Home participation, support and barriers among children with attention-deficit/hyperactivity disorder before and during the COVID-19 pandemic.

OBJECTIVES: Few studies have focused on the participation of children with attention-deficit/hyperactivity disorder (ADHD) in daily routine and leisure activities. This study aimed to compare the participation, support and barriers for children with ADHD at home pre-COVID-19 and during the COVID-19 outbreak. METHODS: The study included 55 children with ADHD aged 6-11 years. Participation frequency, involvement, desire for change, supports and barriers at home were assessed using the Participation and Environment Measure for Children and Youth (PEM-CY). RESULTS: During the COVID-19 pandemic compared with the pre-COVID-19 period, the mean frequency of participation of children with ADHD in computer and video games (5.8% vs 5%, respectively), socialising with other people (7% vs 6.2%) and household chores (5.5% vs 4.6%) was shown to be significantly higher (p < 0.05). Mothers of children with ADHD reported higher levels of involvement during the COVID-19 pandemic compared with the pre-COVID-19 period across four areas of home participation, including computer and video games (4.1% vs 3.2%, respectively), arts, crafts, music and hobbies (3.7% vs 3%), household chores (3.6% vs 2.8%) and personal care management (4.2% vs 3.5%) p < 0.05). Mothers of children with ADHD reported that during the pandemic the following two features of the environment made participation easier than pre-COVID-19 (p < 0.05): cognitive demands (36.4% vs 60%, respectively) and social demands (5.5% vs 34.5%). More mothers reported that services (92.7%), supplies (87.3%) and information (85.5%) were available and/or adequate in the COVID-19 period than pre-COVID-19 (p < 0.05). CONCLUSIONS: Mothers of children with ADHD reported that their children were participating more frequently in some of the home-related activities during the COVID-19 pandemic compared to pre-COVID-19. Reduced cognitive and social demands, and more readily available resources in the home environment during the COVID-19 period resulted in increased home participation compared to pre-COVID-19.

Platelet to lymphocyte ratio (PLR) in alcohol use disorder.

Lymphocyte-related parameters in Alcohol Use Disorder (AUD) have recently been investigated. However, knowledge of platelet to lymphocyte ratio (PLR) in AUD is limited. In this study, we compared complete blood count values of 31 AUD male patients and 31 healthy male controls. There was no significant difference between the two groups in terms of PLR (p = .123). When the age was controlled, there was a negative correlation between the duration of alcohol use and PLR (r = -0.567; p = .005). The significance of the parameters in the AUD group was found to be related to the duration of alcohol use.

Complete blood count alterations due to the opioid use: what about the lymphocyte-related ratios, especially in monocyte to lymphocyte ratio and platelet to lymphocyte ratio?

This study was designed to compare the complete blood count values of opioid users (N = 61) and healthy subjects (N = 61), particularly monocyte-to-lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR). PLR, MLR, and percentage of monocyte (MONO%) were significantly lower in opioid use disorder (OUD) group (P = 0.012, P = 0.005, P = 0.000). The area under the ROC curve of MLR and PLR levels for OUD was 0.349 and 0.368. MONO% correlated with substance use duration. Measurements like lymphocyte-related ratios and MONO% in opioid use can be important in substance monitoring, detection, and differentiation of acute and chronic conditions.

Mean platelet volume and neutrophil to lymphocyte ratio as parameters to indicate the severity of suicide attempt.

This study was designed to compare the complete blood count (CBC) values of 38 violent suicidal attempt (VSA) and 38 nonviolent suicidal attempt (NVSA) patients and 38 healthy controls, particularly mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR). MPV was found to be significantly higher (P = 0.000), and PLT was found to be significantly lower in the VSA group (P = 0.001). NLR was found to be significantly higher (P = 0.005) in the VSA group. The area under the receiver operating characteristic curve of MPV levels for VSA was 0.78 and 0.68 for NLR in the VSA group when compared with the NVSA group.

Effect O6-guanine alkylation on DNA flexibility studied by comparative molecular dynamics simulations.

