New database will allow for more accurate diagnoses and treatment of medical conditions affecting children and youth

sgupta — Mon, 12 Mar 2012 13:39:03 +0000

New database will allow for more accurate diagnoses and treatment of medical conditions affecting children and youth sgupta Mon, 03/12/2012 - 09:39

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Data from children of diverse ethnicities has been used to create a new database of "normal" test values for use by physicians across Canada. (Bigstock photo)

Suzanne Gold

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Establishes series of 'normal' test blood test values as baseline

Led by University of Toronto professor Khosrow Adeli, a team of researchers at The Hospital for Sick Children has developed a comprehensive database that will directly contribute to improved assessment of Canadian children and youth with medical concerns.

Through the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) Project, the researchers invited healthy children and teens of varying ages, genders and ethnicities to submit blood samples. Nearly 2,200 participants provided blood samples and information that the researchers used to determine “normal” values for 40 serum biochemical markers -- substances that can be detected in blood, urine or other bodily fluids and reveal diseases or abnormalities.

“Age, gender and ethnicity can profoundly influence levels of biochemical markers,” said Dr. Adeli, who is cross-appointed to U of T's Departments of Laboratory Medicine and Pathobiology, and Biochemistry at the University of Toronto. “We hope this new database of healthy Canadian children and youth will help improve diagnosis and treatment for a variety of medical conditions.”

When a child undergoes blood tests to diagnose a specific medical condition, physicians, laboratory specialists and the family have one shared goal: to obtain accurate test results. If the test results indicate problems, the clinical team can then determine the best treatment options and provide the necessary care.

Since treatment can depend upon lab test results—and treatment efficacy is also usually monitored by doing these tests—accurate analysis of these results is critically important.” said Adeli, who is also head of the Division of Clinical Biochemistry and senior associate scientist at SickKids.

The ability of lab specialists to interpret the results accurately is dependent upon several important factors, including the availability of accurate reference values, which provide the “normal” result for a healthy child in the general population.

The new database of 40 biochemical markers is now available to hospitals and pediatricians, and will soon be available to the general public online. The researchers reported their development of the database in a recent online paper in the journal Clinical Chemistry.

These crucial reference values have existed in Canada, but until now, these numbers have had significant demographic gaps, experts say. Much of the current data is outdated and includes some reference values that were obtained in the 1980s, when the technology was not as advanced as it is today.

In addition, there has been a need to obtain a more accurate representation of the current population of children in Canada, including children of all pediatric age groups (birth to 18 years), both genders, and a variety of ethnicities that make up the multicultural Canadian population. These often previously-overlooked factors can affect the interpretation of test results.

While similar databases exist in the adult population, obtaining sufficient data from a general population of children is much more challenging. This is due to the significant differences between children at different ages, Adeli explained. For example, a two-year-old would not have the same results as a 10-year-old or a 17-year-old.

“Kids are constantly growing and changing,” said Adeli. “These differences are now documented in a more comprehensive way, which is a major step toward filling the gaps that exist in this area.”

Next steps in this research will include testing study participants for an additional 30 biochemical markers. The scientists will then use transference studies to run tests on different equipment in various hospitals across the country. This would account for any variations between hospitals and help ensure consistent results, regardless of the patient’s geographic location. Moving forward, the database is expected to be updated once every decade to account for technological and population changes.

In addition to SickKids, six other Canadian hospitals from coast to coast are collaborating on the CALIPER Project: Eastern Health/Janeway Children’s Health & Rehabilitation Centre, CHU Sainte-Justine, Children’s Hospital of Eastern Ontario, McMaster Children’s Hospital, Royal University Hospital and B.C. Children’s Hospital.

For more information about the CALIPER Project, or to participate, visit www.caliperproject.com.

The study was supported by the Canadian Institutes of Health Research, Abbott Diagnostics and SickKids Foundation.

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Study finds new way to predict MS diagnosis in children

sgupta — Thu, 10 Nov 2011 09:46:11 +0000

Study finds new way to predict MS diagnosis in children sgupta Thu, 11/10/2011 - 04:46

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Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord. (Bigstock photo)

Suzanne Gold

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MRI, scoring tool make earlier treatment possible

Early MRI scans can help predict the diagnosis of multiple sclerosis (MS) in children, which may permit earlier initiation of treatment, according to a new national study.

The study was led by The Hospital for Sick Children (SickKids) and the University of Toronto and was performed as a part of the Canadian Pediatric Demyelinating Disease Network, a 23-site study that includes all paediatric health-care facilities in Canada. The study is published in the Nov.7 advance online edition of Lancet Neurology.

MS is an autoimmune disease that affects the brain and spinal cord. People with MS develop lesions (patches of inflammation in the central nervous system (CNS)) in which the neurons have been stripped of their myelin (insulating fatty protein).

In this study, the investigators created a rigorous scoring tool that was applied to magnetic resonance imaging (MRI) scans from paediatric patients following their first acute CNS demyelinating attack.

An acute CNS demyelinating attack could involve a variety of symptoms, including loss of vision, tingling in lower limbs, inability to walk, loss of balance or even paralysis. Previously, established criteria have required clinicians to wait until the occurrence of a second attack to make the diagnosis of MS. A second attack could occur as early as a month after the initial attack or many years later.

Although the time to a second attack may take months to years, ongoing disease activity occurs even between attacks. Identifying children with MS through analysis of MRI scans obtained at the first acute attack can lead to rapid diagnosis and to an opportunity to offer treatment even before a second attack.

��οprofessor Brenda Banwell of pediatrics, principal investigator of the study, is a taff neurologist and senior associate scientist at SickKids. She noted that while MRI has been used on adults in this manner, “this is the first time anyone has applied an MRI scoring tool to MRI scans from a population of at-risk pediatric patients. The study demonstrates that there are reliable MRI features present at the first clinical attack that indicate that the biology of MS is already established and has been going on for some time.”

The national prospective incidence cohort study involved 284 eligible children and teens – of which more than half were SickKids patients – between September 2004 and June 2010. More than 1,100 MRI scans were obtained from the participants. Twenty per cent of thechildren were diagnosed with MS 180 days after presenting with a first attack. Using the new technique, the scientists found those patients whose scans revealed two particular types of lesions, T1-weighted hypointense and T2-weighted periventricular lesions, were more likely to be diagnosed with MS. Patients with the highest risk were the ones who had both types of lesions.

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