551
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Marwah A, Suresh PV, Shah S, Misri A, Maheshwari S. Parachute tricuspid valve. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2006; 7:226-7. [PMID: 16290132 DOI: 10.1016/j.euje.2005.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Accepted: 10/05/2005] [Indexed: 11/26/2022]
Abstract
Parachute abnormality of mitral valve frequently occurs with left sided obstructive lesions though occasionally may occur as an isolated lesion. Symptoms depend upon the severity of stenosis and associated lesions. Parachute abnormality of the tricuspid valve has rarely been reported and its association with left to right shunts has not been described so far.
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552
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Shah S, Usherwood T, Toelle B, Jenkins C, Sawyer S. ABS78: A pilot study of Physician Asthma Care Education program in Australia. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2006. [DOI: 10.1016/j.pcrj.2006.04.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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553
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Clarke J, Robson J, Graham J, Shah S, Harriett S. WITHDRAWN: Increase in incidence of childhood empyemas? J Infect 2006. [DOI: 10.1016/j.jinf.2005.11.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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554
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Shah S, Chan B, Sidhu N, Teare G. Measuring Physical Activity Levels Among Adults in Saskatchewan, Canada: Do we Reach Those Who Need it the Most. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s40-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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555
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Petruzziello L, Iacopini F, Bulajic M, Shah S, Costamagna G. Review article: uncomplicated diverticular disease of the colon. Aliment Pharmacol Ther 2006; 23:1379-91. [PMID: 16669953 DOI: 10.1111/j.1365-2036.2006.02896.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Diverticular disease of the colon is the fifth most important gastrointestinal disease in terms of direct and indirect health care costs in western countries. Uncomplicated diverticular disease is defined as the presence of diverticula in the absence of complications such as perforation, fistula, obstruction and/or bleeding. The distribution of diverticula along the colon varies worldwide being almost always left-sided and directly related to age in western countries and right-sided where diet is rich in fibre. The pathophysiology of diverticular disease is complex and relates to abnormal colonic motility, changes in the colonic wall, chronic mucosal low-grade inflammation, imbalance in colonic microflora and visceral hypersensitivity. Moreover, there can be genetic factors involved in the development of colonic diverticula. The use of non-absorbable antibiotics is the mainstay of therapy in patients with mild to moderate symptoms, and the effect of fibre-supplementation alone does not appear to be significantly different from placebo, although no definite data are available. More recently, alternative treatments have been reported. Mesalazine acts as a local mucosal immunomodulator and has been shown to improve symptoms and prevent recurrence of diverticulitis. In addition, probiotics have also been shown to be beneficial by re-establishing a normal gut microflora. In this study, the current literature on uncomplicated diverticular disease of the colon is reviewed.
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556
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Deecher DC, Beyer CE, Johnston G, Bray J, Shah S, Abou-Gharbia M, Andree TH. Desvenlafaxine succinate: A new serotonin and norepinephrine reuptake inhibitor. J Pharmacol Exp Ther 2006; 318:657-65. [PMID: 16675639 DOI: 10.1124/jpet.106.103382] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study was to characterize a new chemical entity, desvenlafaxine succinate (DVS). DVS is a novel salt form of the isolated major active metabolite of venlafaxine. Competitive radioligand binding assays were performed using cells expressing either the human serotonin (5-HT) transporter (hSERT) or norepinephrine (NE) transporter (hNET) with K(i) values for DVS of 40.2 +/- 1.6 and 558.4 +/- 121.6 nM, respectively. DVS showed weak binding affinity (62% inhibition at 100 microM) at the human dopamine (DA) transporter. Inhibition of [3H]5-HT or [3H]NE uptake by DVS for the hSERT or hNET produced IC50 values of 47.3 +/- 19.4 and 531.3 +/- 113.0 nM, respectively. DVS (10 microM), examined at a large number of nontransporter targets, showed no significant activity. DVS (30 mg/kg orally) rapidly penetrated the male rat brain and hypothalamus. DVS (30 mg/kg orally) significantly increased extracellular NE levels compared with baseline in the male rat hypothalamus but had no effect on DA levels using microdialysis. To mimic chronic selective serotonin reuptake inhibitor treatment and to block the inhibitory 5-HT(1A) autoreceptors, a 5-HT(1A) antagonist, N-[2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl]-N-2-pyridinylcyclo hexanecarboxamide maleate salt (WAY-100635) (0.3 mg/kg s.c.), was administered with DVS (30 mg/kg orally). 5-HT increased 78% compared with baseline with no additional increase in NE or DA levels. In conclusion, DVS is a new 5-HT and NE reuptake inhibitor in vitro and in vivo that demonstrates good brain-to-plasma ratios, suggesting utility in a variety of central nervous system-related disorders.
