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Ustinova NV, Namazova-Baranova LS. Role of Pediatrician in Early Risk Evaluation, Diagnosis and Management of Children with Autism Spectrum Disorders. CURRENT PEDIATRICS 2021. [DOI: 10.15690/vsp.v20i2.2255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The article discusses recent ideas about autism: classification approaches, incidence, etiology and pathogenesis, clinical manifestations and diagnosis, comorbid medical conditions, early detection approaches and medical care for children with autism spectrum disorders. The focus is on the information needed for pediatricians in their practice to provide effective medical care for children with neurodevelopmental disorders.
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Affiliation(s)
- Nataliya V. Ustinova
- Research Institute of Pediatrics and Children's Health in Central Clinical Hospital of the Russian Academy of Sciences; Scientific and Practical Center for Mental Health of Children and Adolescents n.a. G.E. Sukhareva
| | - Leyla S. Namazova-Baranova
- Research Institute of Pediatrics and Children's Health in Central Clinical Hospital of the Russian Academy of Sciences; Pirogov Russian National Research Medical University
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2
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Wassef DW, Dhaduk N, Roy SC, Barinsky GL, Kalyoussef E. Helping Children with Special Needs: Who Receives Tympanostomy Tubes? Ann Otol Rhinol Laryngol 2021; 130:954-960. [PMID: 33455429 DOI: 10.1177/0003489420987425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Tympanostomy tubes can prevent sequelae of otitis media that adversely affect long term hearing and language development in children. These negative outcomes compound the existing difficulties faced by children who are already diagnosed with developmental disorders. This study aims to characterize this subset of children with developmental disorders undergoing myringotomy and tympanostomy tube insertion. METHODS A retrospective review using the Kids' Inpatient Database (KID) was conducted, with codes from International Classification of Diseases, Ninth Revision used to query data from the years 2003 to 2012 to determine a study group of children with a diagnosis of a developmental disorder undergoing myringotomy and tympanostomy insertion. This group was compared statistically to patients undergoing these procedures who did not have a diagnosed developmental disorder. RESULTS In total, 21 945 cases of patients with myringotomy with or without tympanostomy tube insertion were identified, of which 1200 (5.5%) had a diagnosis of a developmental disorder. Children with developmental disorders had a higher mean age (3.3 years vs 2.9 years, P = .002) and higher mean hospital charges ($43 704.77 vs $32 764.22, P = .003). This cohort also had higher proportions of black (17.6% vs 12.3%, P < .001) and Hispanic (23.9% vs 20.6%, P = .014) patients, and had lower rates of private insurance coverage (39.6% vs 49%, P < .001). CONCLUSION The population of children with developmental disorders undergoing myringotomy or tympanostomy tube placement has a different demographic composition than the general population and faces distinct financial and insurance coverage burdens. Further study should be done to assess if these differences impact long term outcomes.
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Affiliation(s)
- David W Wassef
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Nehal Dhaduk
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Savannah C Roy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gregory L Barinsky
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Evelyne Kalyoussef
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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3
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Holland Brown T, Salorio-Corbetto M, Gray R, James Best A, Marriage JE. Using a Bone-Conduction Headset to Improve Speech Discrimination in Children With Otitis Media With Effusion. Trends Hear 2020; 23:2331216519858303. [PMID: 31464177 PMCID: PMC6716182 DOI: 10.1177/2331216519858303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The recommended management for children with otitis media with effusion (OME) is
‘watchful waiting’ before considering grommet surgery. During this time speech
and language, listening skills, quality of life, social skills, and outcomes of
education can be jeopardized. Air-conduction (AC) hearing aids are problematic
due to fluctuating AC hearing loss. Bone-conduction (BC) hearing is stable, but
BC hearing aids can be uncomfortable. Both types of hearing aids are costly.
Given the high prevalence of OME and the transitory nature of the accompanying
hearing loss, cost-effective solutions are needed. The leisure industry has
developed relatively inexpensive, comfortable, high-quality BC headsets for
transmission of speech or music. This study assessed whether these headsets,
paired with a remote microphone, improve speech discrimination for children with
OME. Nineteen children aged 3 to 6 years receiving recommended management in the
United Kingdom for children with OME participated. Word-discrimination
thresholds were measured in a sound-treated room in quiet and with 65 dB(A)
speech-shaped noise, with and without a headset. The median threshold in quiet
(N = 17) was 39 dB(A) (range: 23–59) without a headset and
23 dB(A) (range: 9–35) with a headset (Z = −3.519,
p < .001). The median threshold in noise
(N = 19) was 59 dB(A) (range: 50–63) without a headset and
45 dB(A) (range: 32–50) with a headset (Z = −3.825,
p < .001). Thus, the use of a BC headset paired with a
remote microphone significantly improved speech discrimination in quiet and in
noise for children with OME.
