Secondary Disability Research Articles

29 A call for action - The lived experiences of caregivers of children diagnosed with Fetal Alcohol Spectrum Disorder during assessment and following diagnosis

Abstract Background Individuals diagnosed with Fetal Alcohol Spectrum Disorder (FASD) have a heterogeneous range of neurodevelopmental impairments with lifelong impacts on functioning. In Canada, a FASD diagnosis is made through a multidisciplinary team assessment, using the 2015 Canadian FASD Diagnostic Guidelines. Studies show that early diagnosis and intervention reduces secondary FASD related disabilities and improves outcomes in adulthood. However, little has been published about accessibility of services and intervention for children diagnosed with FASD in Canada. Objectives The current study explores the lived experiences of caregivers in (1) undergoing a diagnostic assessment for FASD and (2) obtaining services and interventions for their child in the first two years following diagnosis. Using a qualitative approach, the study aimed to identify strengths and gaps in the system with respect to supporting Canadian children with FASD and their families. Design/Methods Seventy one (71) children were diagnosed with FASD/At Risk for FASD over a one year period at a tertiary Developmental Assessment Center in Canada. Through non-random convenience sampling, 18 caregivers (the child’s legal guardians: 1 biological parent, 9 adoptive parents, 6 family guardians and 2 social workers) consented to participate in semi-structured interviews. Interviews explored caregiver experiences with the FASD diagnostic process as well as access to supports and intervention services after diagnosis. Interviews were transcribed and analyzed using reflexive thematic analysis. Results The following overarching themes were identified: (1) The journey of raising a child with FASD is overwhelming for caregivers; (2) The assessment process was both affirming and disheartening for caregivers; (3) There are significant, multi-level, systemic barriers to accessing supports for children with FASD, and their caregivers; (4) Equity deserving caregivers and their children are particularly vulnerable to falling through the cracks of the medical, educational, and social systems. Within each theme, subthemes further highlight protective factors and specific gaps in the system in supporting children and their families with respect to early intervention, educational/vocational, community and family support. Conclusion Children newly diagnosed with FASD are falling through the cracks of our healthcare system. There are clear disparities in the accessibility of intervention and support for children with developmental differences, even with a diagnosis. Wrap around support is needed for children with FASD and their families, as soon as functional impairments are recognized. A formal funding and support system, based on function, is essential for all children with developmental differences - including children with FASD.

A lifespan perspective on fetal alcohol syndrome: Developmental challenges and outcomes

Fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorder (FASD) result from alcohol exposure during the intrauterine life of the fetus and are the most common nonheritable, avoidable causes of intellectual disability and a wide range of neurobehavioral outcomes. Alcohol causes neurotoxicity in the developing brain. Children with FASD experience behavioral issues from an early age and progress to adulthood. The prevalence of alcohol consumption among women is increasing. Clinically, symptoms in children with FAS manifest in a wide range of ways, probably as a result of the quantity and timing of alcohol exposure, as well as maternal and genetic effects. All of these elements contribute to the mechanisms through which alcohol harms a growing brain, the specifics of which are still largely unknown. Neuroimaging reveals alterations in the structure of the brain, white matter structure, cortical development, and functional connections. However, recent advancements and ongoing research have yielded encouraging findings that could result in the use of FAS screening tools and therapy for individuals. Intervention aims to enhance development, address behavioural challenges, and ensure suitable educational programming. Prioritizing early childhood intervention is crucial to prevent secondary disabilities that may arise from delays in obtaining a definitive diagnosis of Fetal Alcohol Syndrome. Effective nutritional therapies as well as cognitive rehabilitation are now being tested. This disorder represents the intersection of complicated societal, community, family, and biological circumstances that increase the risk for intergenerational suffering, health disparity, and social injustice. This paper aims to guide healthcare professionals and policymaker in enhancing the quality of life for individuals with FAS through effective strategies.

Effectiveness of Physiotherapy for Improving Functionality, Participation, and Quality of Life after a Stroke: Study Protocol for a Randomized Controlled Clinical Trial.

