EVALUATION OF DEVELOPMENTAL OUTCOMES WITH BAYLEY III TEST IN PRETERM INFANTS WITH RESPIRATORY DISTRESS SYNDROME.

Aim of our study was assessment of developmental outcome of neonates with respiratory distress syndrome, evaluation of the impact of RDS on child's health, growth and neurodevelopment at 2 years of age. Case control study included 138 children, from those, 74 preterm (gestational age 32-36 weeks), who were divided into 2 study groups: I groups - involved 38 preterm with RDS and II group - 36 preterm patients without RDS and other neonatal problems. Control group included 42 patients born term with uncomplicated history. To assess the impact of RDS without other co-factors, we excluded from the study children with congenital malformations, genetic and metabolic disorders; intracranial hemorrhage, neuromuscular diseases, severe hyperbilirubinemia, sepsis, congenital infections as well as family with drug or alcohol addiction, severe mental disorder, parents younger than 17 years of age at the time of the baby's birth. The study and control group were homogenous based on family social-economic status, parents education, mean parental age, mother health status, to minimize the bias. We assessed the health status, physical growth and development of children at mean age (corrected age) of 24+4 months. Physical growth was assessed based on the WHO Standard Deviation growth charts, health status based on detailed history and clinical examination, child development was assessed using Bayley Scales of Infant and toddler development III. We calculate composite scores for each sphere and compare mean composite scores of each group to each other. Statistical analyses were based on SPSS 17. The assessment of the health shows that children with RDS as well as prematurely born children without RDS have more respiratory infections during first years of life and more hospitalization than control group. The p-value is >0,5 comparing children with RDS and children with prematurity without RDS, but p < 0,05 if we compare the both group of premature with control group of term infants. Our study does not show that RDS affects significantly the prevalence of acute respiratory infections. The main causes of hospitalization in studied as well as in control group are respiratory tract infections and diarrhea. Growth assessment does not show significant difference in child's height and head circumference, while the percentage of children with underweight according corrected age was more evident in I and II group than in control (p=0,0401). The motor composite scores are lower in premature infants with RDS, but it does not show the significant difference (p=0.7755) compared to second group of premature infants without RDS, at the same time comparing both groups to controls show significant difference (P =0.0021). Mostly were affected fine motor abilities. Assessment of the cognitive scores does not show difference between study and control groups, while the language developmental scores in first and second group were significantly lower than in control (P < 0.0001), but there was no difference between I and groups. We found that premature children at 2 years of age despite RDS have lower scores comparing to term newborns in fine motor and language development. Prematurity increases risk for neurodevelopmental impairments that is important to identify and start early intervention to improve the outcomes. It is shown that neonatal complications (Jaundice, infections, asphyxia and etc.) affect development more than prematurity itself, it is very important to conduct big cohort studies on neonates with RDS to identify the risks associated with RDS and its severity.

ATTENTION DEFICIT HYPERACTIVITY DISORDER AND HAIR HEAVY METAL AND ESSENTIAL TRACE ELEMENT CONCENTRATIONS. IS THERE A LINK?