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Affiliation(s)
| | - Marina Salorio-Corbetto
- 2 Children's Hearing Evaluation and Amplification Resource, Shepreth, Royston, Hertfordshire, UK.,3 Auditory Perception Group, Department of Psychology, University of Cambridge, UK
| | - Roger Gray
- 4 Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Josephine E Marriage
- 2 Children's Hearing Evaluation and Amplification Resource, Shepreth, Royston, Hertfordshire, UK
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Thom RP, Keary CJ, Palumbo ML, Ravichandran CT, Mullett JE, Hazen EP, Neumeyer AM, McDougle CJ. Beyond the brain: A multi-system inflammatory subtype of autism spectrum disorder. Psychopharmacology (Berl) 2019; 236:3045-3061. [PMID: 31139876 DOI: 10.1007/s00213-019-05280-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022]
Abstract
An immune-mediated subtype of autism spectrum disorder (ASD) has long been hypothesized. This article reviews evidence from family history studies of autoimmunity, immunogenetics, maternal immune activation, neuroinflammation, and systemic inflammation, which suggests immune dysfunction in ASD. Individuals with ASD have higher rates of co-morbid medical illness than the general population. Major medical co-morbidities associated with ASD are discussed by body system. Mechanisms by which FDA-approved and emerging treatments for ASD act upon the immune system are then reviewed. We conclude by proposing the hypothesis of an immune-mediated subtype of ASD which is characterized by systemic, multi-organ inflammation or immune dysregulation with shared mechanisms that drive both the behavioral and physical illnesses associated with ASD. Although gaps in evidence supporting this hypothesis remain, benefits of this conceptualization include framing future research questions that will help define a clinically meaningful subset of patients and focusing clinical interactions on early detection and treatment of high-risk medical illnesses as well as interfering behavioral signs and symptoms across the lifespan.
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Affiliation(s)
- Robyn P Thom
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Christopher J Keary
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA
| | - Michelle L Palumbo
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA.,Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Caitlin T Ravichandran
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA.,Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Jennifer E Mullett
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA
| | - Eric P Hazen
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Ann M Neumeyer
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA.,Department of Neurology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Christopher J McDougle
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA. .,Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. .,Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA.
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Thom RP, McDougle CJ, Hazen EP. Challenges in the Medical Care of Patients With Autism Spectrum Disorder: The Role of the Consultation-Liaison Psychiatrist. PSYCHOSOMATICS 2019; 60:435-443. [DOI: 10.1016/j.psym.2019.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 12/20/2022]
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Piras I, Haapanen L, Napolioni V, Sacco R, Van de Water J, Persico A. Anti-brain antibodies are associated with more severe cognitive and behavioral profiles in Italian children with Autism Spectrum Disorder. Brain Behav Immun 2014; 38:91-9. [PMID: 24389156 PMCID: PMC4111628 DOI: 10.1016/j.bbi.2013.12.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/10/2013] [Accepted: 12/24/2013] [Indexed: 12/22/2022] Open
Abstract
Circulating 45 and 62kDa antibodies targeting the cerebellum were previously associated with Autism Spectrum Disorder (ASD), lower adaptive/cognitive function and aberrant behaviors. Moreover, 37, 39 and 73kDa maternal antibodies (mAb) targeting the fetal brain were previously correlated with broad autism spectrum, irritability, abnormal brain enlargement and impaired expressive language. The present study aims towards clinically characterizing individuals with brain-targeted IgG and/or exposed to maternal antibrain antibodies in a large sample of Italian autistic children (N=355), their unaffected siblings (N=142) and mothers (N=333). The presence of patient- and mother-produced anti-brain antibodies does not confer increased risk of autism within the same sibship. However, the 45 and 62kDa antibodies are correlated with autism severity: the 45kDa Ab is associated with cognitive impairment and lower scores at the Vineland Adaptive Behavior Scales, the 62kDa Ab with motor stereotypies, while both correlate with larger head circumference (all P<0.05). On the other hand, maternal 37, 39 and 73kDa antibrain antibodies, either alone or in combination, are correlated with impaired verbal and non-verbal language development, neurodevelopmental delay and sleep/wake cycle disturbances in their autistic children (P<0.05). Presence of the 62kDa autoAb in the child is significantly associated with presence of the 39 and/or 73kDa antibodies in his/her mother. Our results confirm and extend previous observations in an ethnically distinct sample, providing further evidence of a pathomorphic role for anti-brain antibodies in autism while demonstrating their familial clustering.
