| 1. |
- Mårtensson, Thomas, et al.
(författare)
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Choice of Endoscopic Procedure in Children With Clinically Suspected Gastrointestinal Graft-Versus-Host Disease.
- 2018
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Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - 0277-2116 .- 1536-4801. ; 66:5, s. 744-750
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Gastrointestinal graft-versus-host disease (GI-GVHD) is a potentially life-threatening complication after hematopoietic stem cell transplantation. Symptoms indicating GI-GVHD motivates endoscopy with biopsy sampling and histopathological confirmation. Optimal extent of endoscopy in children is, however, presently unknown. Therefore, we aimed to evaluate whether biopsies from the rectosigmoid area versus the rest of the colon/ileocolon with or without biopsies from simultaneous upper endoscopy, were equally reliable for detection of GI-GVHD and relevant differential diagnoses.Methods: Retrospective multicenter study based on histopathological re-evaluation of biopsies and hospital record data, collected from children with suspected GI-GVHD.Results: Forty-four children with 51 endoscopic occasions (81 procedures) were included. Thirty-nine of 51 (76.5%) were diagnosed as GI-GVHD, 14 (27.4%) received a differential diagnosis and 7 (13.7%) had normal histology findings. Comorbidity, that is, simultaneous detection of a differential diagnosis and GI-GVHD, was observed in 9 (23.1%) cases. Cytomegalovirus infection was the most frequent differential diagnosis, 6 of 7 were detected in biopsies from rectosigmoid and esophagogastroduodenal areas. Sensitivity for detection of GI-GVHD in biopsies collected from rectosigmoid-ileocolonic-, rectosigmoid-, or esophagogastroduodenal areas were 97.4%, 84.6%, 83.3%, respectively, and 97.4% when the latter 2 were merged. The difference, nondetected GI-GVHD in the rectosigmoid area versus detected elsewhere in the GI tract, was statistically significant (P = 0.03).Conclusions: Biopsies collected from the rectosigmoid area solely were not optimal for detection of pediatric GI-GVHD. When biopsy sampling from rectosigmoid and upper GI tract areas was combined, the sensitivity for GI-GVHD was, however, equally high as for ileocolonoscopy or full upper and lower endoscopy.
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| 2. |
- Mårtensson, Thomas, et al.
(författare)
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Diagnostic disagreement between clinical standard histopathological- and retrospective assessment of histopathology-based gastrointestinal graft-versus-host disease in children
- 2020
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Ingår i: Pediatric Transplantation. - : WILEY. - 1397-3142 .- 1399-3046. ; 24:8
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Tidskriftsartikel (refereegranskat)abstract
- Background: No previous paediatric study has evaluated the frequency of diagnostic disagreement between clinical standard histopathological assessment (CSHA) and retrospective, independent, histopathological assessment (RIHA) of gastrointestinal Graft-Versus-Host Disease (GI-GVHD).Methods: In a retrospective cohort study, based on gastrointestinal biopsies collected from allogeneic HSCT-treated children (<18 years) with symptom-based GI-GVHD, we evaluated; disagreement of histopathology-based GI-GVHD diagnosis in CSHA vs RIHA, and potential clinical consequences of differences between the assessments. The CSHA-based diagnoses were retrieved from histopathology reports. The RIHA was performed by one pathologist, blinded to the CSHA outcomes and based on the minimal criteria for histopathology-based GI-GVHD diagnosis by theNIH 2014.Results: Seventy children with 92 endoscopic occasions (including 22 re-endoscopies) were enrolled. GI-GVHD was observed in 73% (67/92) of the endoscopies in the RIHA and in 54% (50/92) in the CSHA (P = .014). The RIHA confirmed 94% (47/50) with GI-GVHD and 52% (22/42) with non-GI-GVHD diagnoses, established in the CSHA. Disagreement, that is endoscopic occasions with GI-GVHD solely detected in RIHA or detection of GI-GVHD in CSHA but not in RIHA, was observed in 20/42 (48%) and 3/50 (6%), respectively (McNemar's test, P = .0008). The risk of a subsequent re-endoscopy was higher in endoscopic occasions with GI-GVHD detected in RIHA but not in CSHA vs if non-GI-GVHD were detected in both readings (P = .005).Conclusion: Our results suggest that in children with symptom-based GI-GVHD without histopathological confirmation in CSHA, a second,NIH 2014based histopathological assessment should be considered before performing a re-endoscopy.
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| 3. |
- Sundar Tikmani, Shiyam, et al.
