Mahak Hospital and Rehabilitation Complex

Background: Elastography is a non-invasive diagnostic imaging technique that assesses the elasticity or stiffness of tissues. This study aimed to compare the diagnostic performance of Shear Wave Elastography (SWE) and Strain Elastography (SE) in distinguishing benign from malignant breast masses. Methods: In a prospective study, 447 women with breast masses were evaluated divided into two groups: 223 underwent SE, and 224 underwent SWE. Histopathological findings served as the gold standard. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and Receiver Operating Characteristic (ROC) curves were calculated for both techniques. Data analysis was performed using R software (version 4.3), with t-tests and chi-square tests for group comparisons. Results: The mean age of participants was 46.1±9.8 years. Significant differences were observed between the benign and malignant groups in terms of age, mass size, and family history of breast cancer (p<0.05). For SWE, sensitivity, specificity, PPV, and NPV were 92, 93, 89, and 95%, respectively, compared to 85, 87, 82, and 89%, respectively for SE. The diagnostic accuracy of SWE was higher than SE (93 vs. 86%). The area under the ROC curve was 0.94 for SWE and 0.88 for SE. Conclusion: SWE demonstrated superior diagnostic performance compared to SE in differentiating benign and malignant breast masses. This non-invasive technique can serve as a valuable clinical tool to improve diagnostic accuracy for malignancies and reduce unnecessary biopsies. However, multicenter studies with larger, more diverse samples are needed to validate these findings.

Abstract This cross-sectional study assessed corneal nerve parameters in 53 participants—17 high-risk for Parkinson’s disease (PD), 18 PD, and 18 healthy controls. Corneal nerve density and length were highest in controls, intermediate in high-risk, and lowest in PD (p = 0.004, p = 0.020). Corneal sensitivity was paradoxically highest in the high-risk group (p = 0.02). These findings suggest corneal hypersensitivity may precede structural nerve degeneration in prodromal PD.

This study scrutinizes the impacts of utilizing a socially assistive robot, the RASA robot, during speech therapy sessions for children with language disorders. Two capabilities were developed for the robotic platform to enhance children-robot interactions during speech therapy interventions: facial expression communication (containing recognition and expression) and lip-syncing. Facial expression recognition was conducted by training several well-known CNN architectures on one of the most extensive facial expressions databases, the AffectNet database, and then modifying them using the transfer learning strategy performed on the CK+ dataset. The robot’s lip-syncing capability was designed in two steps. The first step was concerned with designing precise schemes of the articulatory elements needed during the pronunciation of the Persian phonemes (i.e., consonants and vowels). The second step included developing an algorithm to pronounce words by disassembling them into their components (including consonants and vowels) and then morphing them into each other successively. To pursue the study’s primary goal, two comparable groups of children with language disorders were considered, the intervention and control groups. The intervention group attended therapy sessions in which the robot acted as the therapist’s assistant, while the control group only communicated with the human therapist. The study’s first purpose was to compare the children’s engagement while playing a mimic game with the affective robot and the therapist, conducted via video coding. The second objective was to assess the efficacy of the robot’s presence in the speech therapy sessions alongside the therapist, accomplished by administering the Persian Test of Language Development, Persian TOLD. According to the first scenario, playing with the affective robot is more engaging than playing with the therapist. Furthermore, the statistical analysis of the study’s results indicates that participating in robot-assisted speech therapy (RAST) sessions enhances children with language disorders’ achievements in comparison with taking part in conventional speech therapy interventions.

