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Abstract OcculTIng 111 approximately incidcnce ho\\ e\ cr IncreaSes significantly \\ ith ad\ ’1ncing matcmal age. In \\ omen under 30, the incidence is about O.h ill 1000 births; this increase to appro:\imC1tel) 20 in chrulllu”umc :2 I Ut’ the translocatioll of q22 segment to ~lIl()lhcr chromo:-;l)tlle, This has led some investigators to conclude that q22 portion IS responsible for this disease. T\\ 0 enzymes involved In pUrIne metaboiism, GARS and :\ I RS ha\ e been mapped to chromosome 21. As altered purine metabolism is related to mental retardation, this could explain the lowered intellectual capacity of these patients. manifestation of Down syndrome are numerous like mongloid facies, mental retardation and hypotonia characterize Down syndrome and brachycephaly, slant nf the e: es, prominent internal epicanthal folds, spec k led i ri des. 11 ~ll nas{ll bridge, high arched pal ate, large ri fth Ii nger, Do\\n be associated \\’ith congenital heart d ise~he~. decreased acetabular and iliac angles, small pen IS and cryptorch id ism, Ear. nose and throat disorders Il1 Down syndrome interfere \\’ith the full developmental potential and the average intelligence especially during the first two years early detection and aggressIve intervention IS very ill1portant 111 order to decrease the inheritance lag in both the cognitive and communicative Otologic disorders III young children with 0.0\;\:11 syndrom~ may be congenital or acquired, contributing to a r~lati\·elv high incidence of hearing loss ~ither studieS conc~rn~d \\ith thi,’ lSSU~ report~d that thes~ to 7~O o. The majorit) of commun In ) ounger children and h~nce the\ n~ed for monitorinQ b\’ Auditory Brain stem Respons~ unit (ABR) speci~11ly before three and half) ears of life. Otoacoustic emissions (OAEs), called cochlear echoes, are I itcrally small echoes from hair-cell activity within the coch lea in response to acoustic stimulation. The healthy cochlea responds with these echoes every time it processes sound; damaged cochleas do not. OAEs are |