Effects Of Treatment In Children Research Articles

PET/CT in diagnosis and monitoring the effect of treatment in children with malignant tumors

PET/CT in diagnosis and monitoring the effect of treatment in children with malignant tumors

Monitoring Nusinersen Treatment Effects in Children with Spinal Muscular Atrophy with Quantitative Muscle MRI.

Spinal muscular atrophy (SMA) is caused by deficiency of survival motor neuron (SMN) protein. Intrathecal nusinersen treatment increases SMN protein in motor neurons and has been shown to improve motor function in symptomatic children with SMA. We used quantitative MRI to gain insight in microstructure and fat content of muscle during treatment and to explore its use as biomarker for treatment effect. We used a quantitative MRI protocol before start of treatment and following the 4th and 6th injection of nusinersen in 8 children with SMA type 2 and 3 during the first year of treatment. The MR protocol allowed DIXON, T2 mapping and diffusion tensor imaging acquisitions. We also assessed muscle strength and motor function scores. Fat fraction of all thigh muscles with the exception of the m. adductor longus increased in all patients during treatment (+3.2%, p = 0.02). WaterT2 showed no significant changes over time (-0.7 ms, p = 0.3). DTI parameters MD and AD demonstrate a significant decrease in the hamstrings towards values observed in healthy muscle. Thigh muscles of children with SMA treated with nusinersen showed ongoing fatty infiltration and possible normalization of thigh muscle microstructure during the first year of nusinersen treatment. Quantitative muscle MRI shows potential as biomarker for the effects of SMA treatment strategies.

Normative parameters of motor nerve conduction studies in infants

Introduction. Electromyography (EMG) is a modern method of instrumental neurophysiological diagnostics, which includes two main techniques as nerve conduction studies and needle EMG. Parameters of motor nerve conduction studies have been used in a number of clinical studies to evaluate the effectiveness of treatment in children with spinal muscular atrophy (SMA) during the use of pathogenetic therapy (nusinersen). Now, in our country there are no verified normative parameters of motor nerve conduction studies in infants. It is also worth saying that neonatal screening for identifying SMA patients started in 2023 in our country, and currently gene therapy for this disease is increasingly used, so improving methods for instrumental assessment of the dynamics of the condition during treatment, including using EMG, is relevant. 
 Objective: to determine the normative parameters of motor nerve conduction studies in 1–6 months, 7–12 months, and 13–24 months infants without neurological pathology.
 Materials and methods: The motor nerve conduction studies were carried out using a 2-channel electromyograph Neuro-MVP-Micro (Russia) with electrical stimulation of the ulnar nerve and registration of the compound muscle action potential (CMAP) from the abductor digiti minimi muscle. This made it possible to determine the main parameters of the negative peak of the CMAP — distal latency, amplitude and area, and calculate the motor nerve conduction velocity (MNCV) along the distal part of the ulnar nerve. The obtained data for each parameter were subject to normal distribution and presented in the form of mean and standard deviation (M±SD), minimum and maximum values (min – max).
 Results: In the age range of 1–6 months, the amplitude of the CMAP (mV) was 5.0±1.0 (3.0–8.0); CMAP area (ms∙mV) — 9.1 ± 2.1 (5.5–12.9); distal latency (ms) — 2.2 ± 0.2 (1.6–2.5), MNCV (m/s) — 37.5 ± 5.4 (27.5–48.9).
 In the age range of 7–12 months, the amplitude of the CMAP (mV) was 6.2 ± 1.3 (3.8-9.3); CMAP area (ms∙mV) — 11.7 ± 3.0 (6.5–18.6); distal latency (ms) — 2.0 ± 0.2 (1.4–2.4), MNCV (m/s) – 48.4 ± 4.1 (42.1–55.2).
 In the age range of 13-24 months, the amplitude of the CMAP (mV) was 6.4 ± 0.6 (5.0-7.3); CMAP area (ms∙mV) — 13.3 ± 2.8 (9.8–18.2); distal latency (ms) — 2.2 ± 0.2 (1.8–2.5), MNCV (m/s) – 52.6 ± 3.8 (41.8–57.3).
 Conclusion. For the first time, normative parameters of motor nerve conduction studies were obtained in 1–6, 7–12, and 13–24 months infants without neurological pathology. This will make it possible to objectify neurophysiological parameters in neuromuscular diseases in infants.

