Nevin Manimala

Pak J Biol Sci. 2021 Jan;24(10):1067-1076. doi: 10.3923/pjbs.2021.1067.1076.

ABSTRACT

<b>Background and Objective:</b> Natural and Synthetic Zeolite (SZ) is potentially useful for biopharmaceuticals and bio tools due to its unique and outstanding physical and chemical properties. Thus, the present study aimed to evaluate the possible effect of synthetic zeolite in (STZ)-induced diabetic rats. <b>Materials and Methods:</b> About 4 groups of rats were used, (I) normal control, (II) SZ group, (300 mg/kg/day), (III) STZ group, diabetic rats acted as positive control and (IV) STZ+SZ group, included diabetic rats treated with synthetic zeolite (300 mg/kg/day), statistical analysis comparisons between means were carried out using one-way analysis of variance (ANOVA) followed by a post hock (Tukey) multiple comparisons test at p<u>></u>0.05. <b>Results:</b> After six weeks, treatment of diabetic animals with synthetic zeolite markedly exhibited a significant reduction in glucose, lipids, DNA fragmentation, Alanine Aminotransferase (ALAT), Aspartate Aminotransferase (ASAT), urea, creatinine, Malondialdehyde (MDA) and Nitric Oxide (NO) levels concomitant with a significant rise in insulin, Glutathione (GSH), Superoxide Dismutase (SOD) and Catalase (CAT) values close to the corresponding values of healthy ones. <b>Conclusion:</b> In conclusion, synthetic zeolite exhibits multi-health benefits with promising potentials against STZ-induced diabetes, this behaviour may be attributed to its antioxidant and free radical scavenging mechanisms.

PMID:34842377 | DOI:10.3923/pjbs.2021.1067.1076

Pediatr Pulmonol. 2021 Nov 29. doi: 10.1002/ppul.25778. Online ahead of print.

ABSTRACT

BACKGROUND: Newborn screening (NBS) for cystic fibrosis (CF) was implemented in our country on January 1st, 2015, based on immunoreactive trypsinogen tests (IRT/IRT). Here, we aimed to evaluate the diagnoses of patients and follow-up process within the first 5 years of NBS from a tertiary care center.

METHODS: This retrospective cohort study was conducted on patients who were admitted to our pediatric pulmonology department for sweat test (ST) via NBS. Patients with CF with negative NBS results and those with CF with positive NBS and joined our follow-up were also investigated. Clinical outcome measures were compared between patients with CF with positive and negative NBS.

RESULTS: Six hundred sixty infants who were referred for ST via NBS were included. Across the entire study population(n=683), 11.4% of patients had CF (14.1% of had negative NBS in this CF group). The sensitivity of NBS was found as 84.9% and the positive predictive value (PPV) was 9.4%. The median age at diagnosis was older (p<0.001), reluctance for feeding and Pseudobartter syndrome (PBS) were significantly higher at presentation in the negative NBS group. There was no statistically significant difference between the groups regarding weight-for-age (p=0.899) and height-for-age (p=0.491) in the first two years’ follow-ups.

CONCLUSIONS: Our findings showed the low sensitivity and PPV of NBS; therefore, further studies based on all patients in our country are necessary for new cut-off values. PBS and reluctance for feeding should be alarm symptoms for CF even if the infants had negative NBS. Additionally, later diagnosis of patients who had negative NBS did not affect the nutritional outcomes; we need large-scale prospective studies to optimize nutritional benefits for all infants diagnosed via NBS. This article is protected by copyright. All rights reserved.

PMID:34842364 | DOI:10.1002/ppul.25778

Pediatr Pulmonol. 2021 Nov 29. doi: 10.1002/ppul.25777. Online ahead of print.

ABSTRACT

BACKGROUND: Impaired health-related quality of life (HRQoL) is a common problem in pulmonary arterial hypertension (PAH), but there is limited data on HRQoL in children with PAH. We aimed to investigate the quality of life, determine the potential risk factors for poor HRQoL in children with PAH, and to assess the depression and anxiety of their families.

METHODS: We performed a prospective cross-sectional study of children with PAH, healthy peers, and their parents. HRQoL was measured by the self-reported and age adapted KINDL questionnaire. Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS) were used to assess depression and anxiety of parents.

RESULTS: Children with PAH had statistically lower total HRQoL scores than healthy peers (p<0.001). There was no correlation between HRQoL and duration of disease, World Health Organization functional class, pro-b-type natriuretic peptide, 6-minute walk test, combined or single treatment. BDI and HADS scores were significantly higher in the parents of patients (p<0.001, p=0.023, p<0.001, respectively). There was a negative correlation between HRQoL and BDI in patients (p=0.016), while there was no significant correlation between HRQoL and HADS (p>0.05).

