A Rare case of HUS and ADEM

A 3-year-old girl was admitted with typical hemolytic uremic syndrome (HUS) and conservative treatments were initiated. During hospitalization, she had seizures, right hemiparesis, and loss of consciousness. Initial MR of the brain showed changes of acute disseminated encephalomyelitis (ADEM). She was treated with intravenous methylprednisolone and immunoglobulin. Upon improvement of her clinical condition, she was discharged with oral prednisolone which was tapered after two months. After one year fallow-up, the child now has a normal renal function and normal neurodevelopment

A Comparison Study of the Tehran Norms to the Reference Norms on Children Performance of the Bayley III

Objectives The Bayley Scales of Infant and Toddler Development (Bayley III) assess cognitive, language, and motor development of children aged 1–42 months, and have been widely used globally. It is unclear whether or not the reference norms of the Bayley III are acceptable for use in other populations or lead to over or under-estimating development. The purpose of this study was to estimate the distribution of the Bayley scores by age in Persian speaking children and to compare the norms between Persian and reference norms. Materials & Methods We constructed Bayley III norms for cognitive, language, and motor scales using 1,674 typically developing children by consecutive sampling from health care centers. First cut-off point was determined, and then the scaled scores, based on Persian speaking and reference norms, were compared. The proportions of children with low scores (scoring less than -1SD and -2 SD) based on the two norms were compared, to identify over or under-referral for developmental delay resulting from reference norms. Results Scaled scores based on Persian norms varied across values based on reference norms on all subtests. The mean differences were significant across all five sub-tests (p < .05), with large effect sizes for receptive and expressive communication, fine and gross motor sub-tests of .20, .23, .14, and .25 respectively, and with small effect size for cognition sub-test of .02. Large effect sizes for all age groups were found for cognition, expressive communication, and fine motor sub-tests. For the receptive communication sub-test, effect sizes were generally large, with the exception of four age groups. For the gross motor sub-test, effect sizes were generally large, with the exception of six age groups. More children scored below 1 and 2 SD using the Persian norms and resulted in under-referral regarding cognitive, receptive and expressive communication, fine and gross motor skills. Conclusion The Persian norms differ from the reference norms for all sub-tests and these differences are clinically significant. The use of the reference norms leads to fewer referrals in all sub-scales and leads to fewer diagnoses of children with developmental delay. Population specific norms are required to identify children with low scores for referral and intervention

The Relationship between Structure of the Corticoreticular Tract and Walking Capacity in Children with Cerebral Palsy

Background: Disruption in the descending pathways may lead to gait impairments in Cerebral Palsy (CP) children. Though, the mechanisms behind walking problems have not been completely understood.Objective: We aimed to define the relationship between the structure of the corticoreticular tract (CRT) and walking capacity in children with CP.Material and Methods: This is a retrospective, observational, and cross-sectional study. Twenty-six children with CP between 4 to 15 years old participated. Also, we used existed data of healthy children aged 4 to 15 years old. CRT structure was characterized using diffusion tensor imaging (DTI). The DTI parameters extracted to quantify CRT structure included: fractional anisotropy (FA), mean (MD), axial (AD), and radial (RD) diffusivity. Balance and walking capacity was evaluated using popular clinical measures, including the Berg balance scale (BBS), Timed-Up-and-Go (TUG; balance and mobility), six-minute walk test (6 MWT; gait endurance), and 10-meter walk Test (10 MWT; gait speed).Results: There are significant differences between MD, AD, and RD in CP and healthy groups. Brain injury leads to various patterns of the CRT structure in children with CP. In the CP group with abnormal CRT patterns, DTI parameters of the more affected CRT are significantly correlated with walking balance, speed, and endurance measures. Conclusion: Considering the high inter-subject variability, the variability of CRT patterns is vital for determining the nature of changes in CRT structure, their relationship with gait impairment, and understanding the underlying mechanisms of movement disorders. This information is also important for the development or prescription of an effective rehabilitation target for individualizing treatment

Corpus Callosum Functional Activities in Children with Cerebral Palsy

Background: Since cerebral palsy (CP) is a corollary to brain damage, persistent treatment should accompany an alteration in brain functional activity in line with clinical improvements. In this regard, the corpus callosum (CC), as a connecting bridge between the two hemispheres, plays an essential role.Objective: This study aimed to investigate the therapeutic effects of occupational therapy (OT) on CC functional activity and walking capacity in children with cerebral palsy.Material and Methods: In this clinical trial study, 4 children with CP (8.25±1.71 years) received 45 min OT sessions 3 times weekly for 8 weeks. Functional magnetic resonance imaging (fMRI) was acquired while conducting passive motor tasks to quantify CC activation. The pre-post activation changes in CC following therapy were quantified in terms of activated voxels. Walking capacity was evaluated using the timed-up-and-go (TUG), 6-minute walk test (6 MWT), and 10-meter walk test (10 MWT) in pre-and post-treatment.Results: The number of activated voxels in CC indicated significant improvement in participants. Post-treatment activated voxels substantially exceeded pre-treatment active voxels. Clinical measures, including TUG, 6 MWT, and 10 MWT are improved by 11.9%, 12.6%, and 25.4%, respectively.  Conclusion: Passive task-based fMRI can detect the effects of OT on CC functional activity in children with CP. According to the results, OT improves CC functional activity in addition to gait and balance performance