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557
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Divekar A, Shah S, Joshi C. Neurogenic stunned myocardium and transient severe tricuspid regurgitation in a child following nonaccidental head trauma. Pediatr Cardiol 2006; 27:376-7. [PMID: 16596432 DOI: 10.1007/s00246-005-1263-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Neurogenic stunned myocardium is widely reported in the adult literature and is typically associated with subarachnoid hemorrhage. We present a case of neurogenic stunned myocardium and transient severe tricuspid regurgitation in a 7-month-old infant following nonaccidental head trauma.
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558
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Asch F, Shah S, Rattin C, Swaminathan S, Fuisz A, Lindsay J. Lack of sensitivity of the ECG for the detection of old MI: a cardiac magnetic resonance imaging study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2006. [DOI: 10.1016/j.carrev.2006.03.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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559
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560
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Wolffsohn JS, Naroo SA, Motwani NK, Shah S, Hunt OA, Mantry S, Sira M, Cunliffe IA, Benson MT. Subjective and objective performance of the Lenstec KH-3500 "accommodative" intraocular lens. Br J Ophthalmol 2006; 90:693-6. [PMID: 16531421 PMCID: PMC1860198 DOI: 10.1136/bjo.2006.090951] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To determine whether eyes implanted with the Lenstec KH-3500 "accommodative" intraocular lenses (IOLs) have improved subjective and objective focusing performance compared to a standard monofocal IOLs. METHODS 28 participants were implanted monocularly with a KH-3500 "accommodative" IOL and 20 controls with a Softec1 IOL. Outcome measures of refraction, visual acuity, subjective amplitude of accommodation, objective accommodative stimulus response curve, aberrometry, and Scheimpflug imaging were taken at approximately 3 weeks and repeated after 6 months. RESULTS Best corrected acuity with the KH-3500 was 0.06 (SD 0.13) logMAR at distance and 0.58 (0.20) logMAR at near. Accommodation was 0.39 (0.53) D measured objectively and 3.1 (1.6) D subjectively. Higher order aberrations were 0.87 (0.85) microm and lower order were 0.24 (0.39) microm. Posterior subcapsular light scatter was 0.95% (1.37%) greater than IOL clarity. In comparison, all control group measures were similar except objective (0.17 (0.13) D; p = 0.032) and subjective (2.0 (0.9) D; p = 0.009) amplitude of accommodation. Six months following surgery, posterior subcapsular scatter had increased (p<0.01) in the KH-3500 implanted subjects and near word acuity had decreased (p<0.05). CONCLUSIONS The objective accommodating effects of the KH-3500 IOL appear to be limited, although the subjective and objective accommodative range is significantly increased compared to control subjects implanted with conventional IOLs. However, this "accommodative" ability of the lens appears to have decreased by 6 months post-surgery.
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561
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Pappachen S, Smith PR, Shah S, Brito V, Bader F, Khoury B. Postoperative pulmonary complications after gynecologic surgery. Int J Gynaecol Obstet 2006; 93:74-6. [PMID: 16527279 DOI: 10.1016/j.ijgo.2006.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Revised: 01/12/2006] [Accepted: 01/17/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Investigate the frequency of, and risks for postoperative pulmonary complications after surgery for non-malignant gynecologic disorders. METHOD A retrospective component included medical record data for one year. A prospective component enrolled 300 patients consecutively who were scheduled for gynecologic surgeries. RESULT Postoperative pulmonary complications occurred in 1.22% of 328 open abdominal procedures in the retrospective study, and 2.16% of 232 in the prospective study. Pooling the data yielded a frequency estimate of 1.61%. Mean hospital length of stay (pooled data) increased 1.75 days in those with postoperative pulmonary complications. Smoking was the only significant risk factor (relative risk=3.9 using pooled data). CONCLUSION Postoperative pulmonary complications after surgery for non-malignant gynecologic disorders are infrequent but increase hospital length of stay. Smokers are at increased risk.