Efficacy of integrating a semi-immersive virtual device in the HABIT-ILE intervention for children with unilateral cerebral palsy: a non-inferiority randomized controlled trial

BackgroundThe implementation of virtual devices can facilitate the role of therapists (e.g., patient motivation, intensity of practice) to improve the effectiveness of treatment for children with cerebral palsy. Among existing therapeutic devices, none has been specifically designed to promote the application of principles underlying evidence-based motor skill learning interventions. Consequently, evidence is lacking regarding the effectiveness of virtual-based sessions in motor function rehabilitation with respect to promoting the transfer of motor improvements into daily life activities. We tested the effectiveness of implementing a recently developed virtual device (REAtouch®), specifically designed to enable the application of therapeutic motor skill learning principles, during a Hand Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) intervention.MethodsForty children with unilateral cerebral palsy (5–18 years; MACS I-III; GMFCS I-II) were randomly assigned to a control group or a “REAtouch®” experimental group for a 90-h HABIT-ILE day-camp intervention (two weeks). Children in the REAtouch® group spent nearly half of their one-on-one therapeutic time using the REAtouch®. Participants underwent three testing sessions: the week before (T1), after intervention (T2), and at three months follow-up (T3). The primary outcome was the Assisting Hand Assessment (T3–T1; blinded). Secondary outcomes measured uni-bimanual hand function, stereognosis, gait endurance, daily life abilities, and functional goals. Accelerometers and a manual report of daily activities served to document therapeutic dosage and treatment characteristics. We used one-way RMANOVA to compare the efficacies of the two interventions, and non-inferiority analyses to contrast changes in the “REAtouch®” group versus the “HABIT-ILE” control group.ResultsWe found significant improvements in both groups for most of the outcome measures (p < 0.05). There was significant non-inferiority of changes in the REAtouch® group for upper extremities motor function, functional goals attainment, and abilities in daily life activities (p < 0.05).ConclusionsUse of the REAtouch® device during HABIT-ILE showed non-inferior efficacy compared to the conventional evidence-based HABIT-ILE intervention in children with unilateral cerebral palsy. This study demonstrates the feasibility of using this virtual device in a high dosage camp model, and establishes the possibility of applying the therapeutic principles of motor skill learning during specifically designed virtual-based sessions.Trial registration: Trial registration number: NCT03930836-Registration date on the International Clinical Trials Registry Platform (ICTRP): June 21th, 2018; Registration date on NIH Clinical Trials Registry: April 29th, 2019. First patient enrollment: July 3rd, 2018.

Comparison of Bayesian methods for incorporating adult clinical trial data to improve certainty of treatment effect estimates in children.

There are challenges associated with recruiting children to take part in randomised clinical trials and as a result, compared to adults, in many disease areas we are less certain about which treatments are most safe and effective. This can lead to weaker recommendations about which treatments to prescribe in practice. However, it may be possible to 'borrow strength' from adult evidence to improve our understanding of which treatments work best in children, and many different statistical methods are available to conduct these analyses. In this paper we discuss four Bayesian methods for extrapolating adult clinical trial evidence to children. Using an exemplar dataset, we compare the effect of their modelling assumptions on the estimated treatment effect and associated heterogeneity. These modelling assumptions range from adult evidence being completely generalisable to being completely unrelated to the children's evidence. We finally discuss the appropriateness of these modelling assumptions in the context of estimating treatment effect in children.