Stroke survivors experience significant alterations in their daily functionality that has a negative impact on their functionality, participation, and quality of life. Person-centered approaches in Physical Therapy interventions that are focused on functional and meaningful goals help to minimize the impact of the alterations. Therefore, the aim of this study is to assess the effectiveness of a Physical Therapy intervention based on a goal-oriented approach with task-specific training for improving functionality, participation, and quality of life for people with Stroke. A single-blinded randomized controlled clinical trial will be developed. Adults over 50 years old diagnosed with Stroke over 6 months will be included in this study. Participants (n = 62) will be randomly allocated into two groups: The experimental group (n = 31) will receive 30 sessions, three per week during 10 weeks, of Physical Therapy sessions of goal-directed and task-specific training. The control group (n = 31) will follow the same intervention intensity of their usual Physical Therapy treatment. The primary outcome variables quality of life (NewsQol), participation (Ox-PAQ), and gait functionality (FAC) and the secondary outcome variables functional disability (BI), postural control (PASS), dynamic trunk balance (TIS), and functional goals (GAS) will be measured at baseline, after group interventions (10 weeks), and 6 months after the baseline. Statistical analyses will include repeated-measures ANOVA, Student's t-test, or the Mann-Whitney U-test, with a 95% confidence interval and significance level of p < 0.05. Person-centered approaches in Physical Therapy interventions may yield better outcomes in functionality, participation, and quality of life for Stroke patients compared to standardized interventions. ClinicalTrials.gov: NCT06165666 (December 2023).

Fisioterapia precoce na Síndrome de Freeman-Sheldon: relato de caso

Freeman-Sheldonn Syndrome (FSS) is a rare condition that presents as autosomal dominant due to mutations in the embryonic myosin heavy chain (MYH3). Individuals with FSS develop contractures that lead to motor and respiratory impairments and difficulties in eating. Physiotherapy can act in the prevention of skeletal deformities, muscle rebalance and in the improvement of respiratory function, thus aiming to promote more functionality for the patient. This study aimed to report a case of physiotherapy in the FSS. This is the first case report of an infant with FSS seen at a teaching clinic twice a week, lasting 1 hour each session, for a period of two consecutive months. The care protocol was built based on the assessment of the infant's primary and secondary disabilities, from which the functional goals (short, medium and long term) were pre-established and the activities developed aimed at functional improvement. The performance of physiotherapy in the FSS over a period of two months had a positive effect on improving cervical extension in prone posture and improving cervical alignment in supine posture. Physiotherapy plays an important role in the prevention and maintenance of functional aspects, improving the patient's health condition, from increasing functionality and reducing disabilities.

Implementation of an Interdepartmental Model of Complex Rehabilitation in the Perm Region in a Specialized Centre

BACKGROUND: Contemporary Russian system of complex rehabilitation and habilitation of disabled people is in the process of transformation. Application of the biopsychosocial approach through the use of the International Classification of Functioning, Disability and Health as a planning methodology Implementation and evaluation of rehabilitation measures make it possible to implement the key principles of rehabilitation: earlier, comprehensiveness, continuity, individual approach.&#x0D; AIM: To substantiate the possibility of implementing a modern regional interdepartmental model of integrated rehabilitation in a specialized centre, taking into account the structure of disability and the formation of new target rehabilitation groups.&#x0D; MATERIALS AND METHODS: Analysis of the dynamics of primary disability of the adult population, description of the structural and functional model of the creation and operation of a multidisciplinary rehabilitation center in conditions of interdepartmental cooperation.&#x0D; RESULTS: The structure of primary and secondary disability in the Perm Region is characterized by the predominance of persons with disabilities of groups 1 and 2 (60%) of working age, whose disability is caused in 30% of cases by malignant neoplasms. This determines the content of individual rehabilitation and habilitation programs to be developed for persons with disabilities and should be reflected in the development of appropriate infrastructure in the region. Modernization of the whole system, involving the use of targeted rehabilitation groups, ensuring continuity of medical and social activities in the relevant organizations and creating conditions for their continuation in the place of residence, should contribute to the effectiveness of rehabilitation activities in general.&#x0D; CONCLUSION: Recommendations on improvement of the system of complex rehabilitation in the conditions of a specialized center on the basis of interdepartmental cooperation have been proposed as a result of the research.

Novel Interventions on Comorbidities in Patients with Fetal Alcohol Spectrum Disorder (FASD): An Integrative Review.