Alkylation of guanine at the O6 atom is a highly mutagenic DNA lesion because it alters the coding specificity of the base causing G:C to A:T transversion mutations. Specific DNA repair enzymes, e.g. O(6)-alkylguanin-DNA-Transferases (AGT), recognize and repair such damage after looping out the damaged base to transfer it into the enzyme active site. The exact mechanism how the repair enzyme identifies a damaged site within a large surplus of undamaged DNA is not fully understood. The O(6)-alkylation of guanine may change the deformability of DNA which may facilitate the initial binding of a repair enzyme at the damaged site. In order to characterize the effect of O(6)-methyl-guanine (O(6)-MeG) containing base pairs on the DNA deformability extensive comparative molecular dynamics (MD) simulations on duplex DNA with central G:C, O(6)-MeG:C or O(6)-MeG:T base pairs were performed. The simulations indicate significant differences in the helical deformability due to the presence of O(6)-MeG compared to regular undamaged DNA. This includes enhanced base pair opening, shear and stagger motions and alterations in the backbone fine structure caused in part by transient rupture of the base pairing at the damaged site and transient insertion of water molecules. It is likely that the increased opening motions of O(6)-MeG:C or O(6)-MeG:T base pairs play a decisive role for the induced fit recognition or for the looping out of the damaged base by repair enzymes.

Enhanced conformational sampling of carbohydrates by Hamiltonian replica-exchange simulation.

Knowledge of the structure and conformational flexibility of carbohydrates in an aqueous solvent is important to improving our understanding of how carbohydrates function in biological systems. In this study, we extend a variant of the Hamiltonian replica-exchange molecular dynamics (MD) simulation to improve the conformational sampling of saccharides in an explicit solvent. During the simulations, a biasing potential along the glycosidic-dihedral linkage between the saccharide monomer units in an oligomer is applied at various levels along the replica runs to enable effective transitions between various conformations. One reference replica runs under the control of the original force field. The method was tested on disaccharide structures and further validated on biologically relevant blood group B, Lewis X and Lewis A trisaccharides. The biasing potential-based replica-exchange molecular dynamics (BP-REMD) method provided a significantly improved sampling of relevant conformational states compared with standard continuous MD simulations, with modest computational costs. Thus, the proposed BP-REMD approach adds a new dimension to existing carbohydrate conformational sampling approaches by enhancing conformational sampling in the presence of solvent molecules explicitly at relatively low computational cost.

Stabilization of duplex DNA and RNA by dangling ends studied by free energy simulations.

Single unpaired nucleotides at the end of double-stranded nucleic acids, termed dangling ends, can contribute to duplex stability. Umbrella sampling free energy simulations of dangling cytosine and guanine nucleotides at the end of duplex and single stranded RNA and DNA molecules have been used to investigate the molecular origin of dangling end effects. In unrestraint simulations, the dangling end nucleotides stayed close to placements observed in experimental structures. Calculated free energy contributions associated with the presence of dangling nucleotides were in reasonable agreement with experiment predicting the general trend of a more stabilizing effect of purine vs. pyrimidine dangling ends. In addition, the calculations indicate a more significant stabilizing effect of dangling ends at the 5'-end vs. 3'-end in case of DNA and the opposite trend in case of RNA. Both electrostatic and van der Waals interactions contribute to the duplex stabilizing effect of dangling end nucleotides. The free energy simulation scheme could also be used to design dangling end nucleotides that result in enhanced duplex stabilization.

Influence of 8-oxoguanosine on the fine structure of DNA studied with biasing-potential replica exchange simulations.

Chemical modification or radiation can cause DNA damage, which plays a crucial role for mutagenesis of DNA, carcinogenesis, and aging. DNA damage can also alter the fine structure of DNA that may serve as a recognition signal for DNA repair enzymes. A new, advanced sampling replica-exchange method has been developed to specifically enhance the sampling of conformational substates in duplex DNA during molecular dynamics (MD) simulations. The approach employs specific biasing potentials acting on pairs of pseudodihedral angles of the nucleic acid backbone that are added in the replica simulations to promote transitions of the most common substates of the DNA backbone. The sampled states can exchange with a reference simulation under the control of the original force field. The application to 7,8-dihydro-8oxo-guanosine, one of the most common oxidative damage in DNA indicated better convergence of sampled states during 10 ns simulations compared to 20 times longer standard MD simulations. It is well suited to study systematically the fine structure and dynamics of large nucleic acids under realistic conditions, including explicit solvent and ions. The biasing potential-replica exchange MD simulations indicated significant differences in the population of nucleic acid backbone substates in the case of 7,8-dihydro-8oxo-guanosine compared to a regular guanosine in the same sequence context. This concerns both the ratio of the B-DNA substates B(I) and B(II) associated with the backbone dihedral angles ε and ζ but also coupled changes in the backbone dihedral angles α and γ. Such differences may play a crucial role in the initial recognition of damaged DNA by repair enzymes.