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562
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Vijay K, Sharma R, Rao S, John C, Garg R, Arun R, Shah S, Marwah A, Suresh PV, Maheshwari S, Shetty DP. Fontan failure in the current era. Indian J Thorac Cardiovasc Surg 2006. [DOI: 10.1007/s12055-006-0547-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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563
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Krishnamani R, Baran D, Alwarshetty M, Zucker M, Arroyo L, Martin A, Prendergast T, Camacho M, Shah S, McAllister N, Goldstein D. 302. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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564
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Baran D, Zucker M, Arroyo L, Alwarshetty M, Ramirez M, Pinney S, Lubitz S, Gass A, McCahill J, Pardi S, Prevost-Fernandez J, Prendergast T, Goldstein D, Camacho M, Shah S, Cohen M. 235. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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565
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Gohil YM, Patel SB, Goswami KG, Shah S, Soni H. Ultrasonography in obstructive jaundice - a pictorial essay. Indian J Radiol Imaging 2006. [DOI: 10.4103/0971-3026.32250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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566
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Shahpurwala MM, Sani N, Shah S, Shuja F, Shahid K, Tariq H, Huda Z, Zuberi L, Jafar TH, Jafar TH. General medical practitioners in Pakistan fail to educate patients adequately about complications of diabetes. ACTA ACUST UNITED AC 2006. [DOI: 10.1002/pdi.897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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567
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Jan RA, Shah S, Saleem SM, Waheed A, Mufti S, Lone MA, Ashraf M. Sodium and potassium excretion in normotensive and hypertensive population in Kashmir. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2006; 54:22-6. [PMID: 16649734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
One hundred thirty five hypertensive patients and equal number of age and sex matched healthy controls were taken up for studying the relationship of 24 hour urinary sodium and potassium excretion, sodium-potassium molar ratio and body mass index (BMI) with blood pressure in normotensive and hypertensive population in Kashmir. There was statistically significant elevated 24 hour urinary sodium excretion (p < .001), increased Na+-K+ molar ratio, significantly higher BMI in hypertensive population as compared to controls whereas there was a lower 24 hour urinary excretion of potassium (p > .20) in patients with hypertension. Thus sodium and potassium excretion, Na+-K+ molar ratio and body mass index has direct bearing in perpetuation or causation of hypertension in Kashmir which may be related to intake of salt tea.
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568
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Schmitz R, Rohde V, Treckmann J, Shah S. Randomized clinical trial of conventional cholecystectomy versus
minicholecystectomy. Br J Surg 2005. [DOI: 10.1046/j.1365-2168.1997.02814.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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569
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Khan K, Zia-Ullah BSP, Perveen S, Maharvi G, Shah S, Ambreen N, Choudhary M, Atta-ur-Rahman BSP, Voelter W. A Convenient, Highly Versatile Iodination Method of Alcohols Using Cesium Iodide/p- Toluenesulphonic Acid. LETT ORG CHEM 2005. [DOI: 10.2174/157017805774297028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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570
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Cottrell K, Holyoke CW, Kline M, Lee KC, Nassirpour MR, Pasteris RJ, Shah S. Parallel, Solution Phase Synthesis of Dihydropyridine Miticides Via a Versatile Multicomponent Reaction. Comb Chem High Throughput Screen 2005; 8:617-22. [PMID: 16305359 DOI: 10.2174/138620705774575337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A novel class of highly active dihydropyridine miticides was prepared using a multicomponent reaction process. The initial lead was rapidly optimized using solution phase parallel synthesis techniques and a positional scanning approach. Detailed structure-activity relationships were developed for the amino and carbonyl components of the molecule and used to select the best candidates for broad field testing. The chemistry, biology and toxicology of these compounds will be presented along with numerous structural variants of the reaction products.