Prenatal exposure to alcohol can cause Fetal Alcohol Spectrum Disorders (FASDs) after birth, encompassing a spectrum of physical, cognitive, and behavioral abnormalities. FASD represents a severe non-genetic disability avoidable through alcohol abstinence during pregnancy and when planning it. Clinical severity depends on alcohol impact, symptomatology, and resulting disabilities. FASD is a permanent disability with no recognized specific medical care. Conversely, secondary FASD-related disabilities can be symptomatically treated. This integrative review aims to provide information about the novel pharmacological treatments of FASD-associated comorbidities by selecting the last ten years of studies carried out on animals and humans. PRISMA guidelines were followed to search human/animal model studies of pharmacological interventions on FASD comorbidities, using different databases (PubMed, Cochrane, etc.). From 1348 articles, 44 met the criteria after full-text analysis. Firstly, all the reported studies point out that early diagnosis and tailored interventions are the principal tools to reduce FASD-related secondary disabilities, due to the fact that there is currently no approved pharmacological treatment for the tissue damage which produces FASD. Despite limitations in study designs and small sample sizes, these review results highlight how the treatment strategies of children with FASD have changed. In the past, studies focused on treating symptoms, but in the last years, researchers have turned their attention to the prevention targeting central nervous system embryogenesis. Novel treatments like choline and natural antioxidants and nutritional supplements are the most investigated treatments in humans with promising results. More follow-up studies need to be performed, to confirm and generalize reported efficacy to a wide sample size.

Italian Guidelines for the diagnosis and treatment of Fetal Alcohol Spectrum Disorders: multimodal approaches of treatment and intervention.

Fetal Alcohol Spectrum Disorders (FASD) are pervasive disorders that impact various domains of functioning, including self-esteem, familiar and peer relationships, and academic success. The high rate of comorbidity may contribute to delayed diagnosis and treatment. Early diagnosis and intervention that aim at primary symptoms may prevent secondary disabilities and improve the outcomes. No intervention emerged as maximally effective across all symptoms and domains. Consequently, the complex pathophysiology of FASD emphasizes the need for individualized assessment and treatment by using a multimodal approach to intervention.

Early identification of birth defects can reduce secondary disabilities in newborn infants

Early identification of birth defects can reduce secondary disabilities in newborn infants

Fetal Alcohol Spectrum Disorders and Inadequacy of Care: Importance of Raising Awareness in Clinical Practice.

Prenatal alcohol exposure is one of the major avoidable causes of developmental disruption and health abnormalities in children. Fetal alcohol spectrum disorders (FASDs), a significant consequence of prenatal alcohol exposure, have gained more attention recently. This review aims to provide a narrative approach to the scientific literature on the history, clinical presentation, diagnosis, and management of FASDs. A literature search in PubMed, ScienceDirect, and Google Scholar online databases was conducted. The dates of publications ranged from 2000 to 2023. FASD presentations tend to persist into adulthood, which, combined with environmental factors, potentially lead to secondary psychosocial problems and disabilities. This review covers different aspects of FASDs regarding the concept of the umbrella term and public health, somatic, and psychiatric perspectives. FASD management remains an obstacle to health professionals, and mental health problems are underestimated. Its management involves a multi-disciplinary team, which varies according to the patient's individual needs. FASD diagnosis and management have not been sufficiently established and tailored. Stigma, cultural contexts, knowledge gaps, and the heterogeneity of clinical manifestations are significant barriers to an accurate diagnostic process. Further development of early interventions and the elaboration of complex treatment approaches are needed.

The efficacy, acceptability and safety of acceptance and commitment therapy for fibromyalgia – a systematic review and meta-analysis