The aim of our study was to assess hair micro-elemental status in children with attention deficit hyperactivity disorder, determine micro-elemental misbalances and heavy metal concentrations and evaluate its impact on child behavior. Case-control study was conducted at Child Development Center of M. Iashvili Children's Central Hospital in 2015-2017years (Tbilisi, Georgia). We studied 70 children, mean age from 6 to 8 year. Target group involved 35 children with Attention Deficit Hyperactivity Disorder . Control group include 35 children of same age with normal behavior. Groups were homogenous based on different characteristics. To diagnose behavioral problems multi-profile group (pediatrician, neurologist, psychologist) assessment was used and final diagnostic was based on DSM V (Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association) and ICD-10 (International Clasiffication of Desease-10) criteria. Micro-elemental status was detected in the hair, with roentgen-fluorescence spectrometer method (Method MBИ 081/12-4502-000, Apparatus ELVAX-CIP, USA-UKRAIN). We study the content of 27 microelements (Zn, Fe, Cu, Mn, Co, Se, K, Cr, S , Cl, ,Ag ,V, Ni, Rb, Sr, Mo, Sr,, Pb, Hg, Br, Ti, Ba, As, Zr, Sb, Sn, Cd) in the hair in target and control groups. Computer program SPSS - 21 (Statistical Package for the Social Science - 21; Independent Samples T-Test,) was used for statistical analysis. The results of our study revealed deficiency of major elements (Fe, Mn, Co, Se), in target group and deficiency of zinc and cooper in both (control and target) groups,but the mean concentrations of manganese (sig 0,200; p>0,05), cooper(sig 0,813; p>0,05) and selenium(sig 0,320;p>0,05) does not show significant difference between control and target groups. Only in case of zinc (sig 0,000; p<0,05), iron (sig0,000;p<0,05) and cobalt (sig 0,000; p<0,05) deficiency we got significant values and meaningful associations between microelement's deficiency and ADHD.Our research didn't reveal any changes in other 17 elements (K, Cr, S, Cl, Ag, V, Ni, Rb, Sr, Mo, Sr, Ba, As, Zr, Sb, Sn, Cd) levels. We detected contamination with Pb (lead), Hg(mercury) and Ti (titanium) in both groups , but there were significant difference in Pb (sig 0,000; p<0,05) and Hg (sig 0,000; p<0,05) values between control and study groups, while difference of Ti (sig 0,177; p>0,05) level was not significant. Our study suggests that zinc, iron and cobalt deficiency as well as contamination with high lead and mercury are associated with attention deficit hyperactivity disorder.

HAIR HEAVY METAL AND ESSENTIAL TRACE ELEMENT CONCENTRATION IN CHILDREN WITH AUTISM SPECTRUM DISORDER.

Our study aims evaluation of level of essential trace elements and heavy metals in the hair samples of children with autistic spectrum disorder (ASD) and identification of changes that are associated with autistic spectrum disorders. Case-control study was conducted at Child Development Center of Iashvili Children's Central Hospital (LD).We studied 60 children aged from 4 to 5 years old. The concentrations of 28 elements among (Ca,Zn, K, Fe, Cu, Se, Mn, Cr, S, Br, Cl, Co, Ag, V, Ni, Rb, Mo, Sr, Ti, Ba, Pb, As, Hg, Cd, Sb, Zr, Sn, Bi) them trace elements and toxic metals) were determined in scalp hair samples of children (n=30) with autistic spectrum disorder (ASD) and from control group of healthy children (n=30) with matched sex and age. Micro-elemental status was detected in the hair, with roentgen-fluorescence spectrometer method (Method MBИ 081/12-4502-000, Apparatus ALVAX- CIP, USA - UKRAIN) .To achieve the similarity of study and control groups, pre and postnatal as well as family and social history were assessed and similar groups were selected. Children with genetic problems, malnourished children, children from families with social problems were excluded from the study. The diagnosis of ASD were performed by pediatrician and psychologist (using M-CHAT and ADOS) according to DSM IV (Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric association) criteria. The study was statistically analyzed using computer program SPSS 19. Deficiencies of essential trace microelements revealed in both group, but there was significant difference between control and studied groups. The most deficient element was zinc (92% in target and 20% in control), then - manganese (55% and 8%) and selenium (38% and 4%). In case of cooper study revealed excess concentration of this element only in target group in 50% of cases. The contaminations to heavy metals were detected in case of lead (78% and 16), mercury (43% and 10%) and cadmium (38% and 8%). The study statistical results indicated, that deficient concentrations of trace elements such as zinc, manganese, molybdenum and selenium in hair significantly linked with ASD (Kramer's V was 0,740; 0,537; 0,333; 0,417 accordingly). In case of cooper we got excess levels of this element and this data was highly linked with autism spectrum disorder. We got high associations and significant values between of lead, mercury and cadmium concentrations and ASD. Study results indicate that there are significant differences of hair essential trace elements concentrations in children with autism spectrum disorder comparing with healthy children group. The result obtained also showed high contamination to heavy metals such as lead, mercury and cadmium in ASD children compared to healthy ones. So, our study demonstrated alteration in levels of toxic heavy metals and essential trace elements in children with autistic spectrum disorders as compared to healthy children. This suggests a possible pathophysiological role of heavy metals and trace elements in the genesis of symptoms of autism spectrum disorders.

