A-58 Rare Case of Klinefelter Syndrome with 13/14 Balanced Translocation and Absence Epilepsy: Impact of Combined Genotypes on Cognitive Neuropsychological Phenotype

Objective

Klinefelter syndrome (KS) and Robertsonian translocation of 13/14 [rob t(13;14)] are the most common sex-chromosome disorder and chromosome rearrangement, respectively (Engels et al., 2008; Skakkebæk, Wallentin, & Gravholt, 2015). Both are associated with increased risk of cognitive/intellectual disability (ID). A case of KS and de novo (i.e., unbalanced) rob t(13;14) was previously reported (Gül & Şayli, 1994). A case of KS with balanced rob t(13;14) and well-controlled generalized absence epilepsy will be presented with consideration for pediatric neuropsychological practice.

Method

Neuropsychological evaluation of a 12-year-old, right-handed boy diagnosed with comorbid KS, rob t(13;14), and generalized absence epilepsy. Particular attention was given to language given his KS diagnosis. The patient is in a 12:1:1 self-contained classroom with speech-language therapy and social skills groups in place. The patient’s mother is confirmed to have rob t(13;14), whereas paternal contribution is unknown.

Results

Adolescent with a history of language difficulties, especially comprehension. Recent school-based WISC-V FSIQ was in the extremely low range (SS = 53), with weaker verbal comprehension and working memory. Academic achievement was globally very low. Expressive and receptive language, visual perception and motor coordination were extremely low to low average. Verbal list learning and visual attention were near average to average.

Conclusions

This case contributes to the very limited body of pediatric neuropsychological data on the combined genotype of KS with rob t(13;14) and absence epilepsy. Both the KS and rob t(13;14) cognitive phenotypes have been characterized as highly variable, with the comorbidity a likely increased risk for ID.

B-32 The Use of Repeat Neuropsychological Assessment to Guide Treatment of Possible Normal Pressure Hydrocephalus in a Complex Case

Objective

Normal Pressure Hydrocephalus (NPH) is a condition that is characterized by the buildup of cerebrospinal fluid (CSF) in the brain that can cause urinary incontinence, gait disturbance, and cognitive impairment. NPH can be progressive but may be managed or reversed with shunt placement. External Lumbar Drainage (ELD) trials in determining if shunt placement is appropriate are common, but the role of repeat neuropsychological assessments during ELD procedures is not well documented in the literature. Repeat, pre-, peri and post- ELD trial, assessment in a complex case of possible NPH is presented.

Method

33-year-old Hispanic English-Speaking female with cognitive/memory complaints following intraventricular hemorrhage (IVH) secondary to vasculopathy was initially seen for post IVH outpatient neuropsychological evaluation. MRI showed enlarged ventricles/communicating hydrocephalus and workup for NPH was initiated. Repeat inpatient evaluations were completed during the ELD trial, with annual outpatient neuropsychological follow-up.

Results

Gait evaluation was inconclusive. Inpatient testing demonstrated minor improvement immediately following ELD opening, but performances were variable across the 4 days of re-evaluation. Shunt placement was rejected due to neuropsychological findings. Outpatient follow-up of patient over several years has demonstrated mild improvement and not evidence of cognitive decline since ELD trial.

Conclusions

Assessment of cognitive functioning in outpatient and inpatient settings before, during, and for several years following ELD testing was beneficial to ascertain the decision not to place a shunt. Repeat neuropsychological assessment in inpatient and outpatient settings provided crucial information for guiding treatment decisions.

[Joint pain and consumption of analgesics among young elite athletes : Nationwide data from youth basketball]

BACKGROUND

Joint pain may be an early indicator of biomechanical stress. During adolescence the physical development, including the development of the musculoskeletal system, is still ongoing and joint pain requires special attention, especially among young athletes.

OBJECTIVE

Young athletes from the highest national basketball leagues in Germany were questioned about prevalence, location, context and coping strategies concerning joint pain.

MATERIAL AND METHODS

Data were derived from the German "Adolescents' and Childrens' Health in Elite Basketball study" (ACHE study). Analyses were based on an online survey of 182 elite basketball players between 13 and 19 years of age from 46 German teams, conducted between April 2016 and June 2016.

RESULTS

In the highest German leagues 2 out of 3 players suffered from joint pain at the time of the survey (7-day prevalence 64.6%). Pain in the lower extremities occurred most frequently. The 7‑day prevalence for knee and leg pain reached up to 40% and foot pain up to 21%. For 84% of all players, occasional consumption of analgesics was the norm and 40% took them frequently. The consumption of several medicinal substances, especially of cyclooxygenase inhibitors, such as ibuprofen and diclofenac, is widespread among adolescent elite basketball players as 1 out of 7 athletes (13%) used medicinal substances despite being pain-free and 5% used it prophylactically with the purpose of preventing pain.

CONCLUSION

From the point of view of pain medicine, it is not only the high prevalence of pain that is remarkable but also the widespread use of analgesics without a prescription and the misguided conception of adolescent competitive athletes that such medications have preventive effects.

Deprivation amplification due to structural disadvantage? Playgrounds as important physical activity resources for children and adolescents

OBJECTIVES

The deprivation amplification hypothesis postulates that the socially disadvantaged are exposed to further structural deprivation by their residential environment such that social inequalities are therefore amplified. To date, no publication has investigated deprivation amplification solely using playgrounds; the present health geography study investigates this hypothesis with regard to the availability of playgrounds in a typical large German city.