Background Fibromyalgia (FM) is a chronic pain disorder characterised by widespread pain, fatigue and cognitive symptoms. Acceptance and commitment therapy (ACT) aims to improve psychological flexibility and has been found to be beneficial in treating chronic pain; however, there are few studies evaluating its efficacy in treating FM. Aim This systematic review and meta-analysis evaluated the efficacy of acceptance and commitment therapy in patients with fibromyalgia. Methods PubMed, Embase and PsychInfo databases were searched. Randomised Controlled Trials (RCTs) were eligible for inclusion if participants had FM, and the intervention was based on the ACT framework/model, and not combined with any other active therapy; any non-ACT control was accepted. A meta-analysis was performed, with the primary outcomes pain acceptance (chronic pain acceptance questionnaire, CPAQ), health-related quality of life (fibromyalgia impact questionnaire, FIQ), attrition rate and frequency of adverse events, and the secondary outcomes pain intensity, disability, depression, anxiety, and fatigue. Results Six RCTs, with a total of 384, mostly-female, participants were included, with ACT being delivered online, in a group setting, or one-to-one. ACT was superior to controls in improving FIQ score at post-intervention (SMD −1.05, 95% CI −2.02, −0.09) and follow-up (SMD −1.43, 95% CI −2.17, −0.69) and CPAQ post-intervention (SMD 1.05, 95% CI 0.61, 1.49) and at follow-up (SMD 0.95, 95% CI 0.40, 1.49). Attrition was below 20% in 4/6 studies and no adverse events were reported as attributable to ACT. All secondary outcomes showed large-to-moderate pooled effect estimates post-intervention, indicating improvement in anxiety, depression, pain and disability. Fatigue also improved, with a large negative effect. Conclusions The results suggest ACT improved outcomes in patients with FM: there was an overall improvement in all outcomes post-intervention, with most maintained at follow-up. This review was, however, limited by the small body of evidence and differing methodologies of included studies.

Identifying victimization clusters across people with intellectual disabilities: A latent class analysis

BackgroundResearch has shown high rates of victimization among people with intellectual disabilities (ID), but victimization clusters have been barely explored. ObjectiveWe address the gap by examining how reported victimization experiences are grouped into different classes and identifying differences in the characteristics of the individuals in each class. MethodsWe conducted a cross-sectional self-report study with a sample of adults with an ID diagnosis (n = 260). We gathered data about the participants’ victimization experiences and socio-demographics, and then subjected the data to latent class analysis (LCA). ResultsThree different classes were detected: High victimization (n = 27, 10.4 %); medium victimization, low sexual (n = 97, 37.3 %); and low victimization (n = 136, 52.3 %). The results highlight the experiences of sexual and physical victimization among the high-victimization class, in which women are overrepresented, and physical victimization among the medium-victimization class. The study also found that experiences of assault and bias attacks occur to a varying extent across all three classes. The LCA and poly-victimization methods showed substantial agreement but also differences when identifying the most victimized participants. In addition, we detected significant differences between classes in gender, type of school attended, place of residence, legal incapacity, type of support needed, secondary disability and poly-victimization status. ConclusionWe identified distinct underlying ingroup patterns of victimization and sociodemographic inter-class differences that contribute to a better understanding of victimization within the population in question. The results have prevention and intervention implications for caregivers and providers of services for people with ID.

H - 50 Fetal Alcohol Spectrum Disorders and the Criminal Justice System: a Case Study.

Research has identified notable features when considering a diagnosis of FASD. Gestational exposure to alcohol significantly increases the probability of FASD; with Attention Deficit Hyperactive Disorder (ADHD) being the most frequent comorbidity. Both disorders share commonalities in their behavioral phenotype which may likely lead to have negative life outcomes including secondary disabilities when compared to their ADHD-only diagnosed counterparts. This case study provides a process for diagnostic clarification and treatment recommendations within a forensic setting. Starwars, a minor with a documented history of probable intrauterine polysubstance exposure, whose symptoms were noted at age 4, included hyperactivity, attentional, and behavioral deficits. In the absence of medical records, a detailed developmental history was established to opine on the juvenile's Mental State at the Time of the Offense (MSE- offense) of criminal threats on school property. Objective testing noted difficulty with executive function, verbal and non-verbal learning, and attention. In addition, independent school-based testing identified deficits in learning, behavior, and emotion regulation which is consistent with expected neuropsychological assessment results. In the case of Starwars, the referral question sought to establish an MSE-Offense. Considering the probable prenatal alcohol exposure, established behavioral deficits, neurodevelopmental disorder, and cognitive profile - Starwars' ADHD and probable Alcohol- Related Neurodevelopmental Disorder, may have significantly impacted Starwars' ability to appreciate the nature and quality or wrongfulness of his actions.

Sociodemographic Disparities in Educational Services in Children who are Deaf or Hard of Hearing.

