Iranian Journal of Pediatric Hematology and Oncology
Volume:6 Issue: 1, Winter 2016

Peripheral blood vessels, due to availability are used for many years in cancer patients, however in patients with potentially harmful drugs to skin (vesicant drugs) or difficult accessibility to vessels, the use of implantable port (totally implantable venous access port-TIVAP)devices with central vascular access are important.
In this retrospective study, 85 pediatric cancer patients younger than 16 years, with TIVAP implantation, were followed for their complications and outcome. In addition to demographic data, patients’ port complications were assessed and compared with published articles.
Mean days of implanted port usage were 531 ± 358 days in all patients. This period was 287 ±194 days in complicated patients. Complications included as infection (tunnel infection and catheter related blood-stream infection), malfunction and thrombosis, skin erosion, tube avulsion, and tube adhesion to the adjacent vessels were seen in 30.6% of patients.
According to the published data and this experience, the most common complications in TIVAP are infection and catheter malfunction. It is important to notice that in order to prolong its efficacious life, effective sterilization methods, prevention of clot formation and trauma, are the most useful measures.

Oral mucositis is an adverse effect of chemotherapy. Type of chemotherapy regimen is the most important factor causing mucositis. Oral mucositis is usually associated with transient decrease in saliva production. The goal was to study effects of gum consumption on oral mucositis in children undergoing chemotherapy.
This randomized controlled trial was done in Amir Kabir Hospital, Arak, Iran. 130 children to 15 years of age were studied. Control group was composed of 65 children who received mucotoxic drugs. Test group was made up of 65 patients received similar drugs in addition to sugar free gums. Patients consumed 6 pieces of gums per day for 15 days. A standardized follow up form and World Health Organization (WHO) grading system for oral mucositis were used for evaluation of patients during 15 days of treatment.
Severe oral mucositis occurred in 30 (46%) of 65 patients in the test group and in 26 of 65 (40%) patients in the control group. Difference was not statistically significant (P > 0.05). Rate of mild to moderate mucoitis (grade 1 and 2) was significantly lower in patients who used gums (15 % vs. 35%, P Our study showed that stimulation of saliva flow by chewing gum could decrease mild to moderate inflammatory injuries of the oral mucosa during chemotherapy. However, it was not effective to subside severe mucositis.

Data on childhood and adolescent malignant tumors incidence are skimp in developing countries. In this study, we analyzed the incidence and trend of childhood and adolescent cancers in Yazd city, center of Iran between Jan 2004 and Dec 2013.
The various types of malignant tumors were grouped pursuant to the International Classification for Cancer in Children. To analyze the data, descriptive and illative statistical methods were used.
Two hundred twenty-two patients with a malignancy aged less than 18 years were studied with a male to female ratio of 1.36.The mean age of patients was 9.88 (±5.7) years. Leukemia with the frequency of 84 (37.8%) and after that lymphoid malignancies with the frequency of 49 (22.1%) were the most common cancers. There was a low range of oscillation in the incidence rate of malignancies during this period of time (P value= 0.081). Malignancies were mostly in males (P value=0.057) but the whole process of malignancy incidence had gone toward the higher rate of incidence in females. Incidence rate of cancers types was steady. Malignancy incidence was 3-7 cases in hundred of thousands except a year of which this incidence rate was estimated 13.4.
Leukemias and lymphomas were the main cancers in the center of Iran. Childhood and adolescent malignancies may be considerably under-recorded in our province .A childhood and adolescent cancer registry is necessary for exact analysis of these types of malignancies.

Background Immune thrombocytopenic purpura (ITP) is the most prevalent cause of thrombocytopenia in children. Despite the importance of ITP in children under 2- years old, only a few publications are available in the literature. ITP usually presents itself as isolated thrombocytopenia and mucocutaneous bleeding.
Materials and Methods This study was conducted on 187 under 2- year-old children diagnosed with ITP and treated at Dr. Sheikh Hospital from 2004 to 2011.In this retrospective study, clinical symptoms, laboratory findings, history of viral infections, vaccination history, and treatment efficacy in children under 2- years old with ITP were investigated.Patients were followed for one year after being discharged from the hospital.
Results The risk of the disease developing into chronic form was higher in older children (0.001). ITP in children under 3-months old was significantly associated with vaccination (p=0.007). There was no significant differences between male and female patients in regards to newly diagnosed ITP, persistent, and chronic disease status (p = 0.21). No significant difference in bleeding symptoms was observed between patients under 3-months old and 3 to 24-months old (p=0.18).
Conclusion Infantile ITP respond favorably to treatment. The risk of the disease developing into chronic form is higher in 3-to-24-month-old children compared to under-three-month olds.

Background Some researches have shown the association between iron deficiency and migraine headache in adults. The aim of present study was to evaluate efficacy of ferrous sulfate treatment on migraine headaches of 5-15 years old migraineur children with iron deficiency.
Materials and Methods In a quasi- experimental study, monthly frequency, severity, duration and disability of headaches of 5-15 years old migraineur children that prophylactic therapy was indicated in them and had iron deficiency who were referred to Pediatric eurology Clinic of Shahid Sadoughi University of Medical Sciences, Yazd, Iran between 2013 and 2015 and were treated with 2mg/kg/day topiramate plus 4mg/kg/day of ferrous sulfate for three consecutive months, were evaluated and headache characteristics before and after treatment were compared.
Results In this study, 98 children with mean age of 9.72±3.19 were evaluated that 31children 31.6%) had iron deficiency. Monthly frequency (22.89±7.18 vs.14.5±4.56, P= 0.02), severity score (8.12± 1.76 vs. 5.03±1.15, P= 0.02) and disability score of headache (38.23±10.7vs. 30.12±7.46, P= 0.03) were more in children with iron deficiency. Iron therapy was effective in decreasing of monthlyfrequency 22.89± 7.18 vs. 10.13±4.51, P = 0.001), severity score (8.12±1.76 vs. 5.11±1.62, P =0.001), duration (2.14±1.23 vs.1.14±1.01, P= 0.001) and disability score of headache 38.23±10.7 vs. 22.87±8.65, P= 0.01).
Conclusion In children, iron deficiency increased monthly frequency, severity and disability of migraine headache and ferrous sulfate can be used as a safe and effective drug in migraine prophylaxis.

