Association between early and current gastro-intestinal symptoms and co-morbidities in children and adolescents with Angelman syndrome

BACKGROUND

Angelman syndrome (AS) is a neurogenetic disorder that causes severe intellectual disability, expressive language deficits, motor impairment, ataxia, sleep problems, epileptic seizures and a happy disposition. People with AS frequently experience gastrointestinal (GI) symptoms.

METHOD

This study used data from the Global Angelman Syndrome Registry to explore the relationship between early and current GI symptoms and co-morbidity in children and adolescents with AS (n = 173). Two groups that experienced a high (n = 91) and a low (n = 82) frequency of GI symptoms were examined in relation to feeding and GI history in infancy, sleep and toileting problems, levels of language and communication and challenging behaviours. Predictors of GI symptoms were then investigated using a series of logistic regressions.

RESULTS

This analysis found that constipation and gastroesophageal reflux affected 84% and 64%, of the sample, respectively. The high frequency of GI symptoms were significantly associated with: 'refusal to nurse', 'vomiting', 'arching', 'difficulty gaining weight', gastroesophageal reflux, 'solid food transition', frequency of night-time urinary continence and sleep hyperhidrosis during infancy. GI symptoms were not significantly associated with sleep, toileting, language or challenging behaviours. Significant predictors of high frequency GI symptoms were gastroesophageal reflux and sleep hyperhidrosis.

CONCLUSIONS

Future research needs to investigate the association between AS and GI co-morbidity in adults with AS.

Relationships among gastrointestinal symptoms, sleep problems, challenging behaviour, comorbid psychopathology and autism spectrum disorder symptoms in children and adolescents with 15q duplication syndrome

BACKGROUND

Comorbidity is the presence of at least two disorders in one person at one time. This study examined the frequency of gastrointestinal (GI) symptoms, sleep problems, comorbid psychopathology, challenging behaviour and autism spectrum disorder (ASD) symptoms in children and adolescents with duplication 15q syndrome (Dup15q), aged 3-17 years. This study also examined whether challenging behaviour in Dup15q is predicted by age, gender, presence of an intellectual disability, sleep problems, GI symptoms and comorbid psychopathology.

METHOD

Parental measures were completed by 101 parents of children and adolescents with Dup15q. Questionnaires were composed of the Children's Sleep Habits Questionnaire, Behavior Problems Inventory - Short Form, GI Symptom Inventory, Social Communication Questionnaire and the Child Behavior Checklist.

RESULTS

Sleep problems (94%), GI symptoms (87%) and challenging behaviour (100%) were common comorbidities represented in the sample in this study. Significant relationships were found between challenging behaviour and the presence of co-occurring sleep problems, GI symptoms, comorbid psychopathology and ASD symptoms. Further analysis revealed that these comorbidities also predicted challenging behaviour.

CONCLUSION

This research demonstrated the importance of studying the relationships between GI symptoms, sleep problems, comorbid psychopathology, ASD symptoms and challenging behaviour in Dup15q and how these conditions can shape the Dup15q phenotype.

Assessing laparoscopic skills in the novice

Graduate-entry degrees are common in the US and Australia and are offered by 14 universities in the UK. The University of Nottingham has recently seen the integration of its graduate-entry medicine (GEM) students with its traditional medical undergraduates (BMedSci) on their first clinical attachment. Those pursuing a surgical career will be subject to shortened training as part of Modernising Medical Careers. Furthermore, the increase in minimally invasive techniques will lead to simulator training being utilised as this is a method to which laparoscopic skills acquisition lends itself. A number of validated curricula have been developed since the use of simulators was first suggested as a tool for endoscopic surgical training. Indeed, recent work has shown that simulation may improve psychomotor skills within the context of a surgical procedure.

A comparison of two motion analysis devices used in the measurement of lumbar spinal mobility

OBJECTIVE. The aim of the study was to compare lumbar range of motion determined using two computerised dynamic motion analysis devices.

BACKGROUND

Measures of spinal motion are currently used in biomechanical, epidemiological and clinical studies of the low back. It is essential that the various devices used to measure mobility yield similar results, particularly when the absolute values are to be used to assess job suitability, the extent of injury or the need for rehabilitation.

METHODS

Eleven volunteers took part. The ranges of lumbar flexion, extension, lateral bending and axial rotation were measured using the CA6000 Spine Motion Analyser and the Polhemus Fastrak system, using standardised protocols.

RESULTS

Each device showed good test-retest reliability in itself (R0.82). The absolute values for range of flexion in a standing posture were significantly higher with the CA6000 than with the Fastrak (though well correlated); those recorded in sitting were comparable for the two devices. Values for lateral bending using the two devices were well correlated, although small (but significant) differences in the absolute values were found. For extension and axial rotation, the devices gave significantly different values that were also poorly correlated. The 'limits of agreement' for the two devices (calculated to examine whether they could be used interchangeably) were rather wide, especially for extension and axial rotation.

CONCLUSION

The two devices do not always yield comparable measures for spinal mobility. The accuracy of each, in relation to true angular movements of the vertebrae, remains unknown.

RELEVANCE

The two computerised motion analysis devices can each be used reliably in longitudinal studies. However, if 'normal' values for spinal mobility are to be established, they must be considered device-specific.

Extended major histocompatibility complex haplotypes in celiac patients in the west of Ireland

The highest reported prevalence of celiac disease (gluten-sensitive enteropathy) is found in the West of Ireland. Recent genetic data have suggested that major histocompatibility complex-linked loci may have a dominant genetic effect for disease susceptibility in this population compared with a recessive effect in other groups. To further understand the role of the MHC in celiac disease in the West of Ireland, we analyzed markers for 22 MHC haplotypes from celiac patients and compared them with 18 nontransmitted haplotypes found in the parents of celiac children, and with reported haplotypes from other populations. An extended MHC haplotype including [HLA-B8, DR3, DQw2, Bf*S, C4A*Q0, and C4B*1] accounted for 50% of celiac haplotypes but only 27% of nontransmitted parental haplotypes. Compared with other reported haplotypes in celiacs, patients from the West of Ireland show a higher prevalence of HLA-A1 as a component of this extended haplotype, suggesting that although the core haplotype is similar between Irish patients and others, the celiac population in the West of Ireland differs at other HLA loci. We did not observe any other common haplotypes among our patients unlike the situation in other populations. These differences may underlie the possible dominant effect of HLA-linked loci and the unusually high prevalence of celiac disease in the Irish population. We also found that the serum levels of complement components C3c, C4, and factor B were significantly lower among celiac patients than nonceliacs. The lower serum level of C4 appears to be related to the presence of deletions and null alleles at the C4A and C4B loci in celiacs.

Effect of prolonged nifedipine or captopril therapy on lymphocyte magnesium and potassium levels in hypertension

The effect of prolonged treatment with calcium channel blockers on potassium and magnesium stores is uncertain. We measured lymphocyte and serum magnesium and potassium in 28 patients treated for hypertension for 6 months with nifedipine or captopril. There was no difference in serum or lymphocyte concentrations in the two groups compared to 45 healthy, normotensive controls. These results suggest that intracellular cation levels are maintained with prolonged therapy with calcium channel blockers.