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571
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Ohlsson A, Walia R, Shah S. Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2005:CD003481. [PMID: 16235321 DOI: 10.1002/14651858.cd003481.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A patent ductus arteriosus (PDA) complicates the clinical course of preterm infants, increasing their risks of developing chronic lung disease (CLD), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH). Indomethacin is used as standard therapy to close a PDA, but is associated with reduced blood flow to the brain, kidneys and gut. Ibuprofen, another cyclo-oxygenase inhibitor, may be as effective with fewer side effects. OBJECTIVES To determine the effectiveness and safety of ibuprofen compared to placebo or no intervention for closing a PDA in preterm and/or low birth weight infants. To determine the effectiveness and safety of ibuprofen compared to other cyclo-oxygenase inhibitors (including indomethacin, mefenamic acid) for closing a PDA in preterm and/or low birth weight infants. SEARCH STRATEGY Randomized or quasi-randomized controlled trials (RCTs) comparing ibuprofen to placebo or indomethacin or mefenamic acid for therapy of PDA were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2005), MEDLINE (1996 - July 2005), CINAHL (1982 - July 2005), EMBASE (1980 - July 2005), reference lists of published RCTs and abstracts from the Pediatric Academic Societies and the European Society for Pediatric Research meetings published in Pediatric Research (1991 - April 2005). No language restrictions were applied. SELECTION CRITERIA 1) DESIGN: Randomized or quasi-randomized controlled trials 2) POPULATION: Preterm (< 37 weeks gestational age) or low birth weight infants (< 2500 grams) with a clinically or echocardiographically diagnosed PDA 3) INTERVENTION: Administration of ibuprofen for the closure of PDA 4) OUTCOMES: At least one of the following outcomes were reported: failure to close a PDA, mortality, surgical ligation, intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL), NEC, decreased urine output, retinopathy of prematurity (ROP), chronic lung disease (CLD), sepsis, days on supplementary oxygen. DATA COLLECTION AND ANALYSIS At least two authors worked independently at each step of the original review, then compared results and resolved differences. The current update was conducted by one author (AO). Methodological quality of eligible studies was assessed according to blinding of randomization, of intervention and of outcome assessment, and completeness of follow up. Weighted treatment effects, calculated using RevMan 4.2, included typical relative risk (RR), typical risk difference (RD), number needed to treat (NNT) or harm (NNH), and weighted mean difference (WMD), all with 95% confidence intervals (CI). A fixed effect model was used for meta-analyses. Heterogeneity tests including I(2 )were performed to assess the appropriateness of pooling the data. MAIN RESULTS No study using mefenamic acid was identified. One study compared ibuprofen to placebo but results were not reported unblinded to group. Eleven studies including 620 patients compared the effectiveness of ibuprofen to indomethacin for the closure of a PDA. There was no statistically significant heterogeneity of treatment effect for any of the outcomes. For the primary outcome (failure of ductal closure), there was no statistically significant difference between ibuprofen and indomethacin groups [typical RR 0.96 (95% CI 0.74, 1.25)]. There were no statistically significant differences in mortality, surgical duct ligation, duration of ventilator support, IVH, PVL, NEC, time to full enteral feeds, ROP, sepsis, duration of hospital stay or gastrointestinal bleed. For many of these outcomes the sample size was small and the estimates imprecise. The incidence of decreased urine output (< 1cc/kg/hr) was lower in the ibuprofen group as compared to the indomethacin group [NNT 9 (95% CI 5-14)]. This was the only statistically significant clinical finding favouring ibuprofen. CLD defined as oxygen requirement at 28 days post-natally was statistically significantly more likely to occur in the ibuprofen group [typical RR 1.37 (95% CI 1.01, 1.86); NNH 7 (95% CI 3 - 100)]. There was a similar trend for CLD at 36 weeks corrected gestational age. AUTHORS' CONCLUSIONS We found no statistically significant difference in the effectiveness of ibuprofen compared to indomethacin in closing the PDA. Ibuprofen reduces the risk of oliguria. However, ibuprofen may increase the risk for CLD, and pulmonary hypertension has been observed in three infants after prophylactic use of ibuprofen. Based on currently available information ibuprofen does not appear to confer a net benefit over indomethacin for the treatment of a PDA. We conclude that indomethacin should remain the drug of choice for the treatment of a PDA. The most urgent research question to be answered is weather ibuprofen compared to indomethacin confers an improved rate of intact survival (survival without impairment) at 18 months corrected age.
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572
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Nguyen QD, Shah S, Tatlipinar S, Do DV, Anden EV, Campochiaro PA. Bevacizumab suppresses choroidal neovascularisation caused by pathological myopia. Br J Ophthalmol 2005; 89:1368-70. [PMID: 16170134 PMCID: PMC1772874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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573
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Moore JE, Shah S, Kumar V, Ainsworth JR, Page AB, McLean WHI. Follow up of patients with ocular scarring secondary to LOC syndrome treated by amniotic membrane transplantation. Br J Ophthalmol 2005; 89:939-41. [PMID: 16024838 PMCID: PMC1772765 DOI: 10.1136/bjo.2004.059121] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To document and discuss the long term outcome of a new ophthalmic treatment for laryngo-onycho-cutaneous (LOC) syndrome. METHODS Two children were treated by excision of ocular granulation tissue and ocular surface rehabilitation with frozen amniotic membrane (AM). The clinical course of both patients was followed and documented at 2 years and 4 years following the surgery. RESULTS Patient 1 demonstrated limited recurrence of granulation tissue at 10 months. After 36 months, re-growth of granulation and scar tissue required a further three subsequent operations to the right eye in an attempt to keep the optical axis clear. 4 years postoperatively, neither eye has a clear visual axis. In contrast similar surgery for the right eye of patient 2 has been highly successful, with only very limited non-progressive recurrence after 2 years of follow up. The operation to the left eye has been similarly effective although the follow up is only 6 months. CONCLUSIONS Ocular surface rehabilitation with AM is the first partially effective treatment for the eye complications of LOC syndrome. The surprising benefit from AM may stem from the primary pathology of the condition. LOC syndrome is caused by a genetic defect resulting in an unusual N-terminal deletion of the alpha3a chain of the basement membrane protein laminin 5. One mechanism through which AM transplantation may act to reduce ocular scarring in this disease is to supplement the abnormal secreted laminin 5 with healthy transplanted laminin. Despite its initial efficacy one episode of AM treatment does not guarantee long term control of the scarring process and variations in AM graft efficacy may be related to other complicating factors such as limbal stem cell deficiency or severity of the initial scarring process.
