فهرست مطالب

  • Volume:7 Issue:4, 2017
  • تاریخ انتشار: 1396/07/15
  • تعداد عناوین: 8
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  • Seyedeh Zahra Shafipour, Nadia Mosayebi, Fariba Asgari, Dr Zahra Atrkarroushan, Dr Ardalan Pasdaran Pages 198-206
    Background
    Phlebitisis is the inflammation of the veins that negatively affect the patient’s health status. This study was conducted to determine the effect of external use of sesame oil in prevention of chemotherapy-induced phlebitis in children with ALL.
    Materials And Methods
    This double-blind clinical trial was conducted on 60 patients aged 2 to 14 years old who were admitted for chemotherapeutic management to the 17th Shahrivar Hospital, Rasht, Iran, between January 2016 and January 2017.The patients were randomly divided into two groups: intervention and control. Ten drops of sesame oil in the sesame oil group and10 drops of oral liquid paraffin in the control group were given daily for 30 days. Data collection tools were run in both groups: a demographic questionnaire and the Visual Infusion Phlebitis Scale for the measurement of phlebitis. Data were analyzed using SPSS (version 23).
    Results
    The survival time for vein received chemotherapy in the sesame oil group was 44%.The results of the present study showed that there is statistically significant difference between the mean grade of phlebitis in both groups (p = 0.0001).The relative risk of phlebitis incidence was two times more than the sesame oil group.
    Conclusion
    External use of sesame oil can be effective in the prevention of chemotherapy-induced phlebitis.
    Keywords: Chemotherapy, Children, Leukemia, Phlebitis, Sesame Oil
  • Dr Mehdi Ghaderian, Dr Nahid Reisi, Dr Alireza Moafi, Dr Safora Farasat Pages 207-215
    Background
    The protective effects of silymarin on liver and heart have been investigated and identified by many researchers. This study evaluates the protective effects of this substance on hepatotoxicity and cardiotoxcity of chemotherapy drugs in leukemic children.
    Materials And Methods
    In this study, 71 children, aging 2-14 years old, going through the maintenance phase of acute lymphoblastic leukemia (ALL) treatment at Children's Cancer Center of Isfahan University of Medical Sciences (Iran) in 2015 were studied. Two patients died and the remaining patients were divided into intervention and control groups. Intervention group received Mercaptopurin and Methotrexate plus Silymarin 140mg/day and control group were taking only Mercaptopurin and Methotrexate. Liver enzymes, Coagulation tests, Creatine kinase- Muscle and Brain (CK-MB), Ejection fraction and Systolic function (SF) were measured at the first, and 3 and 6 months’ intervals from the commencement of study. The Data was analyzed by using SPSS and P ≤ 0.05 was considered as statistically significant. Associations between variables were analyzed using independent t-test, chi square, and repeated measures ANOVA test.
    Results
    Mean levels of Alanine aminotransferase in both groups increased significantly at 6 months interval (P=0.01, 0.01, for control and intervention groups respectively). Although increment was more among controls, there were no significant differences between the two groups (P= 0.85). Furthermore, Aspartate aminotransferase and Alkaline phosphatase increased in both groups and the increment was significant in the controls (P=0.001, 0.05, for control and intervention groups respectively). Coagulation tests prolonged in the first 3 months in both groups and the prolongation was more in control group. Changes in CK-MB were not significant in intervention and controls (P=0.07, 0.10, respectively) but ejection fraction and SF decreased in both groups, especially among controls.
    Conclusion
    It seems that Silymarin can be useful in prevention of hepatotoxicity and cardiotoxcity of chemotherapy drugs for ALL children.
    Keywords: Acute lymphoblastic leukemia, Cardiotoxity, Hepatotoxicity, Silymarin
  • Dr Neda Sheikh Zakaryaee, Dr Foroozan Atashzadeh-Shoorideh, Dr Fazlollah Ahmadi, Dr Mahdi Fani Pages 216-223
    Background
    The increased prevalence of cancer in children influences the family as the main child caregiver. Regarding the spiritual dimension for increasing the life quality of parents and its effect on the management of the conditions induced by the disease, the goal of this study was to determine the strategy of care in parents of cancer children.
    Materials And Methods
    This study was performed with a qualitative method using the content analysis approach. Fifteen parents of the cancer children who were admitted to the Oncology and Hematology Wards of the Iranian Public Children's Hospitals participated in this study. First, the mothers were interviewed, then other participants, including fathers and mothers who had a special experience about this issue were studied through theoretical sampling. Data were analyzed using content analysis method.
