Down syndrome is caused by trisomy 21, where there is an extra copy of chromosome 21 in each cell. There are three main types of chromosome abnormalities that cause Down syndrome - trisomy 21 (95%), translocation (3-4%), and mosaicism (1%). Advanced maternal age is a risk factor, with the risk increasing from 1 in 1500 for women aged 15-29 to 1 in 50 for women aged 45 and above. Down syndrome is not inherited in a simple Mendelian pattern, and the risk of recurrence depends on the specific chromosomal abnormality involved.
Pediatrics. trisomy 21. Meiotic non-disjunction of chromosome 21. clinical features and associated abnormalities of down syndrome. screening test for down syndrome. counseling for parents in down syndrome.
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Neural tube defects are the most common congenital abnormality in India which can be easily prevented with due information and better nursing practices. Neural Tube Defects can be prevented with intake of folic acid.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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2. CSN Vittal
History
First described by John Langdon Down, 1866
Trisomy 21 described by Professor Jérôme
Lejeune & Turpin in 1959
In 1975, NIH suggested that possessive use of
eponym should be discontinued in the USA, but
in England it remains Down’s Syndrome
4. CSN Vittal
Aetiology There are three main types of chromosome
abnormalities in Down syndrome
1. Trisomy 21 (95 percent)
• an extra 21 chromosome. Instead of the normal number of 46
chromosomes in each cell, the individual with Down syndrome
has 47 chromosomes.
2. Translocation (3 - 4 percent)
• extra 21 chromosome is attached or translocated on to
another chromosome, usually on chromosome 14, 21 or 22.
3. Mosaicism (1 percent)
• some cells have 47 chromosomes and others have 46
chromosomes. Mosaicism is thought to be the result of an
error in cell division soon after conception.
17. CSN Vittal
System wise problems in Down
Syndrome
CNS Intellectual disability
Alzheimer like disease after 25 yrs
Autistic behaviour
CVS CHD 40% - AV cushion defects before 10 mo.
Cor pulmonale
GIT Atresia of gut (Duodenal atresia – 8%)
Hirschprung’s disease
Otological Impaired hearing (60-70% - middle ear effusion)
Excessive Wax ( because auditory canal is narrow)
18. CSN Vittal
Ocular Congenital cataracts 1% (correct before 3 mo.)
Nystagmus (5-30%)
Strabismus (23-44%)
Blepharitis (2-67%)
Refractive Errors (70-80%)
Tear duct stenosis
Cataract after 25 yrs (12-86%)
Immune
system
Frequent infections
Hepatitis B
Autoimmune diseases
Celiac disease
Trace element deficiency
System wise problems in Down
Syndrome
19. CSN Vittal
Endocrine Congenital hypothyroidism 1%
Hypo or hyperthyroidism, Thyroid antibodies
Growth retardation
Orthopedic Muscle hypotonia
Joint laxity
Dislocation of patella and hip
Hallus valgus
Atlantoaxial dislocation (10% radiologically)
Urogenital Renal hypoplasia , post urethral valves
Cryptorchidism, hypospadiasis
Boys - Sterility
System wise problems in Down
Syndrome
20. CSN Vittal
Diagnosis
Prenatal
U/s – Double bubble
Echo - AV canal defects
X- Ray – Short femur or humerus
Echogenic small bowel - Double bubble
appearance
Postnatal
Physical examination
Confirmation
Chromosome evaluation
21. CSN Vittal
During 1st and 2nd trimester serum
testing
What is measure When is it
measured
Where does it
come from
Other information
Pregnancy associated
plasma protein-A
(PAPP-A)
1st
trimester
Produced by the
baby and placenta
Very low in mother’s blood can indicate
poor placentation
Beta human chorionic
gonadotrophin (bhCG)
1st and 2nd
trimester
Produced by the
baby
High levels of bhCG in mother’s blood
indicate problems with pregnancy like fetal
growth restriction
Unconjugated oestriol
(uE3)
2nd
trimester
Produced by the
placenta
Very low levels of uE3 indicate biochemical
disorder of Smith Lemli Opitz syndrome,
steroid sulphatase deficiency
Alfa fetoprotein (AFP) 2nd
trimester
Produced by the
baby
Very high AFP in absence of structural
anomalies indicate problem of pregnancy
