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Types of spina bifida 1 Spina bifida occulta (mildest) Vertebral defect only Skin intact Often asymptomatic Signs: Tuft of hair Dimple Lipoma over spine 2 Meningocele Herniation of meninges only CSF-filled sac Usually no neural tissue damage 3 Myelomeningocele (most severe) Herniation of meninges + spinal cord Major neurological deficits Most common clinically significant type Common sites Lumbosacral region (most common) Cervical and thoracic are rare Risk factors Folic acid deficiency Maternal diabetes Valproate or carbamazepine use Obesity Family history Poor antenatal care Clinical features (myelomeningocele) Lower limb weakness or paralysis Sensory loss Bowel and bladder incontinence Orthopedic deformities (club foot, scoliosis) Hydrocephalus (ArnoldChiari II malformation) Diagnosis Antenatal Maternal serum AFP Ultrasound (1820 weeks) Postnatal Clinical examination MRI spine/brain Management Prevention is key Folic acid 400 g/day (5 mg/day if high risk) Surgical closure of defect Management of complications: Hydrocephalus (VP shunt) Physiotherapy Urologic care Prognosis Depends on level and severity Early intervention improves outcomes Most common neural tube defect affecting the spine = spina bifida

Mean Insulin Secretion Rate Versus Glucose Concentration in Patients with Type 2 Diabetes during Graded Glucose Infusion before (Baseline) and after 12 Weeks of Treatment with Semaglutide or Placebo and in Untreated Healthy During induced hypoglycemia, semaglutide did not alter the counter regulatory responses of increased glucagon compared to placebo and did not impair the decrease of C-peptide in patients with type 2 diabetes