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• Kofi and Kwesi would therefore, have:

• Smaller brains, which is composed from less neurons than what should have been expected from them without passing the hot water massage.

•  Less glial cells that support and maintain the neurons.

• The structure of the neural circuit and the network would be less complex in the number of neurons and the connections between them.

• Swollen synapse because of an oedema during the period that the baby passes hot water massage to the brain (intense period at least of 2 months) would disturb the neural circuit, causing breakdowns in the information transmission between the neurons, which will be exhibited in slow thinking and actions.

• In addition, the building of the neural network or circuit of the newborn baby is shaped by the daily experience he or she passes. Since Kofi and Kwesi will be slower in thinking, they will gain less in term of cognitive development from their daily life experiences.

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Kofi who was 11 days old, and Kwesi who was 9 days old were both in the second week of their life. They were in a sensitive period of their brain development. because neurogenesis, migration and differentiation of cells occur in an acceleration in the first few weeks after birth in mammals and humans [22, 52].

There are no studies that exposed newborn mammal babies to daily heat after birth from their day one. In the following records of experiments on hyperthermia, the intensity of heat, the environmental temperature, and the duration of exposure to the heat the offspring were subject to are crucial factors.

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Offspring exposed to heat:

• Sharma and Cervós-Navarro worked with young rats that were 6 to 9 weeks old. They were placed in an incubator with the condition of 38 degrees Celsius air temperature for 4 hours. This condition caused heat stress to the whole body and resulted in abnormal structures in their brains and even death [13, 20]. The method used by Sharma and Cervós-Navarro was used by other researchers to inflict hyperthermia on mammal offspring.

• In Figure 2 on "hot water massage to a doll" page, we can consider the temperature between the towel and the head of the doll, as the air temperature the anterior fontanelle was directly exposed to. In 24 out of the 27 women that demonstrated the massage with the hot water on the baby doll, the temperature between the towel and the head of the doll was above 39 degrees Celsius. This temperature causes heat stress to a real baby. In 16 out of the 24 women, the temperature between the towel to the head of the doll was above 42 degrees Celsius, reaching up to 48 degrees Celsius.  In these high temperatures there is no need for 4 hours of exposure, minutes can be enough to cause abnormality in brain development [62].

 

Embryos exposed to heat:

• There are also studies on offspring of mammals (including human babies) that their mothers were exposed to heat during pregnancy such as having a fever during pregnancy. The damages recorded in the brains of the offspring after birth in those studies indicated damage that were inflicted on the offspring at different developmental periods of their embryo stage (gestation week). Because processes such as neurogenesis, migration and differentiation of nerve cells occur during the embryo development and after birth in the first few postnatal weeks as well [52], it is very possible that resemble damage happened to Kofi and Kwesi.

• Pregnant mice were placed in a heated water bath of 42 degrees Celsius for 10 minutes once or twice daily from the 12th day to the 15th day of their pregnancy. As a result of that the offspring mice had smaller brains, they were less active in an open field, they learned slowly, and there was a delay in their tasks perform [63]. The method of heating in this study resembles the condition that was found in our study about the hot water massage of the head of Ghanaian babies. The massage with the hot water on the head of Kofi and Kwesi lasted 11 to 13 minutes and even though we witnessed only the morning bath, the same bath followed also in the evening. There is a real possibility that the effects exhibited by the offspring of the mice had happened also to Kofi and Kwesi.

• Even a hot environment which led to an elevation of the body temperature of pregnant sheep by only 1 to 2.1 degrees Celsius caused abnormality in the brain development of their offspring [64].

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Kofi and Kwesi:​

• Optimal growth of cells is at 37 degrees Celsius [65]. Denaturation of cellular proteins occur in mammalian cells starting at 38.7 Celsius degrees. At 43 to 45 degrees Celsius an irreversible denaturation of the proteins occurs [66]. The temperature of the brains of Kofi and Kwesi was for a few minutes above 38 degrees Celsius – at least 1 degree Celsius above normal temperature. Their anterior fontanelles were for a few minutes under heat of 39 to 41 degrees Celsius, only 2 to 4 degrees Celsius above normal temperature which is 37 degrees Celsius. For a few minutes there was a high probability that the proteins in the cells under the anterior fontanelle and its surrounding area passed irreversible denaturation and caused permanent damage to the nerve cells.  