Background Non-organic failure to thrive (NFTT) is the most common cause of failure to thrive (FTT) which is attributed to inadequate nutrition due to economic factors or parental neglect. NFTT can lead to a vicious cycle of poor and inadequate eating and severity of anemia. The aim of this study was to determine the hematological indices in children with NFTT.
Materials and Methods In a cross sectional case control study, iron status and blood indices of forty five aged 6 60 months children with NFTT were evaluated and compared with 45 healthy control children (with matching of age and sex).
Results In this study, the prevalence of anemia was 48.9% in NFTT compared to 11.4% in the control group (pConclusion Based on the results of this study, a correlation between malnutrition and anemia was found. However, further studies are needed to assess and confirm the current outcomes.

Background Candida species are normal microflora of oral cavity, vagina, and gastrointestinal tract. They are the third most prevalent cause of pediatric health care–associated bloodstream fungal infection. This study aimed to provide an epidemiological feature of candidiasis and also presents an antifungal susceptibility profile of clinical Candida isolates among children.
Materials and Methods During July 2013 to February 2015, 105 patients from different hospitals of Isfahan, Iran, were examined for candidiasis by phenotypic tests. Samples were obtained from nail clippings, blood, thrush, BAL, urine, oropharynx, skin, and eye discharge. The age range of patients was between 18 days to 16 years. Genomic DNA of isolates was extracted and ITS1- 5.8SrDNA-ITS2 region was amplified by ITS1 and ITS2 primers. The PCR products were digested using the restriction enzyme MspI. Minimum inhibitory concentration (MICs) was determined using microdilution broth method according to the clinical and laboratory standards institute (CLSI) M27-A3 and M27-S4 documents.
Results Forty-three patients (40.9%) had Candida infection.The most clinical strains were isolated from nail infections (39.5%), and candidemia (13.9%). Candida albicans was the most prevalent species (46.5%). MICs ranges for amphotericin B, fluconazole, and itraconazole were (0.025- 0.75 μg/ml), 0.125-16 μg/ml), and (0.094- 2 μg/ml), respectively.
Conclusion Due to high incidence of Candida infections among children, increasing of fatal infection like candidemia, and emersion of antifungal resistance Candida isolates, early and precise identification of the Candida species and determination of antifungal susceptibility patterns of clinical isolates may lead to better management of the infection.

Evidence indicates RFC1 G80A polymorphism as a risk factor for a number of cancers. Increasing studies have been conducted on the association of RFC1 G80A polymorphism with acute lymphoblastic leukemia (ALL) risk. However, the results were controversial. The aim of the present study was to derive a more precise estimation of the relationship.
PubMed, Embase, Web of Science, Cochrane database, and Google Scholar were searched to get the genetic association studies between RFC1 G80A polymorphism and ALL. All eligible studies for the period up to February 2016 were identified. Subgroup analyses regarding ethnicity were also implemented. All statistical analyses were done with CMA 2.0.
A total of ten studies comprising of 2,168 ALL cases and 2,693 healthy controls were included in this meta-analysis. Overall, no significant association was detected for allelic model (OR = 1.029, 95 % CI 0.754- 1.405, P=0.000), Dominant model (OR = 1.619, 95 % CI 0.847-3.094, P=0.145), recessive model (OR = 1.169, 95 % CI 10.764-1.790, P 0.429), and homozygote model (OR = 1.288, 95 % CI 0.928-1.788, P=0.130). However, there was an obvious association under the heterozygote model (OR = 1.368, 95 % CI 1.056- 1.772, P=0.018). Also, in the stratified analysis by ethnicity, no significant association of this polymorphism with risk of OC was found in the Asian and Caucasian populations. However, there was not significant heterogeneity between heterozygote genetic model (P = 0.15, I2 = 33%) in Caucasian. Therefore, we utilized the fixed-effect model to merge OR value.
Based on the available evidence, no association between RFC1 G80A Polymorphism and ALL risk was observed, even in the subanalysis by ethnicity. The direction of further research should focus not only on the simple relationship of RFC1 G80A Polymorphism and ALL risk, but also on gene–gene and gene-environment interaction.

Iron-deficiency anemia is a widespread public health problem with major consequences for human health especially, children. However, in a fraction of patients an underlying cause is never found during routine investigation. Recent studies have suggested an association between Helicobacter pylori (H. Pylori) infection and iron deficiency anemia.
Here is reported four school aged children (two male, two female) with refractory severe iron-deficiency anemia associated H. Pylori gastritis. Mean age of the patients was 13.62 years old and they were admitted with chief complaints of abdominal, chest pain weakness, headache and respiratory distress. Mean hemoglobin level in patients was 6.2 g/dl with persistence to iron therapy. After the diagnosis and therapy of H. pylori infection, clinical complaints, hemoglobin level and iron profiles were being normal and they gained weight.
This study suggests screening of H. pylori infection and appropriate treatment in any case of refractory moderate to severe irondeficiency anemia, especially with clinical manifestations of gastrointestinal tract in children.