In that study, infants randomized to be fed cow milk formula (CMF) had faster weight-gain velocity during the first 4 months and higher weight-for-length Z scores up to 11.5 months than those randomized to an isocaloric extensive protein hydrolysate formula (EHF). Here we examined associations among infant formula composition, gut microbial composition and maturation, and children’s weight status. Fecal samples collected before and monthly up to 4.5 months after randomization were analyzed by shotgun metagenomic sequencing and targeted metabolomics. The EHF group had faster maturation of gut microbiota than the CMF group, and increased alpha diversity driven by Clostridia taxa. Abundance of Ruminococcus gnavus distinguished the two groups after exclusive feeding of the assigned formula for 3 months. Abundance of Clostridia at 3–4 months negatively correlated with prior weight-gain velocity and body weight phenotypes when they became toddlers. Macronutrient differences between the formulas likely led to the observed divergence in gut microbiota composition that was associated with differences in transient rapid weight gain, a well-established predictor of childhood obesity and other comorbidities.

Associação entre ganho rápido de peso e excesso de peso em crianças de 0 a 5 anos de idade na América Latina

Abstract Objectives: to assess the prevalence of rapid weight gain (RWG) in children born with normal weight and its association with overweight (OW) in four Latin America countries. Methods: cross-sectional study in children aged 0 to 5 from the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher in Brazil and the Encuesta Nacional de Demografía y Salud in Bolivia, Colombia and Peru,using a birth weight ≥2,500g. The outcome variable was OW, the exposure was RWG and breastfeeding (BF) was the adjustment variable. Prevalence, odds ratio and 95% confidence intervalwere estimated using multivariate logistic regression model. Results: there was a greater prevalence of RWG and BF at less than 6 months in Brazil, and a greater prevalence of OW in Brazil and Bolivia. The chances of OW when RWG was present and adjusted for BF were 6.1 times (CI95% = 3.8-9.7) in Brazil, 4.4 times (CI95% = 3.6-5.3) in Bolivia, 6.7 times (CI95% = 5.5-8.2) in Colombia, and 12.2 times in Peru (CI95% = 9.4-15.7) with a p &lt; 0.001 for all countries. Conclusions: RWG in children with normal birth weight was associated with a greater chance of being OW in the four observed Latin America countries.

Characterization of rapid weight gain phenotype in children with narcolepsy.

ObjectivesTo characterize the rapid weight gain (RWG) phenotype associated with the onset of childhood narcolepsy and to determine whether it could constitute a marker of severity of the disease.MethodsRWG was defined using the BMI z‐score slope reported to one year (>0.67 SD) from symptom onset to disease diagnosis. We compared the clinical, metabolic, and sleep characteristics between patients with or without RWG at diagnosis. Pharmacological management, anthropometric, and clinical progression were also evaluated during the follow‐up.ResultsA total of 84 de novo narcoleptic pediatric patients were included; their median age at diagnosis was 12.0 years; 59.5% boys, 90.5% cataplexy, and 98.7% HLA‐DQB1*06:02, 57% had RWG profile. RWG patients were younger at diagnosis than non‐RWG patients, despite a shorter diagnostic delay. They had a higher BMI z‐score and a higher prevalence of obesity at diagnosis, but not at symptom onset, and higher adapted Epworth Sleepiness Scale and Insomnia Severity Index scores than non‐RWG patients. No differences on nocturnal polysomnography and multiple sleep latency tests were found between groups at disease diagnosis. After a median follow‐up of 5 years, RWG patients still had a higher BMI z‐score and a higher prevalence of obesity despite benefiting from the same therapeutic management and displaying improvement in sleepiness and school difficulties.ConclusionsNarcoleptic RWG patients were younger, sleepier, and the prevalence of obesity was higher at diagnosis despite a shorter diagnostic delay than that of non‐RWG patients. These patients had also a higher risk of developing a long‐term obesity, despite a positive progression of their narcoleptic symptoms. RGW could then represent a maker of a more severe phenotype of childhood narcolepsy, which should inspire a prompt and more offensive management to prevent obesity and its complications.