STUDY DESIGN

Between July 2016 and January 2017, all playgrounds in the city of Mannheim, Germany, were identified and evaluated by systematic audits. The playground attributes such as availability, accessibility, surface area, and provided amenities were operationalized using well-established, validated instruments.

METHODS

Geo-information about playgrounds was digitalized in ArcGIS 10.2-10.4 and linked to socioeconomic indicators on the meso-level, that is, on the level of 44 social areas. Availability and accessibility of playgrounds were quantified by calculating kernel density and Euclidean distance, respectively. Playground surface area and equipment provided were linked to the number of children and adolescents in the particular social area. The association between availability and accessibility of playgrounds and area-level indicators were assessed using bivariate and multiple Poisson regressions on the meso-level.

RESULTS

In the city of Mannheim, which covers 145 km² and is home to 311,000 inhabitants, 271 playgrounds were identified. Bivariate and multiple analyses showed no association between availability and accessibility of playgrounds and area-level indicators. However, significant negative associations were found in the bivariate analyses between playground area and amenities provided per child and various area-level indicators, but not in multiple models.

CONCLUSIONS

Children are provided with different opportunities to play and to be physically active, depending upon the population density of their social neighborhood. At least in our study area, many socially disadvantaged families are forced to move to densely populated areas for economic reasons. Against that background, the phenomenon of 'deprivation amplification' was not confirmed for availability and accessibility of playgrounds but for playground area and number of amenities provided.

[The use of sunglasses during leisure time and work : Lack of prevention of sun-induced eye damage]

OBJECTIVE

This study aimed at collecting representative national data on the use of sunglasses on sunny summer days during leisure time or work as well as identifying population and professional groups with a pronounced lack of preventive measures to avoid sun-induced eye damage.

MATERIAL AND METHODS

Within the representative National Cancer Aid Monitoring, data on the use of sunglasses during leisure time was assessed among 3000 individuals aged 14-45 years in 2015, as well as on the use during outdoor work among 485 workers aged 14-45 years in 2016. Associations between the use of sunglasses and sociodemographic characteristics were assessed with the χ²-test. Additionally, descriptive and bivariate methods were used to assess connections between the use of sunglasses at work and each professional group.

RESULTS

While more than half of the general population normally or often wear sunglasses on a sunny summer day, only one third of outdoor workers do so. While approximately every seventh individual surveyed never wears sunglasses during leisure time, among outdoor workers it is one out of three. The use during leisure time increases with age.

DISCUSSION

Use of sunglasses during work could be supported by targeted information on UV-induced eye damage by ophthalmologists and company physicians with additional support from accident insurances and employers. Concerning preventive measures occupational groups such as landscapers, farmers and bricklayers who are strongly exposed to sunlight but rarely wear sunglasses are important groups.

[ARENA-Project atrial fibrillation in the Rhein-Neckar region]

Atrial fibrillation (AF) is the most common form of cardiac tachyarrhythmia. It is estimated that in the Rhein-Neckar region approximately 40,000-50,000 out of 2 million people are affected. Due to demographic changes in the near future there will be a significant increase in the prevalence of AF within the next decades. The ARENA project was initiated by the Foundation Institute for Cardiac Infarction Research (IHF) Ludwigshafen in cooperation with cardiological and neurological departments of neighboring hospitals, resident doctors and pharmacies to improve the awareness and care of patients with AF. The particular aim is the prevention of stroke as one of the most dreaded complications. The project focusses on the following three subtopics: interventions, medication, migration. The aim of the intervention project is to raise awareness of AF as a risk factor for stroke and to improve the diagnostic work-up and care for patients with diagnosed or unknown AF. The subproject medication focusses on the adherence of patients with AF to the prescribed antithrombotic medication. To evaluate differences concerning patients with and without a migration background the subproject migration was initiated.

Interplay between physical cleaning, membrane pore size and fluid rheology during the evolution of fouling in membrane bioreactors

Fouling is one of the most pressing limitations during operation of membrane bioreactors, as it increases operating costs and is the cause of short membrane lifespans. Conducting effective physical cleanings is thus essential for keeping membrane operation above viable performance limits. The nature of organic foulants present in the sludge and the membrane properties are among the most influential factors determining fouling development and thus, efficiency of fouling mitigation approaches. The role of other factors like sludge viscosity on fouling is still unclear, given that contradictory effects have been reported in the literature. In the present study we use a new research approach by which the complex interplay between fouling type, levels of permeate flux, membrane material and feed properties is analyzed, and the influence of these factors on critical flux and membrane permeability is evaluated. A variety of systems including activated sludge and model solutions with distinct rheological behavior has been investigated for two membranes differing in pore size distribution. We present a novel method for assessing the efficiency of fouling removal by backwash and compare it with the efficiency achieved by means of relaxation. Results obtained have proven that backwash delays development of critical fouling as compared with relaxation and reduces fouling irreversibility regardless of fluid rheology. It was shown that backwash is especially effective for membranes for which internal fouling is the main cause of loss in permeability. Nonetheless, we found out that for membranes with tight pores, both relaxation and backwash are equally effective. The critical flux decreases significantly for high-viscosity fluids, such as activated sludge. This effect is mainly caused by an intensified concentration polarization at the feed side rather than by internal fouling events. However, membrane permeability has been proven to rely more on the permeate viscosity than on the feed viscosity: poor rejection of organic fractions showcasing high viscosity causes an acute decline in membrane permeability as a consequence of increased shear stress inside the membrane pores.