    Results
    Data analysis led to the apparent main category of "intelligent rethinking" that included two subcategories: 1) "Cognitive confrontation" with the subsidiary categories of "effort to adopt" and "accept the disease" and 2) Optimism with the subsidiary categories of "hope" and "positive energy".
    Conclusion
    This study showed that spirituality has an important role in accepting and complying with disease by parents of a cancer child. This would lead to managing the conditions and achieving the hope, positive energy, and efficient management of the conditions. Hence, paying attention to this important dimension in caring to achieve the suitable control and management of the conditions and accept the disease by parents is a necessity.
    Keywords: Cancer, Nursing, Qualitative research, Parents, Spirituality
  • Dr Mohammad-Reza Managhchi, Dr Gholamreza Toogeh, Fariba Zarrabi, Dr Mohammad Faranoush, Dr Mohsen Rezaiei, Hemami, Dr Katayoun Karimi, Dr Nader Roushan Pages 224-231
    Background
    The development of inhibitors is a complication factor replacement therapy in hereditary factor VIII deficiency. Several management options are available for the treatment of inhibitor. Rituximab, a monoclonal antibody against CD20, reduces inhibitor level in rare bleeding disorders. The aim of this study was to evaluate the effectiveness of rituximab in lowering or eliminating the levels of factor VIII inhibitors in patients with severe hemophilia A.
    Materials And Methods
    This cross sectional study was conducted on ten male patients with severe hemophilia A with inhibitor titer ≥5 Bethesda Units/ml (BU) during 100 weeks in comprehensive hemophilia care center in Imam Khomeini Hospital. The recruitment period began in September 2010 and continued through November 2012. Patients received rituximab 375 mg/m² weekly from week 1 through 4. Inhibitor titer was measured monthly on week 6 to 22, Then on week 24, 36, 52, and 100. All patients received four doses of rituximab.
    Results
    Major response occurred on four patients (40%).Three patients had a minor response and three patients with no response to treatment. Adverse events were included renal impairment, headache and increase liver transaminase. No severe allergic reaction was observed.
    Conclusion
    Rituximab is useful for eradication or lowering inhibitor titer in severe hemophilia A with high-titer inhibitor. Further clinical trials studies need to evaluate efficacy and safety of the rituximab as an adjunctive therapy in combination immune tolerance induction strategies.
    Keywords: Hemophilia A, Rituximab, Inhibitor, High responder, Therapeutics, CD20 antibody
  • Dr Bahram Darbandi, Dr Sharareh Zarezadeh, Dr Zahra N. Atrkar Rosha, Afagh Hassanzadeh Rad, Dr Adel Baghersalimi Pages 232-236
    Background
    Glucose-6 phosphate dehydrogenase (G6PD) deficiency is the most common inherited enzyme deficiency of red blood cells involving the enzyme pathway of hexose monophosphate. This study was conducted to examine the effect of vitamin E and folic acid on the improvement of acute hemolysis caused by the G6PD deficiency in patients referred to 17 Shahrivar Hospital, Rasht.
    Materials And Methods
    This was a randomized clinical trial conducted on 120 patients with G6PD deficiency. The patients were divided in 4 groups, including vitamin E, folic acid, a combination of both supplements, and control groups. The hemoglobin level and the reticulocyte count of patients during hospitalization, at discharge and two weeks after discharge were evaluated. All patients received standard treatment for acute hemolysis.
    Results
    Mean age of the patients was 44.19± 16.43 months. There was no significant difference between 4 groups in terms of age, gender, and etiology of hemolysis (p>0.05). The consumption of fava bean was the main cause of hemolysis in 95% of patients. The level of hemoglobin and hematocrit, and reticulocyte count during hospitalization and discharge among groups showed no significant difference (p>0.05). However, a significant increase was observed in the level of hemoglobin and hematocrit and reduction of reticulocyte count in patients receiving supplements compared with control group (p=0.001).
    Conclusion
    Considering the low cost, availability, and safety profile of theses supplements, it seems that usage of folic acid and vitamin E can be highly recommended during favism.
    Keywords: Favism, Folic Acid, Vitamin E Hemolysis, Glucose-6 phosphate dehydrogenase
  • Mojgan Amirpour, Dr Hossein Ayatollahi, Dr Mohammad Hadi Sadeghian, Maryam Sheikhi, Somaieh Azarkerdar, Alireza Khiabani, Ehsan Yazdandoust, Seyyede Fatemeh Shams, Sepideh Shakeri Pages 237-244
    Background
    Brain and Acute Leukemia Cytoplasmic (BAALC) is a gene which its expression is confined to progenitor cells; therefore, no expression has been illustrated in mature cells of bone marrow or white blood cells (WBC). In addition, high BAALC expression is associated with poor prognosis in Acute Myeloid Leukemia (AML) individuals and is considered as an important risk factor in Cytogenetic Normal Acute Myeloid Leukemia.
