Neurodevelopmental outcomes in children with isolated congenital diaphragmatic hernia: A systematic review and meta-analysis

Background: Congenital diaphragmatic hernia (CDH) reportedly has neurologic consequences in childhood however little is known about the impact in isolated CDH. / Aims: Herein we aimed to describe the risk of neurodevelopmental complications in children born with isolated CDH. / Materials & Methods: We systematically reviewed literature for reports on the neurological outcome of infants born with isolated CDH. The primary outcome was neurodevelopmental delay. Secondary outcomes included, motor skills, intelligence, vision, hearing, language and behavior abnormalities. / Results: Thirteen out of 87 (15%) studies reported on isolated CDH, including 2624 out of 24,146 children. Neurodevelopmental delay was investigated in four studies and found to be present in 16% (3‐34%) of children. This was mainly attributed to motor problems in 13% (2‐30%), whereas cognitive dysfunction only in 5% (0‐20%) and hearing in 3% (1‐7%). One study assessed the effect of fetal surgery. When both isolated and non‐isolated children were included, these numbers were higher. / Discussion: This systematic review demonstrates that only a minority of studies focused on isolated CDH, with neurodevelopmental delay present in 16% of children born with CDH. / Conclusion: To accurately counsel patients, more research should focus on isolated CDH cases and examine children that underwent fetal surgery

Epidemiology and Clinical Features of Patients with Visceral Leishmaniasis Treated by an MSF Clinic in Bakool Region, Somalia, 2004–2006

Our paper describes the epidemiological features of visceral leishmaniasis in the Bakool region, South Central Somalia, over the years 2004 to 2006. Since 2000, Médecins Sans Frontières has been providing care for patients suffering from visceral leishmaniasis in Huddur, located in a region endemic for visceral leishmaniasis. By the end of 2005, we witnessed a dramatic increase in the number of patients admitted to the Huddur centre with visceral leishmaniasis. In our paper, we provide a description of the profile of patients admitted, thus giving an insight into the epidemiology of visceral leishmaniasis in a part of the world where relatively little has been documented and where the true magnitude of this neglected disease remains unknown

Detection of oligoclonal IgG kappa and IgG lambda bands in cerebrospinal fluid and serum with Hevylite™ antibodies. comparison with the free light chain oligoclonal pattern

<p>Abstract</p> <p>Background</p> <p>Oligoclonal IgG bands in cerebrospinal fluid that are absent in serum indicate intrathecal IgG synthesis and are a sensitive marker of CNS inflammatory diseases, in particular multiple sclerosis. It may be of interest to determine whether these bands are predominantly IgGκ or IgGλ.</p> <p>Methods</p> <p>We have used Hevylite™ antibodies and developed a technique for detection of oligoclonal IgGκ and IgGλ bands by means of isoelectric focusing followed by immunoblotting. The same technique was used for oligoclonal free κ and free λ detection. Among several techniques tested, affinity immunoblotting appears to be the most sensitive; it can detect less than 1 ng of IgGκ or IgGλ paraprotein. We compared oligoclonal IgG profiles with those of oligoclonal IgGκ and IgGλ. There was good agreement concerning the presence or absence of intrathecal synthesis. We observed the ratios between oligoclonal IgGκ and IgGλ bands, and they did not always match the ratios between free κ and free λ bands. We were also able to detect antigen-specific CSF-restricted oligoclonal IgGκ and IgGλ bands in neuroborreliosis. It remains to be determined subsequently by a clinically-oriented prospective study, whether predominant IgGκ/IgGλ or free κ/free λ can be observed more frequently in particular diseases with oligoclonal IgG synthesis.</p> <p>Discussion</p> <p>Very sensitive detection of oligoclonal IgGκ and IgGλ bands in cerebrospinal fluid with Hevylite antibodies is feasible; detection of antigen-specific IgGκ or IgGλ is possible as well. In particular situations, e.g. when difficulties arise in distinguishing between oligoclonal and monoclonal pattern, the test may be of considerable clinical value.</p

The emerging role of insulin-like growth factor 1 receptor (IGF1r) in gastrointestinal stromal tumors (GISTs)

Recent years have seen a growing interest in insulin-like growth factor 1 receptor (IGF1R) in medical oncology. Interesting data have been reported also on IGF1r in gastrointestinal stromal tumors (GISTs) especially in children and in young adult patients whose disease does not harbour mutations on KIT and PDGFRA and are poorly responsive to conventional therapies. However, it is too early to reach conclusions on IGF1R as a novel therapeutic target in GIST because the receptor's biological role is still to be defined and the clinical significance in patients needs to be studied in larger studies. We update and comment the current literature on IGF1R in GISTs and discuss the future perspectives in this promising field

Diagnostic Accuracy of the Leishmania OligoC-TesT and NASBA-Oligochromatography for Diagnosis of Leishmaniasis in Sudan