The evaluation of minimal disseminated disease in the bone marrow of children with Burkitt lymphoma using next generation sequencing

The effectiveness of treatment for children with B-cell non-Hodgkin lymphomas (B-NHL) has reached 85–90% after the introduction of modern risk-adapted treatment regimens that involve risk group stratification based on tumor stage. Bone marrow involvement is traditionally evaluated using quantitative morphological analysis of tumor cells which has, however, a lower sensitivity compared to molecular genetic methods. In our study, we used next generation sequencing (NGS) to identify tumor-specific V-(D)/J-rearrangements of immunoglobulin genes which can be used as a marker for the evaluation of minimal disseminated disease (MDD) in children with B-NHL. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. Here we demonstrated that NGS allows detection of bone marrow involvement at a sensitivity of 10–6 in patients with Burkitt lymphoma, in whom standard morphological analysis failed to reveal the presence of tumor cells. The detection of molecular MDD can improve tumor staging and risk stratification in children with B-cell non-Hodgkin lymphomas.

Influence of Communication Competence and Communication Style on the Nurse-Parent Partnership in Pediatric Nurses

Purpose: The purpose of this study was to examine the relationship of communication competence and communication style with nurse-parent partnership among pediatric nurses. Methods: This study had a descriptive, correlational design. Data were collected from 169 pediatric nurses in B metropolitan city and Y city, from January 2018 to February 2018. A structured questionnaire was administered. Data were analyzed using descriptive statistics, the t-test, one-way analysis of variance, the Scheffé test, the Kruskal-Wallis test, and multiple regression analysis with SPSS version 23.0. Results: Nurse-parent partnership was correlated with communication competence (r=.59, p&lt;.001), an informative communication style (r=.65, p&lt;.001), an affective communication style (r=.68, p&lt;.001), and an authoritative communication style (r=-.30, p&lt;.001). The factors influencing nurse-parent partnership among the study subjects were an affective communication style, an informative communication style, communication competence, and the nurses’ current position. The overall explanatory power of this model was 61.0%, and the most influential factor was an affective communication style. Conclusion: Nurse-parent partnership showed significant correlations with communication competence and affective and informative communication styles. The study may serve as a basic resource for promoting nurse-parent partnership, which increases the effectiveness of treatment for children in pediatric wards and will ultimately help improve the quality of child care.

Classification of tracheobronchial tuberculosis in 252 children

Objective: To provide theoretical basis for early diagnosis and accurate bronchoscopic classification of tracheobronchial tuberculosis (TBTB) in children through analyzing the clinical characteristics, bronchoscopic classifications and treatment effect in children with TBTB. Methods: In this respective study, we collected clinical data of patients with TBTB who accepted bronchoscopies in Interventional Pulmonology Department of Beijing Children's Hospital Affiliated to Capital Medical University between January, 2006 and December, 2019. The basic data, including clinical manifestations, imaging features, bronchoscopic characteristics and effects of interventional therapy were analyzed. The results of the study were statistically described and analyzed using SPSS 22.0 statistical software for relevant data. Results: Total 252 children with TBTB were included in this study. The median age was 1.7 years (quartile: 0.8 years, 5.2 years). Analysis of the classification of TBTB showed that the percent of lymph node fistula type was 96.4% (243/252), ulcerative necrosis type 1.2%(3/252), granulation proliferation type 0.4% (1/252), and cicatricial stricture type 0.8% (2/252). In addition, 1.2% (3/252) of the cases showed the same bronchoscopic manifestations as lymph node fistula type, but it was not clear on imaging whether the caseous material in the lumen was caused by lymph node or lung erosion. Therefore, the "bronchial fistula type" was proposed. Conclusions: Lymph node fistula type of TBTB was the common in children. The classification of lymph node fistula mostly depended on imaging evidence, and this may lead to some uncertainty in classifying TBTB in cases with no imaging evidence of enlarged lymph nodes.