Is It Possible to Allocate Life? Triage, Ageism, and Narrative Identity.

Triage protocols can exclude older patients for the sake of effectiveness and this may be defended as the older have already had their fair share of life, which can mean fair amounts or complete lives. Nevertheless, if life is considered as a narrative, mentioning amounts might be nonsensical. Narratives have a quality of unity; so, life events are fragments whose meanings are dependent on the meaning of the whole. Thus, time units do not represent a reliable measure of the content of life. In addition, people's experience is different from the external flow of time, making its significance relative. Moreover, to compare the completeness of lives qualitatively, it is necessary to have a common cultural understanding, which is improbable to agree on in a modern society. Therefore, basic assumptions of the accounts that refer to fair shares of lives are mistaken, and these accounts do not support age-based rationing.

Can Red Blood Cell and Platelet Parameters Be Associated With Inflammation in Children With Tic Disorder?

OBJECTIVE: Tic disorder (TD) is one of the neurodevelopmental disorders and its etiology has not been fully elucidated. Complete blood count (CBC) values have been used as indicators of a systemic inflammatory response. In our study, we aimed to assess hemogram parameters in drug-naive, comorbidity-free children with TD compared with controls. METHODS: This retrospective study included 62 drug-naive children with TD who had undergone CBC within one month prior to the study. A control group of 48 healthy children, matched for age and gender, without any organic or psychiatric disorders, was included. Statistical analysis was performed by using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States).  Results: Hematocrit (p = 0.044), mean corpuscular volume (p = 0.002), platelet count (p = 0.011), and plateletcrit (p = 0.031) values were significantly higher in the TD group, whereas mean corpuscular hemoglobin concentration (p = 0.00) was significantly lower in the TD group. Additionally, a significant negative correlation was observed between the duration of illness and platelet (p = 0.05, r=-0.282), plateletcrit (p = 0.038, r = -0.295), and neutrophil count (p = 0.006, r = -0.391), while a positive correlation was found between the duration of illness and eosinophil count (p = 0.018, r = 0.336). CONCLUSION: The results revealed several significant differences in hemogram parameters between TD patients and the control group. These may suggest the role of inflammation and/or other underlying mechanisms in TD and may inspire new studies. Future studies with larger and more homogeneous samples, including comprehensive inflammatory markers, may contribute to a deeper understanding of the relationship between inflammation and TD.

Sociodemographic and social barriers to early detection of autism.

BACKGROUND: The increasing incidence of autism spectrum disorder (ASD) is a common finding of many studies. Early diagnosis and appropriate treatment approaches for ASD can provide favourable clinical outcomes. This study aimed to determine the factors affecting the age at diagnosis, in children with ASD. METHODS: Two hundred and two cases diagnosed with ASD were included in the study, according to the DSM-5 diagnostic criteria, at the Mersin City Training and Research Hospital Child and Adolescent Psychiatry outpatient clinics, between April 2021 and August 2022. Clinical features and sociodemographic data that may be related to early diagnosis were investigated. RESULTS: The mean age at diagnosis was 36.76 ± 15.30 months. In 71.3% of cases parents were the first to suspect that children were developmentally different. In 38.1% of the cases, at least one of the parents denied the symptoms and evaluated their child`s development as age-appropriate. It was found that 32.7% of the cases evaluated by pediatricians and 32.5% of cases evaluated by family physicians, were referred to child psychiatry examination. The present study revealed that higher educational level of the father and the middlehigh socioeconomic status, were associated with early diagnosis. There was also a positive correlation between paternal age and age at diagnosis. CONCLUSIONS: The age at diagnosis is below the target level for early diagnosis. Studies should focus on increasing awareness of health professionals and parents about ASD.

Reduction in Retinal Ganglion Cell Layer, Inner Plexiform Layer, and Choroidal Thickness in Children With Autism Spectrum Disorder.