Safety and efficacy of Favipiravir in moderate to severe SARS-CoV-2 pneumonia

Background: We examined the safety and efficacy of a treatment protocol containing Favipiravir for the treatment of SARS-CoV-2. Methods: We did a multicenter randomized open-labeled clinical trial on moderate to severe cases infections of SARS-CoV-2. Patients with typical ground glass appearance on chest computerized tomography scan (CT scan) and oxygen saturation (SpO2) of less than 93 were enrolled. They were randomly allocated into Favipiravir (1.6 gr loading, 1.8 gr daily) and Lopinavir/Ritonavir (800/200 mg daily) treatment regimens in addition to standard care. In-hospital mortality, ICU admission, intubation, time to clinical recovery, changes in daily SpO2 after 5 min discontinuation of supplemental oxygen, and length of hospital stay were quantified and compared in the two groups. Results: 380 patients were randomly allocated into Favipiravir (1 9 3) and Lopinavir/Ritonavir (1 8 7) groups in 13 centers. The number of deaths, intubations, and ICU admissions were not significantly different (26, 27, 31 and 21, 17, 25 respectively). Mean hospital stay was also not different (7.9 days SD = 6 in the Favipiravir and 8.1 SD = 6.5 days in Lopinavir/Ritonavir groups) (p = 0.61). Time to clinical recovery in the Favipiravir group was similar to Lopinavir/Ritonavir group (HR = 0.94, 95% CI 0.75 � 1.17) and likewise the changes in the daily SpO2 after discontinuation of supplemental oxygen (p = 0.46) Conclusion: Adding Favipiravir to the treatment protocol did not reduce the number of ICU admissions or intubations or In-hospital mortality compared to Lopinavir/Ritonavir regimen. It also did not shorten time to clinical recovery and length of hospital stay. © 2021 Elsevier B.V

Applications of microbial processes in geotechnical engineering

Over the last 10-15 years a new field of ‘biogeotechnics’ has emerged as geotechnical engineers seek to find ground improvement technologies which have the potential to be lower carbon, more ecologically friendly and more cost-effective than existing practices. This review summarizes the developments which have occurred in this new field, outlining in particular the microbial processes which have been shown to be most promising for altering the hydraulic and mechanical responses of soils and rocks. Much of the research effort in this new field has been focused on microbially induced carbonate precipitation via ureolysis (MICP); while a comprehensive review of MICP is presented here, the developments which have been made regarding other microbial processes, including microbially induced carbonate precipitation via denitrification and biogenic gas generation are also presented. Furthermore, this review outlines a new area of study: the potential deployment of fungi in geotechnical applications which has until now been unexplored

Characterization of environmental radiological parameters on dose coefficient - Realistic dosimetry compared with epidemiological dosimetry models

Radiation exposure due to all-natural sources amounts to about 2.4 mSv per year. However, this amount might be changed to over 3 mSv y−1 according to the recently introduced ICRP radon dose coefficient factor. Previously, the radon contribution to the total dose from natural sources was about 1.2 mSv y−1. However, after the latest introduced dose conversion factor by ICRP, this value could technically be increased to around 2 mSv y−1. This paper attempts to address the following questions: (i) whether reducing radon concentration to the recommended level could address concerns about radiation exposure in underground workplaces, and (ii) the effects of the difference between the epidemiological dosimetry models and realistic dose estimation. The actual dose conversion factor (DCF) was calculated using measured annual average unattached and equilibrium factors, ranging from 16 ± 9 to 25 ± 10 mSv·WLM−1. Then, the estimated inhalation dose, both from self-calculated DCF and the value reported by ICRP-137, was compared: 5.6 ± 0.7–7.6 ± 0.9 mSv y−1 and 3.3 ± 0.4–3.6 ± 0.5 mSv y−1, respectively. It can be observed that exposure to a radon concentration lower than the recommended level does not guarantee a lower dose than the recommended value. The estimated dose was at least two times greater than the dose using pre-estimated values from epidemiological dosimetry models, specifically in this case study. Further experiments in different underground working environments, excluding caves, are needed for more precise observations. It might also be time to update the data regarding the dose contribution from natural radiation sources, as the radon contribution increased according to ICRP

Radiological Assessment of Indoor Radon and Thoron Concentrations and Indoor Radon Map of Dwellings in Mashhad, Iran

A comprehensive study was carried out to measure indoor radon/thoron concentrations in 78 dwellings and soil-gas radon in the city of Mashhad, Iran during two seasons, using two common radon monitoring devices (NRPB and RADUET). In the winter, indoor radon concentrations measured between 75 ± 11 to 376 ± 24 Bq·m−3 (mean: 150 ± 19 Bq m−3), whereas indoor thoron concentrations ranged from below the Lower Limit of Detection (LLD) to 166 ± 10 Bq·m−3 (mean: 66 ± 8 Bq m−3), while radon and thoron concentrations in summer fell between 50 ± 11 and 305 ± 24 Bq·m−3 (mean 115 ± 18 Bq m−3) and from below the LLD to 122 ± 10 Bq m−3 (mean 48 ± 6 Bq·m−3), respectively. The annual average effective dose was estimated to be 3.7 ± 0.5 mSv yr−1. The soil-gas radon concentrations fell within the range from 1.07 ± 0.28 to 8.02 ± 0.65 kBq·m−3 (mean 3.07 ± 1.09 kBq·m−3). Finally, indoor radon maps were generated by ArcGIS software over a grid of 1 × 1 km2 using three different interpolation techniques. In grid cells where no data was observed, the arithmetic mean was used to predict a mean indoor radon concentration. Accordingly, inverse distance weighting (IDW) was proven to be more suitable for predicting mean indoor radon concentrations due to the lower mean absolute error (MAE) and root mean square error (RMSE). Meanwhile, the radiation health risk due to the residential exposure to radon and indoor gamma radiation exposure was also assessed