Clinical investigator perspectives on the effects of intrathecal idursulfase-IT treatment in children with neuronopathic mucopolysaccharidosis type II

Clinical investigator perspectives on the effects of intrathecal idursulfase-IT treatment in children with neuronopathic mucopolysaccharidosis type II

Дієтотерапія у дітей при ожирінні, асоційованому з лактазною недостатністю дорослого типу

Актуальність. Надлишок лактози в харчуванні дитини, особливо в поєднанні з лактазною недостатністю дорослого типу (генотип С/С 13910), сприяє персистенції хронічного запального процесу, асоційованого з формуванням ускладненого інсулінорезистентністю ожиріння. Низьколактозна дієтотерапія зменшує інсулінорезистентність, сприяє встановленню імуносупресорної спрямованості імунної відповіді за рахунок відсутності лактозозалежного пригнічення галектина 9 — основного ліганда рецептора Т-клітинного апоптозу (Tim-3). Мета дослідження: оцінка ефективності низьколактозної дієти, розробленої за допомогою комп’ютерної програми «Low-lactose diet», при лікуванні ожиріння, асоційованого з лактазною недостатністю дорослого типу, у дітей 6–18 років. Матеріали та методи. Згідно з результатами дослідження поліморфізмів гена лактази (SNP LCT) з 80 дітей 6–18 років, хворих на ожиріння, була виділена група дітей (n = 38), які мали генотип С/С 13910, що відповідає лактазній недостатності дорослого типу. Всі діти були розподілені на дві клінічні групи, які не відрізнялися за кількістю (n = 19), віком, статтю та ступенем клінічних проявів мальабсорбції лактози. Всім пацієнтам була призначена стандартна терапія основного захворювання. Додатково дітям основної групи була призначена низьколактозна дієта, розрахована за допомогою створеної нами комп’ютерної програми «Low-lactose diet». Ефективність лікування оцінювалася за антропометричними і метаболічними критеріями. Результати. Середнє значення індексу маси тіла (ІМТ) у дітей основної групи та групи порівняння на початку дослідження становило 98,00 ± 0,52 та 97,00 ± 0,61 перцентиля. Після проведеного лікування відзначалося вірогідне зниження ІМТ у дітей обох груп (p &lt; 0,05). Середнє значення рівня індексу інсулінорезистентності (НОМА-IR) у дітей основної групи та групи порівняння до лікування становило 6,8 ± 0,3 і 5,7 ± 0,9, а після лікування — 4,4 ± 0,3 і 4,3 ± 0,8 відповідно. Інсулінорезистентність вірогідно (p &lt; 0,05) знижувалася після шестимісячного курсу лікування тільки за умови суворого контролю над вмістом лактози в дієті, що проводився за допомогою комп’ютерної програми «Low-lactose diet». Висновки. Низьколактозна дієта, розрахована за допомогою комп’ютерної програми «Low-lactose diet», сприяє підвищенню ефективності лікування ожиріння у дітей з генотипом С/С 13910 і підвищує чутливість тканин до дії інсуліну, тим самим, ймовірно, попереджаючи розвиток ускладнень, асоційованих з інсулінорезистентністю.

Demonstration of functional rehabilitation treatment effects in children and young people after severe acquired brain injury

ABSTRACT Purpose To examine relationships between functional outcomes after pediatric acquired brain injury (ABI) and measures of rehabilitation dose. Methods An observational study of children receiving residential neurorehabilitation after severe ABI. Results Basic total rehabilitation dose shows a paradoxical inverse relationship to global outcome. This is due to confounding by both initial injury severity and length of stay, and variation in treatment content for a given total rehabilitation dose. Content-aware rehabilitation dose measures show robust positive correlations between fractions of rehabilitation treatment received and plausibly related aspects of outcome: specifically, between rates of recovery of gross motor function and the fraction of rehabilitation effort directed to active practice and motor learning. This relationship was robust to adjustment for therapists’ expectations of recovery. Conclusion Content-aware measures of rehabilitation dose are robustly causally related to pertinent aspects of outcome. These findings are step toward a goal of comparative effectiveness research in pediatric neurorehabilitation.

