Accuracy of Eyes of AI™ Artificial Intelligence Driven Platform for Lateral Cephalometric Analysis

AbstractAim: The objective of this prospective study was to evaluate the accuracy of cephalometric analyses acquired through manual tracing and the Eyes of AITM AI-driven web-based program.Materials and Methods: This prospective study employed randomization conducted via computer software, with a determined sample size of 150 cases. Inclusion criteria encompassed good quality lateral cephalograms available in both digital and print formats, absence of artifacts that might hinder anatomical point location, and presence of a clear calibration ruler for magnification determination. Exclusion criteria included lateral cephalograms with identifiable motion artifacts, resolution disparity, or insufficient contrast, as well as those exhibiting positional errors indicated by ear rod markers. Each lateral cephalogram underwent tracing and analysis using the manual method, as well as Eyes of AITM software. Following landmark plotting, linear and angular measurements of Steiner, Downs, McNamara, and Jefferson analyses were calculated.Results: A comparison of thirty-six cephalometric measurements of Steiner, Downs, McNamara, and Jefferson analyses obtained from manual tracing and AI-driven Eyes of AITM revealed a Concordance Correlation Coefficient (CCC) value above 0.76 for all parameters, indicating strong agreement between manual and AI-driven cephalometric measurements. Furthermore, a CCC value exceeding 0.9 was observed for twenty-eight parameters, indicative of very strong agreement.Conclusion: Automated lateral cephalometric measurements obtained from Eyes of AITM are accurate when compared to manual measurements

Precursor B-cell lymphoblastic lymphoma (PBLL) in children: Pattern of presentation and outcome

Purpose and background: Precursor B-cell lymphoblastic lymphoma (PBLL) is a rare subtype of NHL seen primarily in children or young adults. There are approximately 100 immunophenotyped cases of PBLL; reported in the literature; most as single case reports or very small series. In this report, we describe patterns of presentation, and results of a retrospective study looking at patients with PBLL treated at KFSH and RC between 1993 and 2000.Patients and methods: We present results of a retrospective study looking at patients with PBLL treated at KFSHRC between 1993 and 2000, younger than 14 years of age (cut-off age for pediatric department). Six cases of PBLL were lacking evidence of blood and bone marrow involvement. Histologic sections were available for review in all cases.Results: Twenty one patients were treated for lymphoblastic lymphoma, of which six had a precursor Bcell phenotype. There were three boys and the median age at diagnosis was 6 years (range 3-13). In four of the patients the primary involved were oro-nasopharynx or the paranasal sinuses. One patient had a soft tissue mass in the upper thigh while one patient had a solitary bone lesion in the distal tibia. Four of the patients had limited stage disease (2 stage I and stage II), while 2 were stage IV. Both patients with stage IV disease had CNS involvement with blasts in the CSF. Both had paranasal primaries and had bone infiltration involving the base of the skull, with radiological documentation of intracranial extension in one patient. Median LDH level was 542 IU/L (range 463-5000). Five patients were treated according to B-cell NHL type protocols. Because of the specific diagnosis of PBLL, two of these patients were switched to an ALL-type protocol following post induction intensification; one died in remission due to encephalitis, while the other remained in CR almost 2 years after diagnosis. A third patient suffered a loco-regional relapse 17 months after completing first line therapy, and was re-treated on an ALL-type protocol, and currently is in remission 25 months following relapse. The fourth patient, who received 9 months of post induction therapy, remains free of disease 7 years following diagnosis. The fifth patient had local and CNS progression on therapy, and died of his disease. The last patient with a solitary bone lesion was misdiagnosed as Ewings\u27 Sarcoma and received treatment for that disease. He suffered an isolated CNS relapse, and is in CR 12 months following the relapse, on an ALL treatment protocol.Conclusion: PBLL is a distinct B-cell NHL which involves extralymphatic sites, with particular predisposition for the upper aerodigestive tract. Patients should not be treated on short intensive protocols used for other B-cell NHL but should receive treatment based on ALL protocols like those for treating T-cell LL

ISSN 2347-954X (Print) Monotherapy using Cefepime in Comparison to Dual Therapy (PIP/TAZO plus Amikacin) for Febrile Neutropenic Pediatric Patients with Solid Tumors

Abstract: Infectious diseases are important causes of morbidity and mortality in patients with cancer. Neutropenia has been recognized form any decades as a major risk factor for the development of infections in cancer patients undergoing chemotherapy. Effective strategies to anticipate, prevent, and manage infectious complications in neutropenic cancer patients have led to improved outcomes. The aim of this study was to compare the efficacy and safety of Cefepime monotherapy versus dual therapy with PIP/TAZO plus Amikacin for empirical treatment of neutropenic fever in children with solid tumors. Data of one hundred and thirty episodes in 80 patients treated with monotherapy as well as one hundred and twenty one episodes in 62 patients treated with dual therapy were analyzed. These episodes occurred in patients with solid tumors who were admitted to the pediatric oncology department a

Treatment of a clinically determined lower-risk stage III non-lymphoblastic Non-Hodgkin lymphoma with less intensive therapy does not impact negatively on outcome

Stage III NHL was divided into lower-risk (LR) or high-risk (HR) groups. Results of treatment were retrospectively reviewed for patients between 1993 through 2000. An intensive multiagent protocol was used for IIIHR, and a CHOP-based, milder treatment for IIILR. Most LR therapy was outpatient, while treatment for HR patients was primarily inpatient. Five year EFS and OS for HR (n = 29) and LR (n = 23) groups was 86.2% and 95.6% (P = 0.26), and 93.1% and 100%, respectively (P = 0.4). LR had less toxicity. While these results need prospective confirmation, the data shows that less intensive therapy of a LR group of stage III NHL may not impact negatively on outcome

Is vancomycin monitoring of real value in pediatric cancer patients?