Yucatan Minipig Knee Meniscus Regional Biomechanics and Biochemical Structure Support its Suitability as a Large Animal Model for Translational Research.

Knee meniscus injuries are the most frequent causes of orthopedic surgical procedures in the U.S., motivating tissue engineering attempts and the need for suitable animal models. Despite extensive use in cardiovascular research and the existence of characterization data for the menisci of farm pigs, the farm pig may not be a desirable preclinical model for the meniscus due to rapid weight gain. Minipigs are conducive to in vivo experiments due to their slower growth rate than farm pigs and similarity in weight to humans. However, characterization of minipig knee menisci is lacking. The objective of this study was to extensively characterize structural and functional properties within different regions of both medial and lateral Yucatan minipig knee menisci to inform this model’s suitability as a preclinical model for meniscal therapies. Menisci measured 23.2–24.8 mm in anteroposterior length (33–40 mm for human), 7.7–11.4 mm in width (8.3–14.8 mm for human), and 6.4–8.4 mm in peripheral height (5–7 mm for human). Per wet weight, biochemical evaluation revealed 23.9–31.3% collagen (COL; 22% for human) and 1.20–2.57% glycosaminoglycans (GAG; 0.8% for human). Also, per dry weight, pyridinoline crosslinks (PYR) were 0.12–0.16% (0.12% for human) and, when normalized to collagen content, reached as high as 1.45–1.96 ng/µg. Biomechanical testing revealed circumferential Young’s modulus of 78.4–116.2 MPa (100–300 MPa for human), circumferential ultimate tensile strength (UTS) of 18.2–25.9 MPa (12–18 MPa for human), radial Young’s modulus of 2.5–10.9 MPa (10–30 MPa for human), radial UTS of 2.5–4.2 MPa (1–4 MPa for human), aggregate modulus of 157–287 kPa (100–150 kPa for human), and shear modulus of 91–147 kPa (120 kPa for human). Anisotropy indices ranged from 11.2–49.4 and 6.3–11.2 for tensile stiffness and strength (approximately 10 for human), respectively. Regional differences in mechanical and biochemical properties within the minipig medial meniscus were observed; specifically, GAG, PYR, PYR/COL, radial stiffness, and Young’s modulus anisotropy varied by region. The posterior region of the medial meniscus exhibited the lowest radial stiffness, which is also seen in humans and corresponds to the most prevalent location for meniscal lesions. Overall, similarities between minipig and human menisci support the use of minipigs for meniscus translational research.

Neonatal leptin antagonism improves metabolic programming of postnatally overnourished mice.

Alteration of the perinatal nutritional environment is an important risk factor for the development of metabolic diseases in later life. The hormone leptin plays a critical role in growth and development. Previous studies reported that postnatal overnutrition increases leptin secretion during the pre-weaning period. However, a direct link between leptin, neonatal overnutrition, and lifelong metabolic regulation has not been investigated. We used the small litter mouse model combined with neonatal leptin antagonist injections to examine whether attenuating leptin during early life improves lifelong metabolic regulation in postnatally overnourished mice. Postnatally overnourished mice displayed rapid weight gain during lactation and remained overweight as adults. These mice also showed increased adiposity and perturbations in glucose homeostasis in adulthood. Neonatal administration of a leptin antagonist normalized fat mass and insulin sensitivity in postnatally overnourished mice. These metabolic improvements were associated with enhanced sensitivity of hypothalamic neurons to leptin. Early postnatal overnutrition causes metabolic alterations that can be permanently attenuated with the administration of a leptin antagonist during a restricted developmental window.