Вміст есенціальних мікроелементів в плазмі крові дітей із синдромом біологічно неактивного гормона росту

Метою роботи було підвищення ефективності лікування дітей і підлітків із синдромом біологічно неактивного гормона росту (СБНГР) на основі вивчення вмісту есенціальних мікроелементів (ЕМ) у плазмі крові. Матеріали та методи. В дослідження включено 206 дітей і підлітків з різними формами низькорослості. Діти, хворі на СБНГР, увійшли до групи з 29 осіб (14,08 %): 21 хлопчик (72,41 %) і 8 дівчаток (27,59 %), відставання у зрості яких становило від –2,0 до –4,6 SD. Середній вік дітей — 9,01 ± 0,60 року. Діагноз СБНГР підтверджений наявністю нормальних/підвищених показників гормона росту (ГР) на тлі проведення стимуляційних тестів, різким зниженням рівня інсуліноподібного фактора росту 1 (ІФР-1) та позитивною пробою на чутливість до ГР. Мікроелементний статус оцінювали шляхом визначення рівнів ЕМ (цинку, селену, марганцю, хрому, міді) у плазмі крові методом рентгенофлуоресцентної спектрометрії за допомогою спектрометра ElvaX-med (Україна). Рівні ІФР-1 в плазмі крові визначали імунорадіометричним методом за допомогою стандартних наборів IRMA IGF-1 (Immunotech® kit, Чеська Республіка). Результати. В групі дітей з СБНГР рівень цинку становив 0,57 ± 0,04 мкг/мл, селену — 0,05 ± 0,01 мкг/мл, що вірогідно нижче, ніж у загальній групі дітей з низькорослістю (р &lt; 0,001 та р &lt; 0,05 відповідно). Середні рівні хрому та міді в плазмі крові були зниженими порівняно з показниками дітей з іншими формами низькорослості й становили 0,040 ± 0,003 мкг/мл і 0,79 ± 0,05 мкг/мл відповідно, та були вірогідно нижчими, ніж у дітей контрольної групи (р &lt; 0,001). Середній рівень марганцю в плазмі крові становив 0,06 ± 0,02 мкг/мл, що дещо нижче, ніж у контрольній групі, але невірогідно (р &gt; 0,01). Висновки. У пацієнтів із СБНГР встановлено вірогідне зниження рівнів цинку, селену, хрому та міді у плазмі крові. Отже, на наш погляд, до комплексу обстеження дітей з низькорослістю доцільно включати визначення рівнів ЕМ. При виявленні знижених рівнів ЕМ рекомендовано комбіноване лікування препаратами рекомбінантного ГР та такими, які містять відповідні ЕМ, що значно підвищує ефективність ріст-корегуючої терапії.

The Efficacy, Safety, and Side Effects of Intrapericardial Triamcinolone Treatment in Children with Post-surgical Pericardial Effusion: A Case Series

Intrapericardial triamcinolone can be used to treat chronic pericardial effusion (PE) in adults; however, pediatric data are lacking. In this case series we aim to evaluate the efficacy, safety, and side effects of intrapericardial triamcinolone in children with PE. The incidence and treatment of post-surgical PE from 2009 to 2019 were determined using the institutional surgical database and electronic patient records. Furthermore, a retrospective analysis of efficacy, safety, and side effects of intrapericardial triamcinolone treatment for chronic post-surgical PE was performed. The incidence of postoperative PE requiring treatment was highest after atrial septal defect (ASD) closure when compared to other types of cardiac surgery (9.7% vs 4.3%). Intrapericardial treatment with triamcinolone resolved pericardial effusion in 3 out of 4 patients. All patients developed significant systemic side effects. Surgical ASD closure is associated with an increased risk of development of PE requiring treatment. Intrapericardial triamcinolone is an effective treatment for chronic postoperative PE in children, but is always associated with significant systemic side effects. Close monitoring and treatment of adrenal insufficiency are mandatory in these cases.