Examine the association between sociodemographic factors and Individualized Education Program (IEP) establishment. Retrospective cohort study. Tertiary referral center. Participants included deaf or hard-of-hearing children who were eligible for an IEP with "deafness" or "hard of hearing" as a primary or secondary disability. Primary outcome measures were time intervals between initial referral for services and parental consent; parental consent to determination of eligibility; and initial referral to eligibility (the sum of the previous 2 intervals). Student's t tests and linear regression were used to examine the association between sociodemographic factors and the primary outcome variables. Of the 88 participants, 51 (58%) were male, 45 (51%) were from underrepresented minority (URM) groups, 35 (40%) spoke a primary language other than English, and 53 (60%) utilized public insurance. IEP establishment was significantly delayed in participants who required an English-language interpreter. Most of the delay occurred in the time between the initial referral and parental consent (mean: 115 vs 37 days, P = .02). There were also significant delays from the time of referral for services to eligibility in URM participants (mean: 159 vs 85 days, P = .04). Significant delays were also associated with Minority Status and Language within social vulnerability index percentile rankings. This study found that IEP establishment was delayed in both URM participants and those who required an English-language interpreter. These results highlight the importance of clear communication between the school system and caregivers in the IEP establishment process, particularly with families who require an English-language interpreter or identify as URM.

Statistical indicators of primary and secondary disabilities in children born with very low and extremely low bodyweight

Statistical indicators of primary and secondary disabilities in children born with very low and extremely low bodyweight

Long-Term Effect of Switching From an Anti-CGRP Receptor to an Anti-CGRP Ligand Antibody in Treatment-Refractory Chronic Migraine: A Prospective Real-World Analysis

In migraine patients with a poor response to a calcitonin gene-related peptide monoclonal antibody against the receptor, switching to a calcitonin gene-related peptide monoclonal antibodies against the ligand may be beneficial. This was a long-term real-world prospective analysis conducted in treatment-refractory chronic migraine patients coming from two large tertiary referral headache centres, who did not achieve a meaningful response to erenumab and were switched to fremanezumab. Responders to fremanezumab were considered those who achieved at least 30% reduction in monthly migraine days by month 3, compared to the post-erenumab baseline. Secondary efficacy and disability outcomes were analysed. Thirty-nine patients (female n = 32, 82.1%; median age: 49 years old, IQR = 29.0–56.0) were included. After three months of treatment with fremanezumab, ten out of 39 patients (25.6%) were considered responders. Four of the 11 patients who continued fremanezumab became responders at month 6, increasing the number of responders to 14 patients (35.9%). Responders received a median of 12 injections (IQR = 9.0–18.0) at the time of the analysis. After the last treatment, 13 patients (33.3%) remained responders. The number of mean monthly migraine days significantly decreased from 21.4 at baseline (IQR = 10.7–30.0) to 8.6 (IQR = 3.8–13.9) at the last follow-up. Painkillers intake and HIT-6 score were significantly reduced at the last follow-up. About 1/3 of patients with treatment refractory chronic migraine who have a disappointing response to erenumab and switch to fremanezumab, obtained a meaningful and sustained improvement of their migraine load over time, supporting the appropriateness of this therapeutic approach in clinical practice.

(038) Sexual Issues Due to Comorbidities in Individuals with Fetal Alcohol Spectrum Disorder

Abstract Introduction Fetal alcohol spectrum disorder (FASD) is used to describe the range of conditions associated with prenatal alcohol exposure. FASD is characterized by growth deficits, facial dysmorphia and central nervous system abnormalities. When an individual with an FASD remains undiagnosed and proper interventions are not instituted, secondary disabilities are common. Prenatal exposure to alcohol affects the individual’s development, cognition and learning, which results in characteristic ways of thinking and behaving. Deficits can range from mild cognitive deficits such as subtle effects on executive function, memory and adaptive behavior to profound intellectual disability and severe behavioral problems that result from poor self-regulation. Objectives To examine adverse life outcomes regarding sexual behavior in individuals with FASD. Methods A literature search was performed using keywords relating to Fetal Alcohol Spectrum Disorder, FASD Development, FASD Cognition and FASD Sexual issues. Results Findings showed that one of the strongest correlates of adverse life outcomes including inappropriate sexual behaviors was lack of an early diagnosis. The longer FASD went undiagnosed, the greater the odds of adverse outcomes. One study that examined 415 subjects with FASD of ages ranging from six to fifty-one noted that inappropriate sexual behaviors was the most frequent adverse life outcome increasing with age. Inappropriate sexual behavior was defined by sentencing to a sexual offending treatment program or a persistent pattern of encounters with at least one of these sexual behaviors: obscene phone calls, sex with animals, voyeurism, incest, masturbation in public, compulsions, exposure, promiscuity, sexual advances, and sexual touching. It was concluded that symptoms of FASD may make it challenging to distinguish between inappropriate and appropriate sexual behaviors due to functional and cognitive deficits. For the same reasons, individuals with FASD do not generally improve after standard cognitive behavioral programming for addressing sexually inappropriate behaviors. Conclusions There has been very little empirical research on the role of FASD in inappropriate sexual behavior. In addition, environmental factors associated with prenatal alcohol exposure may play a role in the increased incidence of inappropriate sexual behaviors. One study that examined inappropriate sexual behaviors in individuals with FASD found that almost all the females in the study that exhibited these behaviors had also experienced physical, sexual abuse or violence against themselves. Additionally, half of them had alcohol or drug related issues. Further research into sexual issues related to FASD is required to confirm causality in findings so far. Disclosure No.