(författare)
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Diagnostic accuracy of foot length measurement for identification of preterm newborn in rural Sindh, Pakistan
- 2024
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Ingår i: BMJ Paediatrics Open. - : BMJ Publishing Group Ltd. - 2399-9772. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Assessing gestational age accurately is crucial for saving preterm newborns. In low and middle-income countries, such as Pakistan, where access to antenatal ultrasonography (A-USG) is limited, alternative methods are needed. This study evaluated the diagnostic accuracy of foot length (FL) measurement for identifying preterm newborns in rural Pakistan using A-USG as the reference standard.Methods A test validation study was conducted between January and June 2023 in rural Sindh, Pakistan, within the catchment area of the Global Network for Maternal Newborn Health Registry, Thatta. Singleton newborns whose mothers had an A-USG before 20 weeks of gestation were enrolled. A research assistant measured FL three times using a rigid transparent plastic ruler within 48 hours of birth and the average FL was reported. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and likelihood ratios were calculated. The optimal FL cut-off for the identification of preterm newborns was determined using the Youden Index.Results A total of 336 newborns were included in the final analysis, of whom 75 (22.3%) were born before 37 weeks of gestation. The median gestational age of the newborns was 38.2 weeks, and the median FL was 7.9 cm. The area under the curve was 97.6%. The optimal FL cut-off for identifying preterm newborns was considered as ≤7.6 cm with a sensitivity of 90.8%, specificity of 96.0%, PPV of 86.7% and NPV of 97.3%. A lower cut-off of ≤7.5 cm had a sensitivity of 95.4%, specificity of 84.0%, PPV of 63.1% and NPV of 98.5%.Conclusion In conclusion, this study highlights the utility of FL measurement for identifying preterm newborns in rural settings where A-USG is unavailable before 20 weeks of gestation. Optimal cut-offs of ≤7.6 and ≤7.5 cm provide a simple, cost-effective and reliable tool for clinicians and frontline healthcare providers in rural areas, respectively.
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| 4. |
- Sunder Tikmani, Shiyam, et al.
(författare)
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Exploring gestational age, and birth weight assessment in Thatta district, Sindh, Pakistan : Healthcare providers' knowledge, practices, perceived barriers, and the potential of a mobile app for identifying preterm and low birth weight
- 2024
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 19:4
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionReliable methods for identifying prematurity and low birth weight (LBW) are crucial to ending preventable deaths in newborns. This study explored healthcare providers’ (HCPs) knowledge, practice, perceived barriers in assessing gestational age and birth weight and their referral methods for preterm and LBW infants. The study additionally assessed the potential of using a mobile app for the identification and referral decision of preterm and LBW.MethodsThis qualitative descriptive study was conducted in Thatta District, Sindh, Pakistan. Participants, including doctors, nurses, lady health visitors, and midwives, were purposefully selected from a district headquarter hospital, and private providers in the catchment area of Global Network’s Maternal and Newborn Health Registry (MNHR). Interviews were conducted using an interview guide after obtaining written informed consent. Audio recordings of the interviews were transcribed and analyzed using NVIVO® software with an inductive approach.ResultsThe HCPs had extensive knowledge about antenatal and postnatal methods for assessing gestational age. They expressed a preference for antenatal ultrasound due to the perceived accuracy, though accept practical barriers including workload, machine malfunctions, and cost. Postnatal assessment using the Ballard score was only undertaken sparingly due to insufficient training and subjectivity. All HCPs preferred electronic weighing scales for birth weight Barriers encountered included weighing scale calibration and battery issues. There was variation in the definition of prematurity and LBW, leading to delays in referral. Limited resources, inadequate education, and negative parent past experiences were barriers to referral. Foot length measurements were not currently being used. While mobile apps are felt to have potential, unreliable electricity supply and internet connectivity are barriers.ConclusionThe HCPs in this study were knowledgeable in terms of potential tools, but acknowledged the logistical and parental barriers to implementation.
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| 5. |
- Urooj, Faiza, et al.
(författare)
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Socio-demographic characteristics of children and young people with primary brain tumours : comparison between a public and private sector tertiary hospital in Karachi, Pakistan
- 2024
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Ingår i: JOURNAL OF PAKISTAN MEDICAL ASSOCIATION. - : Pakistan Medical Association. - 0030-9982. ; 74:2, s. 366-369
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Tidskriftsartikel (refereegranskat)abstract
- Primary brain tumours (PBTs) are the commonest solid tumours in children and young people (CYP). A study was conducted at a private and a public sector hospital in Karachi, Pakistan, to determine the socio-demographic and tumour -related characteristics of CYP with PBTs between those presenting to the public and private hospitals. A total of 49 patients were included. The commonest PBT was pilocytic astrocytoma (29%). There were no differences in tumour -related characteristics between the two groups. However, parents of CYP with PBTs presenting to the public sector hospital were significantly less educated and had lower household incomes. No significant differences in age, gender, educational status, and ethnicity of CYP with PBTs were observed. Since CYP with PBTs presenting at the public sector hospital were from significantly lower socioeconomic backgrounds and their parents were less educated, it suggests socio-economic disparities in PBT care for CYPs in Karachi, Pakistan.