Parent-Reported Symptoms and Perceived Effectiveness of Treatment in Children Hospitalized with Advanced Heart Disease

To characterize parent-reported symptom burden and effectiveness of symptom management in children hospitalized with advanced heart disease. Prospective survey study of 161 parents whose child was admitted to a single institution with advanced heart disease between March 2018 and February 2019 using the Survey about Caring for Children with Heart Disease. Of the 161 patients, 54% were under 2years old with a diagnosis of single ventricle physiology (39%), pulmonary hypertension (12%), and other congenital heart disease (28%). Over one-half (56%) of parents reported that their child was experiencing a high degree ("a great deal"/"a lot") of symptoms. The most frequently reported symptoms were pain (68%), fatigue (63%), and breathing difficulties (60%). Of the symptoms that were treated, parents perceived successful treatment to be least likely for their child's sleep disturbance (24%), depression (29%), and fatigue (35%). Parents who reported their child's functional status as New York Heart Association class III/IV were more likely to report that their child was experiencing "a great deal" of symptoms, compared with those who reported class I/II (51% vs 19%, P<.001). Parents who reported their child was experiencing a high degree of suffering from fatigue were also more likely to report a high symptom burden (P<.001). Parents of children with advanced heart disease reported high symptom burden with a broad spectrum of symptoms. Parents reported fatigue and psychiatric symptoms frequently and rarely reported treatment as successful. Parents' view of their child's symptom burden was concordant with their perception of their child's functional status.

The role of cell signaling molecules in the pathogenesis of glomerulonephritis in children

Background: Cytokines are functional class of tiny proteins and glycoprotein and fundamentally they are monomers that function as soluble mediators in an autocrine or paracrine manner. Cytokines are produced by a number of cell types, predominantly leukocytes, and their targets implicate both immune and non-immune cells. Material and methods: This study was performed on 75 children with glomerulonephritis (GN), aged from 2 up to 17 years. There were 20 children with steroid-sensitive nephrotic syndrome (SSNS), 15 children with steroid-resistant nephrotic syndrome (SRNS), 20 children with chronic glomerulonephritis (CGN) nephrotic form and 20 children with CGN mixed form. This study was performed on patients experiencing disease relapse and clinical remission. The control group consisted of 20 healthy children. Results: The results of this study demonstrated increased levels of cell signaling molecules (IL-8, TNF-α, MCP-1, MIP-1α) in the urine during clinical manifestations, valuable result due to their major role in the immunopathogenic mechanism of proteinuria in nephrotic syndrome. Conclusions: Determination of urinary concentrations of cellular signaling molecules may be useful as a predictive non-invasive method for estimating disease activity, monitoring disease progression, differentiating steroid-sensitive nephrotic syndrome from steroid-resistant nephrotic syndrome, and assessing the effectiveness of treatment in children with different variants of GN

Эффективность лечения содружественного косоглазия у детей с гиперметропией методом хемоденервации ботулиническим токсином типа А

Purpose. Evaluation of the effectiveness of concomitant strabismus treatment in children with hyperopia by botulinum toxin type A chemodenervation. Materials and methods. The effectiveness of using botulinum toxin type A chemodenervation was studied in 115 children (230 eyes) from 8 months to 15 years old with concomitant convergent strabismus and hyperopic refraction. All patients were divided into 3 groups: group 1–17 patients with strabismus angle up to 15° according to Hirshberg, group 2–34 patients with strabismus angle from 15 to 25° according to Hirshberg, group 3–64 patients with strabismus angle more than 25° according to Hirshberg. All children received an injection of botulinum toxin type A into the horizontal oculomotor muscles at an average dosage of 3.4. Results. In most cases (68.70%), a positive effect was achieved after one injection. Two injections were given to 30 patients (26.09%), 6 patients were given 3 injections (5.22%). Repeated injections, most often (19.13%), were required in patients with a strabismus angle of more than 25 degrees. The effectiveness of strabismus treatment depends on the initial value of the angle and the adequately selected dose. Most often, a positive result of treatment was observed after one injection of botulinum toxin type A with a volume of 2 to 4. We did not find any complications when using the denervation method. Conclusion. The method of botulinum toxin type A chemodenervation is effective in the treatment of concomitant strabismus in children with hyperopia. Key words: botulinum toxin type A, concomitant strabismus, chemodenervation, children, hyperopia.