Glutaredoxin 1 controls monocyte reprogramming during nutrient stress and protects mice against obesity and atherosclerosis in a sex-specific manner

High-calorie diet-induced nutrient stress promotes thiol oxidative stress and the reprogramming of blood monocytes, giving rise to dysregulated, obesogenic, proatherogenic monocyte-derived macrophages. We report that in chow-fed, reproductively senescent female mice but not in age-matched male mice, deficiency in the thiol transferase glutaredoxin 1 (Grx1) promotes dysregulated macrophage phenotypes as well as rapid weight gain and atherogenesis. Grx1 deficiency derepresses distinct expression patterns of reactive oxygen species and reactive nitrogen species generators in male versus female macrophages, poising female but not male macrophages for increased peroxynitrate production. Hematopoietic Grx1 deficiency recapitulates this sexual dimorphism in high-calorie diet-fed LDLR-/- mice, whereas macrophage-restricted overexpression of Grx1 eliminates the sex differences unmasked by high-calorie diet-feeding and protects both males and females against atherogenesis. We conclude that loss of monocytic Grx1 activity disrupts the immunometabolic balance in mice and derepresses sexually dimorphic oxidative stress responses in macrophages. This mechanism may contribute to the sex differences reported in cardiovascular disease and obesity in humans.

The psychological journey of weight gain in psychosis.

BackgroundRapid weight gain is common with antipsychotic medication. Lost confidence, low mood and medication non‐adherence often follow. Yet, the dynamic interactions between the physical and psychological consequences of weight gain, and implications for intervention, are unknown.ObjectivesWe examined first‐person accounts of weight gain to identify preferences for weight change interventions.DesignA qualitative design was used to explore patients’ experiences of weight change in the context of psychosis.MethodSemi‐structured interviews, analysed using grounded theory, were conducted with 10 patients with psychosis. Sample validation was conducted with peer researchers with lived experience of psychosis.ResultsPatients described that initially the extent and speed of weight gain was overshadowed by psychotic experiences and their treatment. This led to a shocking realisation of weight gain. The psychological impact of weight gain, most strikingly on the self‐concept, was profound. Loss of self‐worth and changed appearance amplified a sense of vulnerability. There were further consequences on mood, activity and psychotic experiences, such as voices commenting on appearance, that were additional obstacles in the challenging process of weight loss. Sedative effects of medication also contributed. Unsuccessful weight loss left little hope and few preferences for interventions. Early information about common weight gain trajectories and working with experts‐by‐experience were valued. Rebuilding self‐confidence, efficacy and worth may be a necessary first step.ConclusionsThe journey of weight gain in patients with psychosis is characterised by loss of self‐worth, agency and hope. There are multiple stages in the journey, each with different psychological reactions, that may need different treatment responses.

Rapid weight gain predicts fight success in mixed martial arts – evidence from 1,400 weigh-ins

ABSTRACT We aimed to analyze whether rapid weight gain (RWG) between the official weigh-in and the time of the fight was associated with fight success in MMA. A total of 700 professional MMA fights involving 1,400 weigh-ins from 21 MMA promotions regulated by the California State Athletic Commission were analyzed. Multilevel logistic regression accounting for individual (i.e. athlete) and cluster levels (i.e. fights) was used to analyze the association of all measures with a theoretical relationship with the dependent variable and without interdependency with one another (i.e. %RWG, sex, body mass division, competition level) with the fight outcome (i.e. win or loss). The odds ratios (OR) with 95% confidence intervals (95%CI) were calculated. The highest mean %RWG was found for the flyweight, bantamweight, featherweight, and lightweight divisions. The %RWG significantly predicted the fight outcome (ß = 0.044; OR = 1.045; 95%CI = 1.014–1.078; p = 0.005) so that for each 1% of additional RWG, the chance of winning increased by 4.5%. With the largest sample to date and in a “real-world” scenario, the present results suggest that the magnitude of RWG is linked to the chance of winning in MMA combats. It is suggested that regulatory commissions, confederations, and event organisers should consider regulating RWG, considering that, despite its detrimental impact on the athletes’ health and performance, the potential advantage might stimulate athletes to invest in rapid weight loss, followed by gain after the official weigh-in to increase their chance of winning.

The Crowded Uterine Horn Mouse Model for Examining Postnatal Metabolic Consequences of Intrauterine Growth Restriction vs. Macrosomia in Siblings.