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574
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Rodriguez R, Taylor O, Shah S, Urstein S. An Emergency Department Prospective, Randomized, Blinded Trial of Suggestive Audio-Therapy Under Deep Sedation for Smoking Cessation. Ann Emerg Med 2005. [DOI: 10.1016/j.annemergmed.2005.06.352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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575
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Hoover-Fong JE, Shah S, Van Hove JLK, Applegarth D, Toone J, Hamosh A. Natural history of nonketotic hyperglycinemia in 65 patients. Neurology 2005; 63:1847-53. [PMID: 15557500 DOI: 10.1212/01.wnl.0000144270.83080.29] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Glycine encephalopathy, also known as nonketotic hyperglycinemia (NKH), is an autosomal recessive disorder caused by a defect in the glycine cleavage system. NKH is classically associated with neonatal apnea, lethargy, hypotonia, and seizures, followed by severe psychomotor retardation in those who survive. METHODS To determine the natural history of NKH, the authors mailed a 44-question survey to 170 households in the International NKH Family Network. RESULTS Data for 65 patients (36 boys, 29 girls) were collected from 58 families. One-third of the subjects died; 8 girls died during the neonatal period, and 14 patients died thereafter (2 girls, 12 boys). Median age of death for boys was 2.6 years vs <1 month for girls (p = 0.02). Mean birth weight and length, occipitofrontal circumference, and gestation duration were normal. Two-thirds of infants were ventilated during the neonatal period; of these, 40% died. Ninety percent had confirmed seizures, 75% during the first month of life. Interestingly, three NKH patients never developed seizures. An abnormal corpus callosum and/or hydrocephalus were associated with especially poor gross motor and speech development. Of 25 patients living > or =3 years, 10 were able to walk and say/sign words; all were boys. In six families with more than one affected child, disease course and mortality were similar within each family. CONCLUSIONS This study reveals a striking and unexpected gender difference in mortality and developmental progress. Of the two-thirds of nonketotic hyperglycinemia patients surviving the newborn period, up to 20% (mostly boys) may learn to walk and communicate by saying or signing words.
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MESH Headings
- Adolescent
- Age of Onset
- Agenesis of Corpus Callosum
- Anticonvulsants/therapeutic use
- Apnea/etiology
- Apnea/therapy
- Child
- Child, Preschool
- Disease Progression
- Female
- Glycine/blood
- Glycine/cerebrospinal fluid
- Health Surveys
- Humans
- Hydrocephalus/epidemiology
- Hydrocephalus/etiology
- Hyperglycinemia, Nonketotic/complications
- Hyperglycinemia, Nonketotic/epidemiology
- Hyperglycinemia, Nonketotic/metabolism
- Hyperglycinemia, Nonketotic/mortality
- Infant
- Infant, Newborn
- Male
- Myoclonic Epilepsy, Juvenile/drug therapy
- Myoclonic Epilepsy, Juvenile/epidemiology
- Myoclonic Epilepsy, Juvenile/etiology
- Nystagmus, Pathologic/epidemiology
- Nystagmus, Pathologic/etiology
- Pregnancy
- Pregnancy Complications/epidemiology
- Psychomotor Disorders/epidemiology
- Psychomotor Disorders/etiology
- Registries
- Respiration, Artificial
- Retrospective Studies
- Seizures/drug therapy
- Seizures/epidemiology
- Seizures/etiology
- Sex Factors
- Surveys and Questionnaires
- Survival Analysis
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