Treating children with disinhibited social engagement disorder symptoms: Filial therapy

IntroductionChildren affected by social neglect and other forms of abuse are at significant risk of developing mental health problems as well as social, academic, and behavioral functioning difficulties. Some studies have assessed the effectiveness of treatment for children with trauma-attachment disorder. Nevertheless, some questions remain to be answered regarding appropriate treatment.ObjectivesAim This research identified how filial therapy affects the extent to which foster parents are responsive, sensitive, and attentive to the needs of their children in their care. Subsequently, the study explored how this bond, influenced during filial therapy, affects the signs and symptoms of disinhibited social engagement disorder.MethodsMethod This study used case study as the methodology to research the influence of filial therapy (CPRT) in foster children who show the symptoms of disinhibited social engagement disorder- aged three to six. Two sets of foster parents received a 10-session filial therapy model (CPRT) across 10 weeks. Pre and post measures of the parent-child relationship were analyzed.ResultsResult The findings indicate that filial therapy greatly enhances the bond between foster parents and children with DSEDs. Moreover, these improvements in the bond diminished the symptoms of disinhibited social engagement disorder.ConclusionsConclusion The impact of filial therapy as a responsive intervention reduced the symptoms of disinhibited social engagement disorder. The symptoms have declined very likely as a result of rebuilding, regenerating, and enhancing the relationship between foster children and foster parents.DisclosureNo significant relationships.

Effectiveness of Treatment in Children With Cerebral Palsy.

Objective: The objective of this study was to assess the effectiveness of conservative and surgical treatment in cerebral palsy children by evaluating the Medical Research Council (MRC) grading system, modified Ashworth scale, and Barthel Activities of Daily Life (ADL) scale.Method: This prospective case series was performed using a non-probability consecutive sampling technique at the Department of Orthopedic Surgery and Traumatology, King Edward Medical University/Mayo Hospital, Lahore from October 2011 to November 2013. Two hundred children of all ages, having cerebral palsy diagnosed on history and clinical examination were enrolled in the study. Children were treated with conservative and surgical treatment. Pre- and post-treatment, all children were classified based on movement disorder (spastic, athetoid, ataxic, and mixed), parts of the body involved (paraplegic, tetraplegic, diplegic, hemiplegic, monoplegic, double hemiplegic, and triplegic), and gross motor function (GMFCS level I-IV). Their muscle power and tone were assessed using the MRC grading system and modified Ashworth scale, respectively. Assessment of disability and daily function was done by ranking disability grading and Barthel ADL, respectively. The range of motion (ROM) of each joint was assessed clinically. Children were divided based on the treatment method as non-surgical versus surgical treatment.Results: Out of a total of 200 children, the mean age of the children was 7.86±4.17year. There were 134 (67.0%) males and 66 (33.0%) female children. Classification on basis of movement disorder, body part involved, and gross motor function at three-month intervals till twelve months was performed. From the first presentation of children till the last follow-up time period, i.e., 12th month there was no change in the movement disorder (a type of CP, body parts involved, and GMFCS). The final rating of overall treatment results shows that there were 84 (42%) patients who had a poor outcome, and only 35 (17.50%) patients had a fair treatment outcome and 81 (40.50%) patients had good treatment outcomes. Conclusion: The conservative and surgical management showed no effect on movement disorder of the child although, on the final rating scale fair to good treatment outcome was observed in all children. There was an improvement in muscle power grading on the ADL, but no significant improvement was seen on the improvement of type, parts of the body involved, gross motor function classification, modified Ashworth, and ranking disability grading of the children.