CONCLUSION: We demonstrated impairment of HRQoL of children with PAH. In addition, there was a correlation between the depression of the families and the quality of life of the children. This article is protected by copyright. All rights reserved.

PMID:34842358 | DOI:10.1002/ppul.25777

Orthod Craniofac Res. 2021 Nov 29. doi: 10.1111/ocr.12542. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the accuracy of cephalometric landmark identification between artificial intelligence (AI) deep learning convolutional neural networks (CNN) You Only Look Once, Version 3 (YOLOv3) algorithm and the manually traced (MT) group.

SETTING AND SAMPLE POPULATION: The American Association of Orthodontists Federation (AAOF) Legacy Denver collection was used to obtain 110 cephalometric images for this study.

MATERIALS AND METHODS: Lateral cephalograms were digitized and traced by a calibrated senior orthodontic resident using Dolphin Imaging. The same images were uploaded to AI software Ceppro DDH Inc The Cartesian system of coordinates with Sella as the reference landmark was used to extract x- and y-coordinates for 16 cephalometric points: Nasion (Na), A point, B point, Menton (Me), Gonion (Go), Upper incisor tip, Lower incisor tip, Upper incisor apex, Lower incisor apex, Anterior Nasal Spine (ANS), Posterior Nasal Spine (PNS), Pogonion (Pg), Pterigomaxillary fissure point (Pt), Basion (Ba), Articulare (Art) and Orbitale (Or). The mean distances were assessed relative to the reference value of 2 mm. Student paired t-tests at significance level of P < .05 were used to compare the mean differences in each of the x- and y-components. SPSS (IBM-vs. 27.0) software was used for the data analysis.

RESULTS: There was no statistical difference for 12 out of 16 points when analysing absolute differences between MT and AI groups.

CONCLUSION: AI may increase efficiency without compromising accuracy with cephalometric tracings in routine clinical practice and in research settings.

PMID:34842346 | DOI:10.1111/ocr.12542

Matern Child Nutr. 2021 Nov 29:e13286. doi: 10.1111/mcn.13286. Online ahead of print.

ABSTRACT

This systematic review and meta-analysis aimed to assess the robustness of designs and tools used in nutrition social behaviour change communication (NSBCC) interventions and establish their effectiveness. EBSCOhost as an umbrella database including Medline (Ovid) and CINAHL, EMBASE, and ProQUEST databases were searched for peer-reviewed articles from January 1960 to October 2018. Additional sources were searched to identify all relevant studies including grey literature. Studies’ biases were assessed according to Cochrane handbook. Pooled estimate of effectiveness of interventions on infant and young child feeding (IYCF) practices and child nutritional status with 95% confidence intervals were measured using random-effects models. Eighty studies were included in this review: Fifty-one (64%) were cluster randomised controlled trials (RCTs), 13 (16%) were RCTs and 16 (20%) quasi-experimental. Of the included studies, 22 (27%) measured early initiation of breastfeeding, 38 (47%) measured exclusive breastfeeding, 29 (36%) measured minimum dietary diversity, 21 (26%) measured minimum meal frequency, 26 (32%) measured height for age z-scores (HAZ), 23 (29%) measured weight for height z-scores (WHZ), 27 (34%) measured weight for age z-scores (WAZ), 20 (25%) measured stunting, 14 (17%) measured wasting, and 11 (14%) measured underweight. The overall intervention’s effect was significant for exclusive breastfeeding (EBF) (odds ratio = 1.73; 95% confidence interval [CI]: 1.35-2.11, p < 0.001), HAZ (standardized mean differences [SMD] = 0.19; 95% CI: 0.17-0.21; p < 0.001), WHZ (SMD = 0.02; 95% CI: 0.004-0.04; p < 0.001), and WAZ (SMD = 0.04; 95% CI: 0.02-0.06; p < 0.001). Evidence shows the effectiveness of NSBCC in improving EBF and child anthropometric outcomes. Further research should test the impact on child nutritional status with clearly specified and detailed NSBCC interventions.

PMID:34842341 | DOI:10.1111/mcn.13286

Pediatr Blood Cancer. 2021 Nov 29:e29483. doi: 10.1002/pbc.29483. Online ahead of print.

ABSTRACT

OBJECTIVE: Pediatric oncology survivors are at risk for executive function (EF) and working memory (WM) deficits, which can be measured via performance-based measures or rating scales. Previous studies have shown these measurement methods to be weakly correlated. This study aimed to describe parent-rated EF and performance-based WM (PBWM) in pediatric brain tumor (BT) survivors, examine change in EF and PBWM across time, and investigate the relationship between parent-rated WM and PBWM.