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Affiliation(s)
- I.S. Piras
- Unit of Child and Adolescent NeuroPsychiatry, Laboratory of Molecular Psychiatry and Neurogenetics, University “Campus Bio-Medico”, Rome, Italy
| | - L. Haapanen
- Department of Internal Medicine, University of California, Davis, Davis, CA, USA,University of California, Davis M.I.N.D. Institute, Davis, CA, USA,Children’s Center for Environmental Health, University of California, Davis, Davis, CA, USA
| | - V. Napolioni
- Unit of Child and Adolescent NeuroPsychiatry, Laboratory of Molecular Psychiatry and Neurogenetics, University “Campus Bio-Medico”, Rome, Italy
| | - R. Sacco
- Unit of Child and Adolescent NeuroPsychiatry, Laboratory of Molecular Psychiatry and Neurogenetics, University “Campus Bio-Medico”, Rome, Italy,Department of Experimental Neurosciences, I.R.C.C.S. “Fondazione Santa Lucia”, Rome, Italy
| | - J. Van de Water
- Department of Internal Medicine, University of California, Davis, Davis, CA, USA,University of California, Davis M.I.N.D. Institute, Davis, CA, USA,Children’s Center for Environmental Health, University of California, Davis, Davis, CA, USA
| | - A.M. Persico
- Unit of Child and Adolescent NeuroPsychiatry, Laboratory of Molecular Psychiatry and Neurogenetics, University “Campus Bio-Medico”, Rome, Italy,Department of Experimental Neurosciences, I.R.C.C.S. “Fondazione Santa Lucia”, Rome, Italy,Mafalda Luce Center for Pervasive Developmental Disorders, Milan, Italy,Corresponding author at: Unit of Child and Adolescent NeuroPsychiatry, Laboratory of Molecular Psychiatry and Neurogenetics, University “Campus Bio-Medico”, Via Àlvaro del Portillo 21, Rome, Italy. Tel.: +39 06225419155. (A.M. Persico)
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Mezzelani A, Landini M, Facchiano F, Raggi ME, Villa L, Molteni M, De Santis B, Brera C, Caroli AM, Milanesi L, Marabotti A. Environment, dysbiosis, immunity and sex-specific susceptibility: a translational hypothesis for regressive autism pathogenesis. Nutr Neurosci 2014; 18:145-61. [PMID: 24621061 PMCID: PMC4485698 DOI: 10.1179/1476830513y.0000000108] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Autism is an increasing neurodevelopmental disease that appears by 3 years of age, has genetic and/or environmental etiology, and often shows comorbid situations, such as gastrointestinal (GI) disorders. Autism has also a striking sex-bias, not fully genetically explainable. Objective Our goal was to explain how and in which predisposing conditions some compounds can impair neurodevelopment, why this occurs in the first years of age, and, primarily, why more in males than females. Methods We reviewed articles regarding the genetic and environmental etiology of autism and toxins effects on animal models selected from PubMed and databases about autism and toxicology. Discussion Our hypothesis proposes that in the first year of life, the decreasing of maternal immune protection and child immune-system immaturity create an immune vulnerability to infection diseases that, especially if treated with antibiotics, could facilitate dysbiosis and GI disorders. This condition triggers a vicious circle between immune system impairment and increasing dysbiosis that leads to leaky gut and neurochemical compounds and/or neurotoxic xenobiotics production and absorption. This alteration affects the ‘gut-brain axis’ communication that connects gut with central nervous system via immune system. Thus, metabolic pathways impaired in autistic children can be affected by genetic alterations or by environment–xenobiotics interference. In addition, in animal models many xenobiotics exert their neurotoxicity in a sex-dependent manner. Conclusions We integrate fragmented and multi-disciplinary information in a unique hypothesis and first disclose a possible environmental origin for the imbalance of male:female distribution of autism, reinforcing the idea that exogenous factors are related to the recent rise of this disease.
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Affiliation(s)
- Alessandra Mezzelani
- Institute for Biomedical Technologies, National Research Council, Via Fratelli Cervi 93, 20090 Segrate (MI), Italy
- Correspondence to: Alessandra Mezzelani, Institute for Biomedical Technologies, National Research Council, Milan, Segrate, Italy.
| | - Martina Landini
- Institute for Biomedical Technologies, National Research Council, Via Fratelli Cervi 93, 20090 Segrate (MI), Italy
| | - Francesco Facchiano
- Istituto Superiore di Sanità, Rome, Viale Regina Elena 299, 00161 Roma, Italy
| | - Maria Elisabetta Raggi
- IRCCS “E. Medea” – Ass. “La Nostra Famiglia”, Via Don Luigi Monza, 20, 23842 Bosisio Parini (LC), Italy
| | - Laura Villa
- IRCCS “E. Medea” – Ass. “La Nostra Famiglia”, Via Don Luigi Monza, 20, 23842 Bosisio Parini (LC), Italy
| | - Massimo Molteni
- IRCCS “E. Medea” – Ass. “La Nostra Famiglia”, Via Don Luigi Monza, 20, 23842 Bosisio Parini (LC), Italy
| | - Barbara De Santis
- Istituto Superiore di Sanità, Rome, Viale Regina Elena 299, 00161 Roma, Italy
| | - Carlo Brera
- Istituto Superiore di Sanità, Rome, Viale Regina Elena 299, 00161 Roma, Italy
| | - Anna Maria Caroli
- Dip. Scienze Biomediche e Biotecnologie, Università degli Studi di Brescia, Viale Europa 11, 25123 Brescia (BS), Italy
| | - Luciano Milanesi
- Institute for Biomedical Technologies, National Research Council, Via Fratelli Cervi 93, 20090 Segrate (MI), Italy
| | - Anna Marabotti
- IRCCS “E. Medea” – Ass. “La Nostra Famiglia”, Via Don Luigi Monza, 20, 23842 Bosisio Parini (LC), Italy
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