Cadmium Toxicity: Insight into Sources, Toxicokinetics, and Effect on Vital Organs and Embryos

Background: Elemental cadmium, cadmium oxide, sulfide, and chloride are resurrected to the atmosphere from both natural and anthropogenic sources. cadmium concentrations in the blood, urine and kidney cortex are substantially higher in smokers compared to never smokers. Absorbed cadmium accumulates primly in the renal cortex and liver. The pancreas, thyroid, gall-bladder and testes can also include comparatively high concentrations. Objectives: The current review aimed to highlight on the effect of cadmium chloride on vital organs and embryos. Absorption of cadmium from the lungs is a major source of exposure between smokers and the occupationally exposed. Cadmium accumulates with age even a maximum level is arrived at about age 50. Metallothionein has been identified in the liver, kidneys, duodenum, urine and blood of animals. It has been postulated that metallothionein passes through the red cell membrane and is transformed to the kidney. Cadmium being a divalent cation is accumulated by transfers mechanisms developed for necessary metals. Cadmium may interact with zinc, iron, magnesium, manganese, calcium and selenium and cause their secondary disability and so break down metabolism, resulting in the final morphological and functional changes in many organs. Toxicity could result from cadmium (Cd2+) interacting with cellular ingredients until without get into the cell, but by interaction with receptors on their surface. Cadmium forms covalent and ionic bonds with atoms of sulfur, oxygen, and hydrogen present in the sulfhydryl groups, disulfide, carboxyl, imidazole or severally amino compounds present in the cells, causing significant disruption of their homeostasis. The principle target organelle of cadmium is the mitochondria. Symptoms of acute cadmium intoxicating usually appear after 24 hours are shortness of breath, general weakness, fever. It can also cause pulmonary edema, pneumonia and in acute cases, respiratory failure and death. Cadmium accumulates in the renal cortex and induces tubular damage. It may cause nephrotoxicity by procreating free radicals and/or by inducing necrosis, apoptosis and creatinine increase in plasma and urea increase in the serum. Exposure to cadmium can cause skeletal damage. Cadmium is attached to low bone mineralization, a high rate of fractures, increased osteoporosis and intense bone pain. It accumulates in the proximal tubular cells, it compresses cellular functions, which may result in reduced transformation among two forms of vitamin D3. This is probably to causes a decrease in calcium absorption and bone mineralization, which in turn may produce osteomalacia. The skeletal effects observed in young rats exposed to cadmium during the period of rapid skeletal growth and teratogenesis or skeletal effects recorded include sirenomelia (fused lower limbs), Amelia (absence of one or more limbs) and retard ossification of the sternum and ribs, dysplasia of facial bones and rear limbs and edema. Cadmium has been shown to be both embryotoxic and teratogenic in a different of animal species. It accumulates in human placenta and its concentration in cord blood increase with maternal exposure. Cadmium may be responsible for decreasing the volume of fetal capillaries in the terminal villi of the placenta. Furthermore, increasing the connective tissue about the fetal vessels changed synthesis of serum and amniotic fluid proteins and decreased expression of growth factors also may key a role in cadmium teratogenicity. Cadmium induces oxidative stress in many organisms at the cellular level, which may outcomes in physiological damage to various organs such as kidneys, liver, lung, pancreas, testes, placenta and bones Cadmium induces oxidative stress in many organisms at the cellular level, which may outcomes in physiological damage to various organs such as kidneys, liver, lung, pancreas, testes, placenta and bones. Reactive oxygen species reacting with polyunsaturated fatty acids of cell membranes initiate lipid peroxidation process that results in modulation of proteins, alteration in membrane components and this reason the loss of their impartiality and irrevocable damage. Conclusion: It can be concluded that symptoms of acute cadmium intoxicating are shortness of breath, general weakness, fever. pulmonary edema, and pneumonia. Cadmium accumulates with age in the different organs in the body and induces oxidative stress at the cellular level, which may outcomes in physiological damage to various organs such as kidneys, liver, lung, pancreas, testes, placenta and bones. Reactive oxygen species reacting with polyunsaturated fatty acids of cell membranes initiate lipid peroxidation process that results in modulation of proteins, alteration in membrane components and this reason the loss of their impartiality and irrevocable damage. Cadmium has been shown to be both embryotoxic and teratogenic in a different of animal species.