METHOD: The sample included 56 patients diagnosed with a BT in childhood (M_age = 6.94 years; SD = 4.05) seen twice for clinical neuropsychological evaluation. PBWM was examined via the auditory WM scale from a Wechsler intelligence measure or Differential Ability Scales-II. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF)/BRIEF-P/BRIEF-2 as a measure of global EF (Global Executive Composite [GEC]), metacognitive skills (Metacognitive Index/Cognitive Regulation Index [MI/CRI]), behavioral regulation (Behavior Regulation Index [BRI]), and emotional regulation (Emotion Regulation Index [ERI]).

RESULTS: GEC, MI/CRI, and ERI at Time 1 were significantly above the mean (p < .01); BRI and PBWM did not differ from the normative mean. All measures were significantly higher than the normative mean at Time 2 (p < .05). PBWM was both clinically and statistically elevated (p < .001). There was a significant change across time in PBWM (p < .05), but not GEC, MI/CRI, ERI, or BRI. PBWM was weakly correlated with the BRIEF WM subscale at Time 1 and Time 2 (all p > .05).

CONCLUSIONS: Multiple measures of EF should be considered when providing diagnoses and recommendations for pediatric BT survivors. Furthermore, given declines across time, findings document need for continued monitoring and reassessment of survivors as they get further out from treatment.

PMID:34842333 | DOI:10.1002/pbc.29483

Pediatr Blood Cancer. 2021 Nov 29:e29421. doi: 10.1002/pbc.29421. Online ahead of print.

ABSTRACT

BACKGROUND: Ovarian mature teratoma (OMT) is a common ovarian tumor found in the pediatric population. In 10%-20% of cases, OMT occurs as multiple synchronous or metachronous lesions on ipsi- or contralateral ovaries. Ovarian-sparing surgery (OSS) is recommended to preserve fertility, but total oophorectomy (TO) is still performed.

DESIGN: This study reviews the clinical data of patients with OMT, and analyzes risk factors for second events. A national retrospective review of girls under 18 years of age with OMTs was performed. Data on clinical features, imaging, laboratory studies, surgical reports, second events and their management were retrieved.

RESULTS: Overall, 350 children were included. Eighteen patients (5%) presented with a synchronous bilateral form at diagnosis. Surgery was performed by laparotomy (85%) and laparoscopy (15%). OSS and TO were performed in 59% and 41% of cases, respectively. Perioperative tumor rupture occurred in 23 cases, independently of the surgical approach. Twenty-nine second events occurred (8.3%) in a median time of 30.5 months from diagnosis (ipsilateral: eight cases including one malignant tumor; contralateral: 18 cases; both ovaries: three cases). A large palpable mass, bilateral forms, at diagnosis and perioperative rupture had a statistical impact on the risk of second event, whereas the type of surgery or approach did not.

CONCLUSION: This study is a plea in favor of OSS as the first-choice treatment of OMT when possible. Close follow-up during the first 5 years is mandatory considering the risk of 8.3% of second events, especially in cases with risk factors.

PMID:34842332 | DOI:10.1002/pbc.29421

Pediatr Blood Cancer. 2021 Nov 29:e29473. doi: 10.1002/pbc.29473. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: Despite the pervasiveness of late effects in childhood cancer survivors, many parents feel inadequately informed about their child’s risks. We assessed early parental knowledge of risks of late effects and predictors of increased knowledge.

DESIGN/METHODS: Parents of children receiving cancer treatment at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center were surveyed about their knowledge of their child’s likelihood of eight late effects. Individual risk for each late effect (yes/no) was assessed using the Children’s Oncology Group’s Long-Term Follow-Up Guidelines v5 as a reference. Descriptive statistics were used to summarize knowledge scores; ordinal logistic regression was used to identify predictors of higher knowledge.

RESULTS: Of 96 parent participants, 11 (11.46%) correctly identified all of their child’s risks for the eight late effects. Five of eight was the median number of correctly identified late effect risks. Among 21 parents whose children were at risk for ototoxicity, 95% correctly identified this risk. Conversely, parents of at-risk children were less knowledgeable about risks of secondary malignancy (63% correct identification, of N = 94 at risk), cardiac toxicity (61%; N = 71), neurocognitive impairment (56%; N = 63), and infertility (28%; N = 61). Ordinal logistic regression analysis identified no significant differences in parental knowledge of late effect risks by any factors evaluated.

CONCLUSIONS: Gaps in parental knowledge of potential late effects of childhood cancer treatment emerge early in a child’s care, and parents are more knowledgeable about some late effects, such as ototoxicity, than others, such as infertility. As no child- or parent-specific factors were associated with increased knowledge of late effect risks, interventions must be applied broadly.