(fetal growth restriction)
Inhibin A 2nd
trimester
Produced by the
placenta
Very high levels indicte poor placentation
22. CSN Vittal
Preventive Screening – 1st
Trimester
Maternal serum PAPP – A * Increased
Maternal free b hCG Increased
Fetal nuchal translucency
thickness
> 4 mm (USG)
*pregnancy-associated plasma protein A
* Blood collected ideally between 9 -1 2W
23. CSN Vittal
Preventive Screening
1
• Serum a-fetoprotein
• Decreased
2
• Unconjugated estradiol level
• Decreased
3
• Human chorionic gonadotrophin
• Incresed
Triple Test
(Kettering test or the Bart's test)
– Done during 2nd trimester
– 65% detection rate
24. CSN Vittal
Preventive Screening 2nd
trimester
1
• Serum a-fetoprotein
• Decreased
2
• Unconjugated estradiol level
• Decreased
3
• Human chorionic gonadotrophin
• Incresed
4
Inhibin A
• Increased
Quadruple Test - 75% detection rate
* Blood collected ideally between 15 -17 W
26. CSN Vittal
3 D CT image of pelvis : Broad, laterally flattened iliac wings
27. CSN Vittal
For couples who come late or opt for the initial
screening with serum markers and
ultrasonography
Karyotyping by amniocentesis (16— 18 weeks) or
transabdominal CVS, or cordocentesis (after 18
weeks).
The karyotype results are available within a week with
cord blood samples and direct CVS preparations.
The results of amniotic fluid cultures take about 2- 3
weeks.
The risk of fetal loss after CVS is about 3—4% and
with cordocentesis it is about 3%.
Amniocentesis poses the lowest risk of about 0.5-1%.
28. CSN Vittal
Non-invasive Prenatal Screening
Analyzing cell-free fetal DNA in maternal serum is an
important advance in prenatal diagnosis of Down
syndrome.
Next-generation DNA sequencing has reduced the cost
of this procedure, which has a high degree of accuracy
(98% detection rate) and applicability.
29. CSN Vittal
Down syndrome Screening - overview
SCREENING TEST DETECTION
RATE (%)
1st
Trimester
NT measurement 64-70
NT measure + PAPP-A, free or total b-hCG 82-87
2nd
Trimester
Triple screen (metarnal serim AFP, hCG, uE3) 69
Quadruple screen (metarnal serim AFP, hCG, uE3
+ Inhibin A)
81
1st and 2nd
Trimesters
Integrated (NT, PAPP-A, quadruple screen) 94-96
Serum integrated(PAPP-A, quadruple screen) 85-88
30. CSN Vittal
Treatment : Goals
Appropriate and timely management of age-
specific Down syndrome–related medical and
developmental conditions
Early intervention for maximal potential of
developmental skills including occupational,
speech, and physical therapy
Injury and abuse prevention
Identify and refer family or caregivers to
financial and medical support programs
Develop an individual education plan before
transition to preschool
31. CSN Vittal
Management
Early stimulation : involve therapists and special educators
whose goal is to help the baby develop motor skills,
language, social skills and self-help skills
Physiotheroapy
Antioxidants like Zn – Alzheimer’s disease
AEDs – for epilepsy
CVS / GI Abnormalities : Corrective surgeries
Refractory errors : Appropriate lenses
Speech & Language Defects: Specialist speech therapies
Anemia: Appropriate nutrients
Hypothyroidism : Thyroxine
Skin disorders : Moisteners, appropriate therapies
Low cholesterol diet
Immune deficiencies: Vitamin C and Antibiotics
32. CSN Vittal
Management - Monitoring
Hearing tests - at birth or by 3 months of age.
A complete blood count (CBC).
Check for signs of leukemia.
Thyroid evaluation
Heart evaluation
X-rays to evaluate bones in the neck
Dislocation of the neck bones (atlantoaxial dislocation).
between ages 3 and 5 to look for signs of loose ligaments that
may lead to dislocation.
Evaluation for Sleep Apnea
Eye testing – once in an year
34. CSN Vittal
Life Expectations
The typical life expectancy of people with
Down syndrome has nearly doubled in
recent decades, from 25 years in 1983 to
49 years in 1997
About 13% of people with Down syndrome
live longer than 68 years
35. CSN Vittal
Down Syndrome is inherited as ..
A. Autosomal recessive
B. X-linked recessive
C. Autosomal dominant
D. All of the above
E. None of the above