Cerebrospinal fluid sulfatide isoforms lack diagnostic utility in separating progressive from relapsing-remitting multiple sclerosis.

Multiple sclerosis (MS) is an immune-mediated demyelinating disorder of the central nervous system. The glycosphingolipid sulfatide, a lipid particularly enriched in the myelin sheath, has been shown to be involved the maintenance of this specific membrane structure. Sulfatide in cerebrospinal fluid (CSF) may reflect demyelination, a dominating feature of MS. We investigated the diagnostic utility of CSF sulfatide isoform levels to separate different courses or phenotypes of MS disease. This was a mono-center, cross-sectional study of relapsing-remitting MS (RRMS) (n=45) and progressive MS (PMS) (n=42) patients (consisting of primary PMS (n=17) and secondary PMS (n=25)) and healthy controls (n=19). In total, 20 sulfatide isoforms were measured in CSF by liquid chromatography-mass spectrometry. CSF total sulfatide concentrations, as well as CSF sulfatide isoform distribution, did not differ across the study groups, and their levels were independent of disease course/phenotype, disease duration, time to conversion to secondary PMS, age, and disability in MS patients. CSF sulfatide isoforms lack diagnostic and prognostic utility as a biomarker for progressive MS.

Outcomes of Primary Flexor Tendon Repairs in Zones 2 and 3: A Retrospective Cohort Study

The aims of this retrospective cohort study were to present outcomes of zone 2 and 3 primary flexor tendon repairs and to evaluate how clinical outcomes change over time within and between zones of injury at weeks 6, 13, and26. Data were retrieved from a multicenter flexor tendon cohort registry from 2014 to 2021. The inclusion criteria were: (1) adult patients after primary flexor tendon surgery in zone 2 or 3, (2) flexor digitorum profundus laceration of >50%, (3) 4-6 multistrand flexor digitorum profundus core suture, and (4) early active motion protocol. The primary outcome was the range of motion. Secondary outcomes were strength, patient satisfaction on an 11-point Likert scale, and self-reported physical function measured with the Disability of the Arm, Shoulder, and Hand questionnaire 6, 13, and 26 weeks after surgery. We evaluated 33 patients after 39 tendon repairs in zone 3 and 174 repairs in zone 2 of 163 patients. Range of motion significantly improved over time in both zones (P < .001 to .01). Between-group range of motion differences were nonsignificant except for week 26 (P < .001) for the zone 3 group. Hand strength significantly improved in both zones over time (P < .001 to .01), while between-zone strength differences were statistically nonsignificant (P= .37 to .93). Patient satisfaction was generally good to high (mean 6.8 to 8.0 points) with significant within-group changes in both zones (P < .001). There were no relevant between-zone differences in Disability of the Arm, Shoulder, and Hand scores at any time point. Patients had significantly improved clinical outcomes in both zones. The zone of injury significantly affected the total active motion scores at the final assessment after 26 weeks for the zone 3 injuries. For the secondary outcomes hand strength, patient satisfaction, and Disability of the Arm, Shoulder, and Hand scores, we discovered no significant between-group differences. Therapeutic IV.

Patients With Prenatal Alcohol Exposure Frequently Misdiagnosed, Face Multiple Challenges

Patients With Prenatal Alcohol Exposure Frequently Misdiagnosed, Face Multiple Challenges