PMID:34842331 | DOI:10.1002/pbc.29473

J Magn Reson Imaging. 2021 Nov 29. doi: 10.1002/jmri.28007. Online ahead of print.

ABSTRACT

BACKGROUND: Medulloblastoma, ependymoma, and pilocytic astrocytoma are common pediatric posterior fossa tumors. These tumors show overlapping characteristics on conventional MRI scans, making diagnosis difficult.

PURPOSE: To investigate whether apparent diffusion coefficient (ADC) values differ between tumor types and to identify optimum cut-off values to accurately classify the tumors using different performance metrics.

STUDY TYPE: Systematic review and meta-analysis.

SUBJECTS: Seven studies reporting ADC in pediatric posterior fossa tumors (115 medulloblastoma, 68 ependymoma, and 86 pilocytic astrocytoma) were included following PubMed and ScienceDirect searches.

SEQUENCE AND FIELD STRENGTH: Diffusion weighted imaging (DWI) was performed on 1.5 and 3 T across multiple institution and vendors.

ASSESSMENT: The combined mean and standard deviation of ADC were calculated for each tumor type using a random-effects model, and the effect size was calculated using Hedge’s g.

STATISTICAL TESTS: Sensitivity/specificity, weighted classification accuracy, balanced classification accuracy. A P value < 0.05 was considered statistically significant, and a Hedge’s g value of >1.2 was considered to represent a large difference.

RESULTS: The mean (± standard deviation) ADCs of medulloblastoma, ependymoma, and pilocytic astrocytoma were 0.76 ± 0.16, 1.10 ± 0.10, and 1.49 ± 0.16 mm² /sec × 10^-3 . To maximize sensitivity and specificity using the mean ADC, the cut-off was found to be 0.96 mm² /sec × 10^-3 for medulloblastoma and ependymoma and 1.26 mm² /sec × 10^-3 for ependymoma and pilocytic astrocytoma. The meta-analysis showed significantly different ADC distributions for the three posterior fossa tumors. The cut-off values changed markedly (up to 7%) based on the performance metric used and the prevalence of the tumor types.

DATA CONCLUSION: There were significant differences in ADC between tumor types. However, it should be noted that only summary statistics from each study were analyzed and there were differences in how regions of interest were defined between studies.

EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 3.

PMID:34842328 | DOI:10.1002/jmri.28007

J Magn Reson Imaging. 2021 Nov 29. doi: 10.1002/jmri.28008. Online ahead of print.

ABSTRACT

BACKGROUND: Preoperative differentiation of borderline from malignant epithelial ovarian tumors (BEOT vs. MEOT) is challenging and can significantly impact surgical management.

PURPOSE: To develop a multiple instance convolutional neural network (MICNN) that can differentiate BEOT from MEOT, and to compare its diagnostic performance with that of radiologists.

STUDY TYPE: Retrospective study of eight clinical centers.

SUBJECTS: Between January 2010 and June 2018, a total of 501 women (mean age, 48.93 ± 14.05 years) with histopathologically confirmed BEOT (N = 165) or MEOT (N = 336) were divided into the training (N = 342) and validation cohorts (N = 159).

FIELD STRENGTH/SEQUENCE: Three axial sequences from 1.5 or 3 T scanner were used: fast spin echo T2-weighted imaging with fat saturation (T2WI FS), echo planar diffusion-weighted imaging, and 2D volumetric interpolated breath-hold examination of contrast-enhanced T1-weighted imaging (CE-T1WI) with FS.

ASSESSMENT: Three monoparametric MICNN models were built based on T2WI FS, apparent diffusion coefficient map, and CE-T1WI. Based on these monoparametric models, we constructed an early multiparametric (EMP) model and a late multiparametric (LMP) model using early and late information fusion methods, respectively. The diagnostic performance of the models was evaluated using the receiver operating characteristic (ROC) curve and compared to the performance of six radiologists with varying levels of experience.

STATISTICAL TESTS: We used DeLong test, chi-square test, Mann-Whitney U-test, and t-test, with significance level of 0.05.

RESULTS: Both EMP and LMP models differentiated BEOT from MEOT, with an area under the ROC curve (AUC) of 0.855 (95% CI, 0.795-0.915) and 0.884 (95% CI, 0.831-0.938), respectively. The AUC of the LMP model was significantly higher than the radiologists’ pooled AUC (0.884 vs. 0.797).

DATA CONCLUSION: The developed MICNN models can effectively differentiate BEOT from MEOT and the diagnostic performances (AUCs) were more superior than that of the radiologists’ assessments.

LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2.

PMID:34842320 | DOI:10.1002/jmri.28008