• What does happen after the exposure to the heat?  Will the brain not be able to recover from such minor damages? 

       Unfortunately, the body can not fully compensate the damage after the heat exposure is over.

       Hyperthermia delays mitosis (cell division) and causes cell death in dividing cells. Neurogenesis and proliferation are involved           with cells divisions. 

• In the case of guinea pigs, mitotic activity (cell division) ceased from the time of heating until 4 to 8 hours (depending on the extent of temperature elevation) after heating. An exaggerated burst of mitotic activity resumed when signs of apoptosis (death of cells) was seen and persisted for one hour, but this did not appear to compensate for the loss of neurons that occurred for 4 to 8 hours before that.

 

Death cell after hyperthermia:

• Death of cells can continue for hours after the exposure to the heat. Death of cells heated during division is a major feature of the heat-damaged embryonic brain. It can be seen in the brain of mice embryos soon, even within minutes, after the pregnant mice were in a hot water bath that the elevation of temperature was only 2 to 3.8 degrees above 37 degrees Celsius [62]. The death of neurons after heat exposure is an additional death to the apoptosis process which is a natural process that accompanies neurogenesis as a regulation of preventing the perpetuation of DNA that may have been mutated by the heat [67].

• The smaller number of neurons after heat exposure appeared to regulate the number of glial cell production. Consequently, smaller number of oligodendroglia was produced (but they produced appropriate amounts of myelin). So even though relative concentration of cells to myelin was normal, there was deficiency in the total number of cells and total myelin produced. Since no compensatory growth was apparent, the number of axons that could be myelinated would be reduced or the axons would not have enough myelin sheaths around them. This would result in a slow activity of the neural circuit and slow actions.  

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It is important to note that only a small number of additional divisions would have been needed to make up the deficit in neuron number, but this did not appear to happen. Because of this, the offspring had a deficiency in learning abilities [68].

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The number of dead neurons in the brain of Kofi and Kwesi during the massage with the hot water and hours after that could not be compensated by the growth of new neurons. The repetition of the massage in the evening could only increase the number of dead neurons. 

The number of dead cells is not the only factor in neurogenesis that was affected by the heat. Expansion of neurons , elongating their axon, forming branches of dendrites and synapses to enable them to communicate with distance neurons in other layer or areas in the brain in order to form the neural network or neural circuit, were affected too

• The complexity of the cortical circuitry and the individual components of the cortical layer, determines its functional capabilities.

       Among the different nerve cells in the cortical layers are the important stimulating nerves pyramidal cells (Figure 1). The                       degree of complexity of prefrontal cortex pyramidal cells influences the prefrontal cortex function, and therefore, the cognition.         Differences in the prefrontal structure and the complexity of the pyramidal nerve cells in different anthropoid species (including         humans) are likely to influence the differences in their cognitive styles. Humans have the most dramatic increase in pyramidal             cell complexity in the prefrontal [70]. 

• A study of pyramidal cells in the cerebral cortex of newborn guinea pigs after their mothers were exposed to heat during their pregnancy showed that they were reduced in size but retained the basic topology (geometrical shape and spatial relations) of normal cells. However, their dendritic arborization were shortened (Figure 2), particularly those of the first order dendrites, and this could affect the complexity of the pyramidal neurons network [69]. As the dendrites brunches are shorter, and or fewer, less signal inputs are integrated into the nerve cell and processed to form a solid information that is sorted in the brain. This would result in lower cognition abilities.

Also, Kofi and Kwesi might have suffered from reduced dendrite arborization as the results of the hot water massage to their head leading to a reduction in their future cognitive abilities.

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Figure 1: Pyramidal cells in layers 3 and 5 in the cortical                         Figure 2: Reduction in dendrites

layers of the cortex [modified from p13].                                                   arborization of a mature neuron                                                                                                                               [modified from p14].

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Temporal window of development: 

Even though development may seem to be a continual process, each neuro-developmental process occurs within a relatively narrow temporal window at a specific time. This means that damage that occurs in a specific temporal window can not be repaired once the time of that window of development has passed, and so can not be compensated for. What was damaged in the brains of Kofi and Kwesi in their first week of life can not be completely rebuilt in the second week of their life, and so on.

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