Vancomycin is not nephrotoxic by itself but many patients using it with other nephrotoxic agents show nephrotoxicity to some extent. Whether to monitor or not to monitor vancomycin needs further study. The aim of the present study was to investigate the significance of monitoring vancomycin serum levels in pediatric patients treated from different malignancies. 150 newly diagnosed pediatric patients, with various types of malignancy treated with different nephrotoxic agents including vancomycin, were recruited in the study. All patients had normal renal functions at the start of the study and were divided into three groups; Group I included 50 (21 females) patients received vancomycin without monitoring (VWOM group); Group II included 50 (19 females) patients received vancomycin with monitoring (VWM group); Group III (Control group) included 50 (23 females) patients received vancomycin-free antimicrobial agents (VF group). Vancomycin trough level was determined only for VWM group. The effectiveness of monitoring was estimated by the ability to achieve more rapid response, decrease hospital stay and nephrotoxicity and its effect on total dose of vancomycin. There was a significant decrease in nephrotoxicity in VWM and VF groups, 9 subjects (18%), compared to 15 subjects (30%) in VWOM group (p=0.016). The time needed to show a response achievement was significantly decreased in VWM group compared to VWOM group with mean (SD) of 6.5 (2.5) and 8.7 (3.6) days, respectively (p=0.015). That led to shorter hospital stay in VWM group compared to VWOM group with mean (SD) of 10.1 (3.4) and 12.4 (4.2) days, respectively (p=0.003). Monitoring vancomycin level was important in the examined high risk groups of pediatric cancer patients studied. [Med-Science 2018; 7(1.000): 54-57

COVID-19-Associated Pulmonary Fungal Infection among Pediatric Cancer Patients, a Single Center Experience

Patients with COVID-19 are at risk of developing secondary complications such as invasive pulmonary aspergillosis and mucormycosis. This is a retrospective study including all cancer children diagnosed with COVID-19-associated pulmonary fungal infection (CAPFI) during the period 2020–2021. A total of 200 patients were diagnosed with COVID-19, out of which 21 (10%) patients were diagnosed with CAPFI, 19 patients (90%) with COVID-aspergillosis (CAPA), and 2 (10%) patients with COVID-mucormycosis (CAM). Patients with CAPFI were classified using the “2020 ECMM/ISHAM consensus criteria”; proven in 2 (10%) patients, probable in 12 (57%), and possible in 7 (33%) patients. Although the hematological malignancy patients were already on antifungal prophylaxis, breakthrough fungal infection was reported in 16/21 (75%), 14 (65%) patients had CAPA while on echinocandin prophylaxis, while 2 (10%) patients had CAM while on voriconazole prophylaxis. Overall mortality was reported in 8 patients (38%) while CAPFI-attributable mortality was reported in 4 patients (20%). In conclusion, clinicians caring for pediatric cancer patients with COVID-19 should consider invasive pulmonary fungal infection, even if they are on antifungal prophylaxis, especially with worsening of the clinical chest condition. A better understanding of risk factors for adverse outcomes may improve clinical management in these patients

Carbapenem-Resistant <i>Enterobacteriaceae</i> (CRE) among Children with Cancer: Predictors of Mortality and Treatment Outcome

Carbapenem-resistant Enterobacteriaceae (CRE) is an important emerging threat among pediatric cancer patients, with a high mortality rate. This retrospective study included all pediatric cancer patients with (CRE) bloodstream infections (BSIs) at a children’s cancer hospital in Egypt (2013–2017). Two hundred and fifty-four pediatric cancer patients with CRE BSI were identified; 74% had hematological malignancies, and 26% had solid tumors. Acute myeloid leukemia was the most common hematological malignancy (50%). The main clinical features for acquiring CRE-BSI were previous antibiotics exposure (90%), profound neutropenia (84%), prolonged steroid use (45%), previous colonization with a resistant pathogen (35%), ICU admission within 90 days (28%), and central venous catheter use (24%). E. coli was the most common isolated pathogen (56%), followed by Klebsiella pneumoniae (37%). All isolates were resistant to carbapenem with an MIC 8 μg/mL in 153 (55%). The overall mortality rate was 57%, and 30 day mortality was reported in 30%. Upon multivariate analysis, for the patients with Klebsiella pneumoniae BSI, carbapenem resistance with an MIC > 8 μg/mL and associated typhlitis or pneumonia were predictors of poor outcome. In conclusion, CRE-BSI is a major threat among pediatric cancer patients in limited resource countries with limited options for treatment. Antimicrobial stewardship for early detection through routine screening, adequate empirical treatment, and timely adequate therapy may impact the outcome for such high-risk patient groups