Differential placental blood flow and nutrient transport can lead to both intrauterine growth restriction (IUGR) and macrosomia. Both conditions can lead to adult obesity and other conditions clustered as metabolic syndrome. We previously showed that pregnant hemi-ovariectomized mice have a crowded uterine horn, resulting in siblings whose birth weights differ by over 100% due to differential blood flow based on uterine position. We used this crowded uterus model to compare IUGR and macrosomic male mice and also identified IUGR males with rapid (IUGR-R) and low (IUGR-L) postweaning weight gain. At week 12 IUGR-R males were heavier than IUGR-L males and did not differ from macrosomic males. Rapid growth in IUGR-R males led to glucose intolerance compared to IUGR-L males and down-regulation of adipocyte signaling pathways for fat digestion and absorption and type II diabetes. Macrosomia led to increased fat mass and altered adipocyte size distribution compared to IUGR males, and down-regulation of signaling pathways for carbohydrate and fat digestion and absorption relative to IUGR-R. Clustering analysis of gonadal fat transcriptomes indicated more similarities than differences between IUGR-R and macrosomic males compared to IUGR-L males. Our findings suggest two pathways to adult metabolic disease: macrosomia and IUGR with rapid postweaning growth rate.

Comparison of locomotion problems and its economic impact on Cobb and Ross broiler strains

The rapid weight gain and fast muscle growth due to intense genetic selection and improved nutrition for additional breast muscle in broiler commercial strains affect chickens health. In order to compare the main locomotive problems in broilers of Cobb and Ross strains, two pens from a commercial farm in Veracruz, Mexico were used. The first pen housed 16,500 males and 16,500 females of Cobb strain and the second one 16,500 males and 16,500 females of Ross strain. Chicks were checked for locomotion problems from day one until their sale. Animals with problems were recorded and necropsies were performed to identify the pathology. Out of 1406 animals with locomotive problems (2.13% of the total), 58.9% were Cobb and 41.1% Ross (P &lt;0.05). The frequency of locomotive problems was 2.51% for Cobb and 1.75% for Ross. Most common individual lesions were osteochondrosis (38.61%), inflamed joints with purulent contents (37.13%), and valgus (19.65%). Locomotive problems appeared since the first week, but its number increased as birds gained weight, particularly from the fourth week on. Problems occurred more in males than in females and in Cobb birds than in the Ross strain. Economic loss due to locomotion problems was higher for the Cobb strain.

Breast-feeding, rapid growth in the first year of life and excess weight at the age of 2 years: the 3D Cohort Study.

To assess relationships between breast-feeding, rapid growth in the first year of life and overweight/obesity status at the age of 2 years. As part of an observational, longitudinal study beginning in early pregnancy, multivariable logistic regressions were used to assess associations between breast-feeding duration (total and exclusive) and rapid weight gain (RWG) between birth and 1 year of age, and to determine predictors of overweight/obesity status at the age of 2 years. Nine hospitals located in the province of Quebec, Canada. A sample of 1599 term infants who participated in the 3D Cohort Study. Children having RWG in the first year and those having excess weight at the age of 2 years accounted for 28 % and < 10 %, respectively. In multivariable models, children breastfed < 6 months and from 6 months to < 1 year were, respectively, 2·5 times (OR 2·45; 95 % CI 1·76, 3·41) and 1·8 times (OR 1·78; 95 % CI 1·29, 2·45) more likely to show RWG up to 1 year of age compared to children breastfed ≥ 1 year. Children exclusively breastfed < 3 months had significantly greater odds of RWG in the first year (OR 1·94; 95 % CI 1·25, 3·04) compared to children exclusively breastfed for ≥ 6 months. Associations between breast-feeding duration (total or exclusive) and excess weight at the age of 2 years were not detected. RWG in the first year was found to be the main predictor of excess weight at the age of 2 years (OR 6·98; 95 % CI 4·35, 11·47). The potential beneficial effects of breast-feeding on rate of growth in the first year of life suggest that interventions promoting breast-feeding are relevant for obesity prevention early in life.