The leishmaniases are a group of vector-borne diseases caused by protozoan parasites of the genus Leishmania. The parasites are transmitted by phlebotomine sand flies and can cause, depending on the infecting species, three clinical manifestations of leishmaniasis: visceral leishmaniasis (VL), post kala-azar dermal leishmaniasis (PKDL) and cutaneous leishmaniasis (CL) including the mucocutaneous form. VL, PKDL as well as CL are endemic in several parts of Sudan, and VL especially represents a major health problem in this country. Molecular tests such as the polymerase chain reaction (PCR) or nucleic acid sequence based assay (NASBA) are powerful techniques for accurate detection of the parasite in clinical specimens, but broad use is hampered by their complexity and lack of standardisation. Recently, the Leishmania OligoC-TesT and NASBA-Oligochromatography were developed as simplified and standardised PCR and NASBA formats. In this study, both tests were phase II evaluated for diagnosis of VL, PKDL and CL in Sudan

Patient profiles in Dutch forensic psychiatry based on risk factors, pathology, and offense

Forensic psychiatry embodies a highly heterogeneous population differing widely in terms of diagnoses, crimes committed, and risk factors. All of these are vitally important for treatment indications and should be accounted for in research. However, there is limited empirical knowledge of patient profiles. This study constructed patient profiles on the basis of the three domains mentioned above. Participants were found guilty of having committed crimes due to psychiatric disorders and were admitted to Forensic Psychiatric Center (FPC) 2landen or FPC De Kijvelanden in the Netherlands. Retrospective data were retrieved from patient files. Diagnoses were assessed according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria and risk factors according to the Historical Clinical Future–30 (HKT-30) instrument. Latent class analysis was conducted to define typologies; external variables were included for validation. Four different classes or “patient risk profiles,” with varying psychopathologies, risk factors, and crimes, were identified. Results were consistent with previous studies, and external validation with the Psychopathy Checklist–Revised (PCL-R) two-factor model and the four facets of the PCL-R agreed with results found. Results display specific risk factors for specific psychopathology/offense combinations

Forensic psychiatric treatment evaluation: The Clinical evaluation of treatment progress with multiple forensic routine outcome monitoring measures

The likelihood of recidivism is considered to be the most important outcome measure in forensic psychiatry. Therefore, forensic psychiatric treatment focuses on the reduction of the risk of recidivism by treating dynamic risk and protective factors, aiming to reduce risk factors while enhancing protective factors during treatment. The goal of this study is to assess treatment progress with the Instrument for Forensic Treatment Evaluation (IFTE) in a Dutch forensic psychiatric centre (n = 240). Latent Class Analysis was conducted to reconfirm previously found patient profiles. Patient profiles were based on risk factors, psychopathology, and offence type. Repeated measures ANOVAs were conducted to assess treatment progress for the whole patient group, for high and low risk patients, and for patients who had been in treatment for a period longer and shorter than one year. Latent Class Analysis has not reconfirmed the previously found profiles, therefore a repeated measures ANOVA was not conducted on profile level. On group-level, no significant progress was found. Though, patients with low protective behaviour, low resocialization scores, and high problem behaviour scores displayed significant treatment progress. Patients with low problematic behaviour showed a significant increase of problematic behaviour and patients with high protective behaviour a decrease of protective behaviour. Results indicated an interaction effect between time of admission and the factor resocialization skills, however this effect was not found for the other two factors. Results imply that higher risk patients can show more treatment progress than lower risk patients

Forensic psychiatric treatment evaluation:The Clinical evaluation of treatment progress with multiple forensic routine outcome monitoring measures

The likelihood of recidivism is considered to be the most important outcome measure in forensic psychiatry. Therefore, forensic psychiatric treatment focuses on the reduction of the risk of recidivism by treating dynamic risk and protective factors, aiming to reduce risk factors while enhancing protective factors during treatment. The goal of this study is to assess treatment progress with the Instrument for Forensic Treatment Evaluation (IFTE) in a Dutch forensic psychiatric centre (n = 240). Latent Class Analysis was conducted to reconfirm previously found patient profiles. Patient profiles were based on risk factors, psychopathology, and offence type. Repeated measures ANOVAs were conducted to assess treatment progress for the whole patient group, for high and low risk patients, and for patients who had been in treatment for a period longer and shorter than one year. Latent Class Analysis has not reconfirmed the previously found profiles, therefore a repeated measures ANOVA was not conducted on profile level. On group-level, no significant progress was found. Though, patients with low protective behaviour, low resocialization scores, and high problem behaviour scores displayed significant treatment progress. Patients with low problematic behaviour showed a significant increase of problematic behaviour and patients with high protective behaviour a decrease of protective behaviour. Results indicated an interaction effect between time of admission and the factor resocialization skills, however this effect was not found for the other two factors. Results imply that higher risk patients can show more treatment progress than lower risk patients