    Materials And Methods
    This retrospective study was designed to evaluate prognostic importance of BAALC gene expression in pediatric AML patients. Recently, recognized 114 AML Iranian children with age range of 1-15 years were entered in this study during 2012-2015. Real-Time PCR was applied for BAALC gene.
    Results
    High BAALC gene expression was detected in 47 patients (41.2%) and low expression in 67 patients (58.8%). High BAALC gene expression group (n=47) contained23 males and 24 females. All patients were followed up for 2 years to measure disease prognosis. BAALC expression was a main unfavorable prognostic factor in AML patient’s especially normal karyotype. AML cases with high BAALC expression had considerable further cumulative risk after 25 months; it was 39 months in low expressed cases. All of cytogenetic normal acute myeloid leukemias (CN-AML) and high BAALC expressed patients died. High BAALC expression in AML cases was associated with considerable shorter overall survival (OS).
    Conclusion
    According to our findings, BAALC expression is a significance poor prognostic factor in AML patients with normal karyotype. This study suggests new therapeutic strategies to ameliorate the treat rate of AML patients. Further research with longer follow up and larger sample size is required to definite statistical perusals.
    Keywords: BAALC, gene Expression, Pediatrics, prognosis
  • Dr Gholamreza Badfar, Dr Marzieh Parizad Nasirkandy, Dr Masoumeh Shohani, Akram Mansouri, Ehsan Shabani, Shoboo Rahmati, Ali Soleymani, Dr Milad Azami Pages 245-259
    Growth disorders are considered as one of the common complications of thalassemia major patients. The present study was conducted to examine the prevalence of short stature, underweight, and delayed puberty in patients with thalassemia major in Iran.
    This review study was conducted based on systematic review and meta-analysis protocol (PRISMA) until 2017. To access relevant literature, two researchers independently searched Magiran, Medlib, Iranmedex, SID, PubMed, Scopus, ScienceDirect, Web of Science, as well as Google Scholar search engine. Pooled prevalence rates were calculated using a random effects model. Data were analyzed using Comprehensive Meta-Analysis Software (Version 2).
    In 18 studies, including 2,446 Iranian thalassemia major patients, the prevalence of short stature was estimated to be 52.3% (95%CI: 45.7-58.8). The lowest prevalence of short stature was in the North of Iran (42.4% [95%CI: 34.7-50.4]) and Mazandaran province (31.8% [95%CI: 27.5-36.5]), and the highest prevalence was in the South (64.6% [95%CI: 51.2-72.1]) and Fars province (71.4% [95%CI: 49.8-86.3]). The prevalence of short stature among males and females was estimated to be 48.7% (95%CI: 39.3-58.1) and 40.4% (95%CI: 30.4-51.2), respectively, and male to female odds ratio was 1.21 (95%CI: 1.01-1.46, P=0.03). Prevalence of delayed puberty and underweight in Iranian thalassemia major patients were estimated to be 67.5% (95%CI: 46.8-83.1) and 47.6% (95%CI: 37.0-58.4), respectively.
    The results of this meta-analysis showed that the prevalence of short stature, delayed puberty, and underweight in Iranian thalassemia major patients is very high. Therefore, new planning and policies seem necessary to minimize the complications in patients with thalassemia major .
    Keywords: Delayed Puberty, Growth Disorders, Thalassemia
  • Dr Shirin Sayyahfar, Dr Shahla Ansari, Dr Mahtab Rahbar, Dr Elham Zarei Pages 260-263
    Langerhans cell histiocytosis (LCH) is an abnormal proliferation of Langerhans cells in one or more organs; bone is the most frequently involved organ in which the skull is the most frequent .The clavicle is rarely the primary site of the LCH, thereby the timely diagnosis is often delayed and most of the patients are primarily treated for acute or chronic osteomyelitis. Herein we report a 10 years old girl with swelling and pain in the medial end of the left clavicle admitted in Aliasghar Children’s Hospital in 2015 and final diagnosis of the LCH which was initially misdiagnosed as osteomyelitis. The LCH should be considered in the differential diagnosis of any lytic or destructive lesion of the clavicle for timely diagnosis and prevention of inappropriate treatment.
    Keywords: Clavicle, Histiocytosis, Langerhans cell histiocytosis, Osteomyelitis, Pediatrics