Модель прогнозу ефективності лікування гемангіоми у дітей

Hemangioma is one of the most common benign tumors in newborns. It is a neoplastic proliferative tumor characterized by a period of growth (proliferation) after birth and possible spontaneous involution (regression). Despite the increased interest in the problems of hemangioma treatment and a large number of developed techniques, no clear criteria for choosing a therapy method and its effectiveness exist. Further search for effective treatment methods is necessary because of the variety of forms, localization and prevalence of hemangiomas. The purpose of this work was to develop and test models for predicting the effectiveness of hemangioma treatment in children. Material and methods. The indicators of 84 children with hemangioma who received three types of treatment were used to develop the models. Propranolol was used for the treatment of the first group of children (17 people), timolol was used in the second group (15 people), timolol with compression was used in the third group (52 children). Results and discussion. Hemangioma treatment outcome prediction models have been developed using fuzzy logic. The value of the developed models lies in the fact that indicators that are determined during the initial examination of the child are used to determine the possible outcome of treatment and to choose its optimal tactics. To predict the effectiveness of propranolol treatment the term of the treatment onset and the activity of hemangioma according to hemangioma severity scale are informative. Additional indicators are the period from the birth of a child to the appearance of hemangioma and deviations from the normal values of the clinical blood test indicators. When using timolol, the main informative indicators for predicting the effectiveness of treatment are the period from the treatment onset, the activity of hemangioma according to hemangioma severity scale and the duration of treatment, which can be selected from the interval from 5 to 11 months. The sFasL1 values and the baby’s birth weight are used as additional indicators. When using timolol with compression for predicting the effectiveness of treatment, the main informative indicators are the duration of treatment, the period of the treatment onset and the indicator according to hemangioma severity scale at the beginning of treatment. The duration of treatment can be chosen in each case, based on the desired result, from the range of 5-19 months. Data on the morphological type of hemangioma, the depth of its spread and the presence of factors provoking its growth are used as additional indicators. The average values of errors of the models of predicting indicators characterizing the effectiveness of treatment using various methods were 0.03-9.1% for the indicator according to HSS; for the indicator according to VAS1(visual analog scale) was 2.2-9.4%; for the indicator according to VAS2 was 0.98-5.0%. Conclusion. Developed models for predicting the effectiveness of hemangioma treatment allowed the doctor choosing the most effective method and determining its duration. The software module that implements a support system for a doctor’s decision making as for selecting the optimal method for treating hemangioma can be used in healthcare institutions of various levels of provision of medical aid

Social disparities in obesity treatment for children age 3-10 years: A systematic review.

Socio-economic status and ethnic background are recognized as predictors of risk for the development of obesity in childhood. The present review assesses the effectiveness of treatment for children according to their socio-economic and ethnic background. Sixty-four systematic reviews were included, from which there was difficulty reaching general conclusions on the approaches to treatment suitable for different social subgroups. Eighty-one primary studies cited in the systematic reviews met the inclusion criteria, of which five directly addressed differential effectiveness of treatment in relation to social disparities, with inconsistent conclusions. From a weak evidence base, it appears that treatment effectiveness may be affected by family-level factors including attitudes to overweight, understanding of the causes of weight gain and motivation to make and maintain family-level changes in health behaviours. Interventions should be culturally and socially sensitive, avoid stigma, encourage motivation, recognize barriers and reinforce opportunities and be achievable within the family's time and financial resources. However, the evidence base is remarkably limited, given the significance of social and economic disparities as risk factors. Research funding agencies need to ensure that a focus on social disparities in paediatric obesity treatment is a high priority for future research.