PURPOSEConstitutional mismatch repair deficiency syndrome (CMMRD) is a lethal cancer predisposition syndrome characterized by early-onset synchronous and metachronous multiorgan tumors. We designed a surveillance protocol for early tumor detection in these individuals.PATIENTS AND METHODSData were collected from patients with confirmed CMMRD who were registered in the International Replication Repair Deficiency Consortium. Tumor spectrum, efficacy of the surveillance protocol, and malignant transformation of low-grade lesions were examined for the entire cohort. Survival outcomes were analyzed for patients followed prospectively from the time of surveillance implementation.RESULTSA total of 193 malignant tumors in 110 patients were identified. Median age of first cancer diagnosis was 9.2 years (range: 1.7-39.5 years). For patients undergoing surveillance, all GI and other solid tumors, and 75% of brain cancers were detected asymptomatically. By contrast, only 16% of hematologic malignancies were detected asymptomatically (P < .001). Eighty-nine patients were followed prospectively and used for survival analysis. Five-year overall survival (OS) was 90% (95% CI, 78.6 to 100) and 50% (95% CI, 39.2 to 63.7) when cancer was detected asymptomatically and symptomatically, respectively (P = .001). Patient outcome measured by adherence to the surveillance protocol revealed 4-year OS of 79% (95% CI, 54.8 to 90.9) for patients undergoing full surveillance, 55% (95% CI, 28.5 to 74.5) for partial surveillance, and 15% (95% CI, 5.2 to 28.8) for those not under surveillance (P < .0001). Of the 64 low-grade tumors detected, the cumulative likelihood of transformation from low-to high-grade was 81% for GI cancers within 8 years and 100% for gliomas in 6 years.CONCLUSIONSurveillance and early cancer detection are associated with improved OS for individuals with CMMRD.

The COVID-19 pandemic has been particularly devastating for Iran. Children with cancer are generally immunosuppressed and especially vulnerable to SARS-CoV-2 infections. We report the treatment and outcomes of pediatric oncology patients with COVID-19 at the MAHAK Pediatric Cancer Treatment and Research Center (MPCTRC) in Tehran. We enrolled pediatric oncology patients who experienced SARS-CoV-2 infections from March 18, 2020, to January 28, 2021. The COVID-19 diagnostic criteria at MPCTRC were based on imaging and clinical presentation because of specific challenges diagnosing SARS-CoV-2 infections with molecular testing, which was locally developed and conducted at centers other than MPCTRC. We enrolled nine outpatients and eight inpatients (mean age = 9 years), seven of whom had a diagnosis of leukemias, and five who had brain tumors. COVID-19 symptoms were mild in fourteen patients, and three patients were asymptomatic. Of twelve patients who received molecular testing for SARS-CoV-2 infection, eight were negative and four were positive. Of nine patients tested for IgG and IgM antibodies, one was positive. Three patients died of COVID-19, all of whom were hospitalized. Mild COVID-19 symptoms did not appear to affect the outcomes of the pediatric patients with cancer who received treatment at MPCTRC during the study period.

Background: Iran has greatly suffered from the COVID-19 pandemic. Iranian children with cancer are especially vulnerable; therefore, we describe the care of patients with COVID-19 who received treatment at the MAHAK Pediatric Cancer Treatment and Research Center (MPCTRC) in Tehran. Patients and Methods: Children who experienced SARS-CoV-2 infections from March 18 to May 18, 2020, were enrolled in the study. Because of specific challenges diagnosing SARS-CoV-2 infections with molecular testing in Iran, the diagnostic criteria at MPCTRC were based on imaging and clinical presentation. We divided the patients into inpatient and outpatient cohorts according to the treatment they received and collected demographic, diagnostic, treatment, and outcome data. Molecular testing was developed locally and performed at centers other than MPCTRC. Results: Eleven patients (outpatient, n = 7) with a mean age of 9.2 years were enrolled in the trial. The most common cancer diagnoses were brain tumors (n = 4) and leukemias (n = 3). Eight patients had mild COVID-19 symptoms, and three were asymptomatic. Molecular testing of SARS-CoV-2 infections was performed for six patients, and all were negative. Only one child died of COVID-19. Discussion: In our small case series, mild COVID-19 symptoms did not appear to affect the outcomes of pediatric patients with cancer. Quality assurance of locally developed molecular testing of SARS-CoV-2 infections should also be considered.

Neuroblastoma is an extracranial solid tumor that is most commonly observed in children, yet it is rare to have brain metastasis in neuroblastoma during primary involvement or relapse. In this article, we report a successful treatment of high risk neuroblastoma with primary leptomeningeal metastasis based on developing countries facilities and explain combination chemotherapy (a classic regimen with salvage regimen based on temozolamid and methotroxate intratechal chemotherapy and localized radiation therapy) as a multimodal therapy.