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| 6. |
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| 7. |
- Zahid, Nida
(författare)
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Risk factors and late effects of primary brain tumor in children and young people treated at tertiary care hospitals of Karachi, Pakistan
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Despite significant advancements, primary brain tumors (PBTs) sadly remains a major cause of morbidity and mortality, especially among children and young people (CYP) worldwide.Aims: This study aimed to evaluate the risk factors and late effects of PBTs among CYP and their primary caregivers at tertiary care hospitals in Karachi, Pakistan.Method: Study 1 was a matched case-control study at a private tertiary care hospital. Telephonic interviews were conducted with mothers of 122 cases (CYP with PBTs, ages 5-21) and 122 controls (CYP without tumors, ages 5-21) treated between 2017 and 2022. Conditional logistic regression was used for data analysis with STATA software version 12. Studies II to IV were prospective cohort studies conducted at private and public tertiary care hospitals. Forty-eight CYP with PBTs and their primary caregivers were recruited. CYP were assessed pre-treatment and at 12 months post-treatment for neurocognitive outcomes using validated tools such as the Slosson Intelligence Tool, Raven's Progressive Matrices, and Wechsler Intelligence Scale. Quality of life (QoL) of CYP and their caregivers were evaluated using the Pediatric Quality of Life Inventory. Generalized estimating equations were used for data analysis with STATA software version 12. Study V was a pilot exploratory study. The microRNA expression was assessed using quantitative polymerase chain reaction (qPCR). Data was analyzed by R software.Results: The risk factors of PBTs among CYP were maternal analgesic use, paternal addictive substance use (specially smoking), higher household income, and lower paternal education. Predictors of neurocognitive outcomes in CYP were tumor type, surgical resection, post-treatment seizures, lower socioeconomic status, and low maternal education. Predictors of QoL in CYP were hydrocephalous managed with shunt and/or EVD and surgical resection. Factors affecting the QoL and family functioning of primary caregivers (mothers) included CYPs having post-treatment seizures, CYP's cognition and QoL scores, and financial burden of the disease. A significant correlation was found between pre-treatment miRNA-210 and miRNA-10b with non-verbal neurocognition at 12 months post-treatment. Conclusions: The study identified sociodemographic and antenatal risk factors associated with PBTs in CYP. It also highlighted the factors impacting the neurocognitive outcomes in CYP and QoL outcomes in CYP and their mothers. Understanding these predictors can guide the development of cost-effective treatments aimed at reducing the neurocognitive and psychological burdens faced by CYP and their primary caregivers. Future research should focus on larger-scale, multi-country studies to ensure broader applicability and generalizability of the findings.
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| 8. |
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| 9. |
- Bao, Jiming, et al.
(författare)
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Nanowire-induced Wurtzite InAs Thin Film on Zinc-Blende InAs Substrate
- 2009
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Ingår i: Advanced Materials. - : Wiley. - 1521-4095 .- 0935-9648. ; 21:36, s. 3654-3654
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Tidskriftsartikel (refereegranskat)abstract
- InAs pyramids and platelets on a zinc-blende InAs substrate are found to exhibit a wurtzite crystal structure. induced by wurtzite InAs nanowires, wurtzite InAs thin film and its associated zinc-blende/wurtzite heterocrystalline heterostructures may open up new opportunities in band-gap engineering and related device applications.
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| 10. |
- Bao, Jiming, et al.
(författare)
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Optical properties of rotationally twinned InP nanowire heterostructures
- 2008
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Ingår i: Nano Letters. - : American Chemical Society (ACS). - 1530-6992 .- 1530-6984. ; 8:3, s. 836-841
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Tidskriftsartikel (refereegranskat)abstract
- We have developed a technique so that both transmission electron microscopy and microphotoluminescence can be performed on the same semiconductor nanowire over a large range of optical power, thus allowing us to directly correlate structural and optical properties of rotationally twinned zinc blende InP nanowires. We have constructed the energy band diagram of the resulting multiquantum well heterostructure and have performed detailed quantum mechanical calculations of the electron and hole wave functions. The excitation power dependent blue-shift of the photoluminescence can be explained in terms of the predicted staggered band alignment of the rotationally twinned zinc blende/wurzite InP heterostructure and of the concomitant diagonal transitions between localized electron and hole states responsible for radiative recombination. The ability of rotational twinning to introduce a heterostructure in a chemically homogeneous nanowire material and alter in a major way its optical properties opens new possibilities for band-structure engineering.
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