Birth weight and postnatal weight gain as predictors of abdominal adiposity in childhood and adolescence: A cohort study in northeast Brazil

To evaluate the influence of weight and body proportionality at birth as well as weight gain in the first six months of life on waist size at eight and 18 years of age. It is a prospective cohort involving 163 full-term low birth weight infants (LBW) and 212 appropriate birth weight infants (ABW) born in 1993 and 1994 from five municipalities in the northeast region of Brazil with a poor socioeconomic status. The sample consisted of 214 adolescents recruited at birth and reassessed at eight and 18 years of age. The multiple linear regression analysis showed that rapid weight gain between birth and six months of age most contributed to the variation in waist circumference (WC) at eight years (10.9%) and 18 years (2.8%). ABW explained 2.1% and 2.9% of the variation in WC at eight and 18 years of age, respectively. Male sex contributed more to the difference in the WC at eight years of age (3.9%) than 18 years of age (1.5%). ABW and rapid weight gain in the first six months of life had positive influence on waist size and may be related to the accumulation of abdominal adiposity in childhood and adolescence. • Rapid postnatal weight gain predicted higher waist size at school age and adolescence. • Pre- and postnatal factors act as modulators of waist size throughout life. • Obesity multicausality may have developmental origins.

Promoting Responsive Bottle-Feeding Within WIC: Evaluation of a Policy, Systems, and Environmental Change Approach.

Bottle-fed infants are at greater risk for overfeeding and rapid weight gain (RWG); evidence-based strategies for promoting healthy bottle-feeding practices are needed. Our aim was to assess whether policy, systems, and environmental (PSE) strategies for promoting responsive bottle-feeding practices within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were associated with lower risk for RWG. We conducted a matched-pair cluster randomized trial. PSE strategies were implemented at 3 WIC clinics in Los Angeles County. PSE clinics were compared with 3 matched control clinics. Mothers and infants were assessed when infants were newborn and 3 months and 6 months of age. Participants were mothers (n= 246) who enrolled their newborn infants (younger than 60 days) into WIC between May and August2019. Infant weight was assessed and standardized to sex- and age-specific z scores. RWG was defined as weight-for-age z score change > 0.67. Mothers completed questionnaires assessing responsive and pressuring feeding styles, breast- and bottle-feeding patterns, and perceptions of WIC experiences. Logistic regression with estimation via generalized estimating equations and linear mixed models with repeated measures assessed effects of PSE strategies on categorical and continuous outcomes, respectively. Infants in PSE clinics had significantly lower likelihood of exhibiting RWG (P= .014) than infants in control clinics. Mothers in PSE and control clinics reported similar levels of responsive and pressuring feeding style and similar prevalence of breastfeeding and bottle-feeding. Mothers in PSE clinics trended toward feeling better supported with respect to their decision to bottle-feed (P= .098) and had more stable intentions to stay in the WIC program (P= .002) compared with mothers in control clinics. PSE strategies focused on promoting more inclusive assessment of infant feeding, tailored bottle-feeding counseling, and increased education and support for responsive bottle-feeding were associated with lower risk for RWG among WIC infants.

THE RELATIONSHIP BETWEEN CEREBROSPINAL FLUID PRESSURE AND ATHEROGENIC INDEX OF PLASMA IN IDIOPATIC INTRACRANIAL HYPERTENSION PATIENTS

Background: Idiopathic intracranial hypertension (IIH) is a disease thought to be associated with obesity and rapid weight gain. There is no objective parameter with practical use in its follow-up and treatment other than optical coherence tomography. Objective: The aim of our study is to investigate the relationship between atherogenic index of plasma (AIP) and cerebrospinal fluid (CSF) pressure. Methods: Serum vitamin B12, vitamin D, homocysteine, folic acid, triglyceride (TG), high density lipoprotein cholesterol (HDL-C) levels, CSF pressure, CSF microprotein levels were recorded from the file data of patients diagnosed with IIH. AIP was calculated by dividing the TG level logarithmically by HDL-C. Height (kg) and weight (kg) data of the patients were used to calculate the body mass index (BMI). Results: File data of 64 patients were examined. 8 patients with secondary intracranial hypertension were excluded from the study. 80.36% of the patients were overweight, 16.07% were obese, 3.57% were with normal weight. There was no significant correlation between vitamin B12, vitamin D, homocysteine, HDL-C and CSF microprotein levels and CSF pressure level in patients with a diagnosis of IIH. There was a negative correlation between folic acid level and CSF pressure level, and a positive correlation between BMI, TG, AIP and CSF pressure level. Conclusion: Using folic acid supplements and drugs that reduce TG levels can contribute positively to the course of the disease.