ASSOCIATION BETWEEN SHORT STATURE AND HAIR ELEMENTS.

Aim - assessment of hair elemental status, determination of elemental imbalances and heavy metal concentration and evaluation its impact on child liner growth. Case-control study involves 112 children less than 5 years old (target group - 54 children with short stature, control - 58 children with normal physical development). Medical history, nutritional status, anthropological parameters were assessed. Patients with genetic and endocrine disorders, family short stature were excluded from the study. Child elemental status was detected in the hair, with roentgen-fluorescence spectrometer method. Statistical analysis was conduced using SPPS19. Assessment of the dietary history does not reveal any significant differences between the groups, the only exception was consumption of fish, that was statistically significantly lower than in control (p<0,05). The study revealed deficiency of some elements in both (study and control) groups, but there were significant difference between the groups: Zn deficiency 90% versus 40% (p<0,05), Ca deficiency 62 and 36 (p<0,05), Cu deficiency 50 and 16 (p<0,05) and Mn deficiency 30 and 6 (p<0,05) accordingly. Level of some elements (K, S, Br, Cl, Co, Ag, V, Ni, Rb, Sr, Ti, Ba, As, Cd, Zr, Sb) have normal values. Some element deficiency (Fe, Mo, Se) was higher in study group but the difference was not significant. The study revealed high level of hair lead in both groups: all patients (100%) of target group have elevated level of hair lead, among them in 35,8% the content of lead was above so-called minimal allowed level (p<5,0 ppm) and in 64,5% the content of lead in the hair was above so-called maximal allowed level (p≥5,0 ppm). In the control group, lead in the hair was detected in 78% of cases, though the concentration was only in 2% of cases higher than so called maximum allowed. Our study clearly indicated deficiency of trace elements, particularly essential ones and high lead contamination in children with short stature. Our study proves, that analyzing of trace elements and heavy metals levels and evaluation of its influence on health and development have great importance especially during early years, in the critical period of active growth and development.

WITHDRAWN: MS related employment and disease modifying treatment in the German working population: 1994-2009.

Ahead of Print article withdrawn by publisher.

Epilepsy-related employment prevalence and retirement incidence in the German working population: 1994-2009.

Epilepsy-related employment prevalence and retirement incidence were investigated in the German working population from 1994 to 2009. The overall mean prevalence of employment of people with epilepsy was 5.1±0.2 per 1000 workers. The employment rate among people with epilepsy increased from 63.5% in 1994 to 65.9% in 2000 (0.4% annually) and then more steeply from 66.8% in 2001 to 76.9% in 2009 (1.4% annually). A prominent increase in rate of employment of people with epilepsy since 2001 was temporarily associated with approval of leviteracetam in 2000 (P<0.001, OR=8.3, CI=6.45-10.12). The overall mean employment rate of people with epilepsy was lower than that of the general population (68.5% vs 90.1%, P<0.001). The overall mean incidence of epilepsy-related retirement (RI) during the study was 4.6±1.6/1000, similar to the RI for people with other illnesses (5.1±0.8/1000), and the risk of retiring because of epilepsy was not higher than that for other illnesses over the entire study period (P=0.52, OR=1.11, CI=0.86-1.43). The RI among workers with epilepsy, however, sharply declined from 8.3/1000 in 1994 to 2.9/1000 in 2000 (-65%, < 0.001), followed by a slight increase and stabilization at 3.9/1000 workers between 2001 and 2009. The decline in RI among people with epilepsy was temporarily associated with legislation of the Law on Support of Employment in 1996 (P=0.032, OR=2.15, CI=1.17-2.89) and approval of lamotrigine in 1993 (P=0.024, OR=2.64, CI=2.17-3.88). These patterns suggest that drug treatment and legislative laws may have led to increased employment and reduced retirement rates for people with epilepsy.