PURPOSES: The aim of this study was to evaluate the retinal nerve fiber layer (RNFL), choroidal layer, inner plexiform layer (IPL), and ganglion cell layer (GCL) in patients with autism spectrum disorder (ASD). METHODS: In this study, we measured the thickness of the RNFL, GCL, IPL, and choroidal thickness using a spectral optical coherence tomography (OCT) device and we compared the results between the children diagnosed with ASD and healthy controls. Correlation between the Childhood Autism Rating Scale (CARS) and the OCT data was evaluated. RESULTS: Both ASD and control group consisted of 40 subjects (30 males and 10 females). Of the children in the ASD group, 29 had normal intelligence and 11 had mild intellectual disability (MID). The mean age of patients in the ASD group and control groups were 9.77 ± 3.37 years and 9.85 ± 3.97 years (p = 0.928). There was a statistically significant difference between the ASD group and the control group in the nasal and nasal-superior sectors of the RNFL layers in the left eye when all the lower layers of RNFL were assessed. In both eyes, the children with ASD had considerably lower mean choroidal thicknesses than the controls. When compared to the controls, the GCL and IPL volumes in the individuals with ASD were considerably lower in both eyes. Compared to the MID group, the left GCL volume of the nasal-inferior group was noticeably higher. A significant correlation was found between CARS scores and left GCL left IPL. CONCLUSIONS: In contrast to RNFL in the ASD group, significant reductions in IPL, GCL, and choroidal thickness were observed in both eyes. It is thought that GCL may be a much more important biomarker than RNFL in terms of representing the structural deterioration in the brain. In addition, these results may form the basis for a new perspective on the use of OCT for the diagnosis and clinical course of autism.

Psychological profiles, quality of life, and parental attitudes in children with Sighing dyspnea.

BACKGROUND: There are a limited number of studies investigating the relationship of sighing dyspnea (SD) with psychiatric disorders and various mental states. METHODS: This cross-sectional study enrolled 39 pediatric patients with SD, but free from apparent cardiopulmonary diseases, who presented to a pediatric pulmonology policlinic between June and December 2019 and age-gender matched 34 healthy children were recruited for comparison. Patient characteristics, psychological or physical trauma history, and cigarette smoke exposure were recorded. All the participants completed the "NOSE scale," "Modified Borg Scale," "Children Depression Inventory," "Screen for Child Anxiety Related Disorders," "Pediatric Quality of Life Inventory," "Stress Coping Style Scale," "Family Assessment Device," and "Parents Attitude Scale." RESULTS: Compared to the control group, there was a statistically significantly higher rate in the SD group of physical or psychological trauma history (35.9% vs. 14.7%, p = .04) and passive cigarette smoking (60.5% vs.27.3%, p = .005). When the groups were compared in respect of depression and anxiety levels, the depression score, total anxiety level, somatic/panic, generalized anxiety and fear of school points were determined to be statistically significantly higher in the SD group. The QoL scores (total, physical, and psychosocial) in the SD group were found to be statistically significantly lower than those of the control group. CONCLUSION: To the best of our knowledge, this is the first study to have examined the psychological profiles of SD patients and their families in detail, and to have evaluated the effect of SD on quality of life.

Identification and characterization of acute infection with parvovirus B19 genotype 2 in immunocompromised patients in Poland.

Parvovirus B19 (B19V) is divided into three genotypes. Genotypes 2 and 3 may cause diagnostic difficulties and their epidemiology is not well understood. In the present study the prevalence of B19V genotypes in patients with symptomatic infection in Poland was evaluated and the course of infection in patients infected with non-genotype 1 strains is described. Real-time PCR, able to detect all three genotypes of B19V was used to screen patient plasma samples. Sixty-nine, mainly acute-phase B19V DNA positive cases were identified in patients from hematological and obstetric/gynecological wards between 2004 and 2008. Thirty patients were studied in greater detail and genotyping was performed by analysis of the NS1/VP1u region. The majority of samples were genotype 1. However two (6.6%) strains were identified as genotype 2, associated with high viremia and identified in a kidney transplant recipient with anemia and a leukemia patient, following chemotherapy, with pancytopenia. A change of immunosuppression treatment in the former and treatment with intravenous immunoglobulin in latter, resulted in normalization of clinical parameters, and whilst viral loads fell, B19V DNA was still detectable. The kidney transplant recipient subsequently became pregnant with no clinical complications, although persistently infected with B19V genotype 2. This is the first description of symptomatic cases of genotype 2 B19V infection in Eastern Europe suggesting that acute infection, particularly among immunocompromised patients with these virus strains may be more prevalent than thought.