Chapter 4 - Developmental disorders affecting the respiratory system: CCHS and ROHHAD

Rapid-onset Obesity with Hypothalamic dysfunction, Hypoventilation, and Autonomic Dysregulation (ROHHAD) and Congenital Central Hypoventilation Syndrome (CCHS) are ultra-rare distinct clinical disorders with overlapping symptoms including altered respiratory control and autonomic regulation. Although both disorders have been considered for decades to be on the same spectrum with necessity of artificial ventilation as life-support, recent acquisition of specific knowledge concerning the genetic basis of CCHS coupled with an elusive etiology for ROHHAD have definitely established that the two disorders are different. CCHS is an autosomal dominant neurocristopathy characterized by alveolar hypoventilation resulting in hypoxemia/hypercarbia and features of autonomic nervous system dysregulation (ANSD), with presentation typically in the newborn period. It is caused by paired-like homeobox 2B (PHOX2B) variants, with known genotype-phenotype correlation but pathogenic mechanism(s) are yet unknown. ROHHAD is characterized by rapid weight gain, followed by hypothalamic dysfunction, then hypoventilation followed by ANSD, in seemingly normal children ages 1.5-7 years. Postmortem neuroanatomical studies, thorough clinical characterization, pathophysiological assessment, and extensive genetic inquiry have failed to identify a cause attributable to a traditional genetic basis, somatic mosaicism, epigenetic mechanism, environmental trigger, or other. To find the key to the ROHHAD pathogenesis and to improve its clinical management, in the present chapter, we have carefully compared CCHS and ROHHAD.

Pseudotumor Cerebri Syndrome (PTCS), Clinico-Radiological Profile: A Prospective Study.

The aim of the study was to classify patients of Pseudotumor Cerebri Syndrome (PTCS) on the basis of newer classification along with its clinico-radiological correlations. A prospective study was conducted at a tertiary care teaching hospital. A total of 25 consecutive patients who fulfilled the new diagnostic criteria for PTCS were enrolled after taking informed written consent. A thorough clinical history, neurological examination and neuroimaging was carried out. Patients were classified into Primary and Secondary PTCS followed by Definite, Probable and Suggested as per new nomenclature. Out of 25 patients, there were 9 patients in the primary PTCS group and 16 in the secondary PTCS group. Mean duration of symptoms was 40.84 ± 45.68 days. Primary PTCS group patients were significantly overweight and had higher BMI as compared to the secondary group with significant number of patients reporting recent rapid weight gain. The CSF pressure and protein were non-significantly higher in the primary PTCS group. We could classify 17 (68%) patients in our study as definite PTCS, 7 (28%) as probable PTCS and suggested PTCS in one patient. In secondary PTCS group there were 16 (64%) patients. APLA positivity was found to be the most common etiology for secondary PTCS with statistical significance (P = 0.025). Early recognition along with appropriate classification and prompt treatment can prevent vision loss in PTCS. Apart from obesity, recent weight gain is also closely related with primary PTCS.

Care of the Immigrant Child.

Care of the Immigrant Child.

СОПРЯЖЕННОСТЬ ПЛОДОВИТОСТИ ОВЦЕМАТОК ЮЖНОЙ МЯСНОЙ ПОРОДЫ С ИХ ВОЗРАСТОМ И ДРУГИМИ ФАКТОРАМИ

The paper analyzes data on the fertility of sheep of the southern meat breed, studies the correlation between the fertility of the uterus and the indicators of the live weight of its lambs at weaning. The period under review covered 5 lambs. It shows a gradual increase in reproductive indicators by 3-4 lambs and their subsequent decrease associated with the extinction of fertility at an older age. The uterus, stably producing offspring capable of rapid weight gain, as well as uterus with high fertility, which can be used to preserve the valuable gene pool of the breed, have been identified.