Comparison of different estimation methods for extreme value distribution.

The extreme value distribution was developed for modeling extreme-order statistics or extreme events. In this study, we discuss the distribution of the largest extreme. The main objective of this paper is to determine the best estimators of the unknown parameters of the extreme value distribution. Thus, both classical and Bayesian methods are used. The classical estimation methods under consideration are maximum likelihood estimators, moment's estimators, least squares estimators, and weighted least squares estimators, percentile estimators, the ordinary least squares estimators, best linear unbiased estimators, L-moments estimators, trimmed L-moments estimators, and Bain and Engelhardt estimators. We also propose new estimators for the unknown parameters. Bayesian estimators of the parameters are derived by using Lindley's approximation and Markov Chain Monte Carlo methods. The asymptotic confidence intervals are considered by using maximum likelihood estimators. The Bayesian credible intervals are also obtained by using Gibbs sampling. The performances of these estimation methods are compared with respect to their biases and mean square errors through a simulation study. The maximum daily flood discharge (annual) data sets of the Meriç River and Feather River are analyzed at the end of the study for a better understanding of the methods presented in this paper.

On the Ottoman consent documents for medical interventions and the modern concept of informed consent.

Information for patients prior to medical intervention is one of the principles of modern medical practice. In this study, we looked at an earlier practice of this principle. Ottoman judges had record books called sicil. One of the categories in sicils was the consent documents called riza senedi, which was a patient-physician contract approved by the courts. These contracts were especially for the protection of physicians from punishment if the patient dies. It is not clear whether patients were informed properly or not. Consent for minors was obtained from parents. However, a situation where an adult does not have the capacity to consent, was not clear in these documents. Any sign of free withdrawal of consent was not found in these records. Due to the legal system of Ottoman State, these contracts were related to Islamic law rather than modern civil law. We aim, in this paper, to present a legal practice, which is possible to consider as an early example of the informed consent practice.

The understanding of risk factors for eating disorders in male adolescents.

OBJECTIVE: The study aimed to describe the medical, psychiatric, and cultural features of adolescent males with an eating disorder (ED). MATERIALS AND METHODS: This retrospective evaluation took place at Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey, and covered a 4-year period between 2010 and 2013. Sixty adolescents were diagnosed with an ED during this period, 47 (78.3%) were females and 13 were males (21.7%) male. All 13 male patients who met full criteria for an ED according to the DSM criteria were included. Medical and psychiatric records of male patients treated for an ED were re-evaluated. RESULTS: The most striking finding of the study was that the female to male ratio became 3.6:1, with the increasing number of male adolescents with an ED. In our study, medical findings and complications of males with ED were similar to those seen in females. However, the most predominant gender difference was the co occurrence of a comorbid physical or mental illness. CONCLUSION: It is imperative to raise awareness of EDs in males. Although the medical findings of the study suggest that male and female adolescents with EDs are clinically similar to each other, the understanding of certain gender-specific risk factors shown in our study, such as a medical illness and/or obesity and co-morbid psychiatric diagnosis, are essential in raising suspicion. Further studies that especially evaluate cultural and social factors that affect parenting styles for boys are important in addessing possible risk factors for the development of EDs in males within different societies.

Effect of 8-oxoguanine on DNA structure and deformability.

8-Oxoguanine (oxoG) is an abundant product of oxidative DNA damage. It is removed by repair glycosylases, but exactly how the enzymes recognize oxoG in the large surplus of undamaged bases is not fully understood. The lesion may induce changes in the properties of naked DNA that facilitate the recognition. In this work, we assess the effect of oxoG on DNA structure and mechanical deformability. We performed extensive unrestrained, atomic resolution molecular dynamics simulations to parametrize a nonlocal, rigid base mechanical model of DNA. Our data indicate that oxoG induces unwinding of the base pair step at the 5'-side of the lesion. This brings the damaged DNA closer to its conformation in the initial complex with bacterial glycosylase MutM. The untwisting is partially caused by different BII substate populations and is further enhanced by the base-sugar repulsion within oxoG. On the other hand, our analysis shows that damaged and undamaged DNA have very similar harmonic stiffness. These results suggest an indirect readout component of the MutM-DNA initial complex formation. They also help one to understand the effect of oxoG on the formation of nucleosomes and looped gene regulatory complexes.