Iranian Journal of Pediatric Hematology and Oncology
Volume:12 Issue: 2, Spring 2022

The current research seeks to present a comparative study of the effect of filgrastim and pegfilgrastim in the treatment of fever and neutropenia in leukemia patients.

The present study is a blind randomized clinical trial. The study population is comprised of 120 children with acute lymphoblastic leukemia (ALL) who were admitted to the hospital due to mild febrile neutropenia during 2019. Included patients were divided into two groups. Filgrastim (10 micrograms/ kilogram, daily subcutaneously) and pegfilgrastim (100 micrograms per kilogram of a subcutaneous dose) were used for groups, respectively. Fever monitored every 6 hours, and neutrophil count was performed every 48 hours. The questionnaire designed in the study included age, type of drug side effects, number of days of neutropenia, and fever cessation time. Then, the data were analyzed by SPSS software.

  Leukemic children with fever and neutropenia (N=120) were included in the study, which was 59 (49.1%) male and 61 (50.9%) female by the mean age of 79±44 months. The mean days of neutropenia correction in the filgrastim and pegfilgrastim groups were 5 and 4 days, respectively, which was not significantly different (p =0.08). There was no correlation between patients’ complications and types of treatments (p>0.05). Muscular pain was the most common complication observed among 4 cases and 1 case following filgrastim and pegfilgrastim administration, respectively. Furthermore, hyperleukocytosis following pegfilgrastim consumption was observed in two cases.

There was no significant correlation between the duration until the cessation of fever and the number of neutropenia days in the two groups receiving pegfilgrastim and filgrastim. Therefore, the fever and neutropenia improve with pegfilgrastim earlier than filgrastim; besides, fewer injections, patient comfort, and less musculoskeletal pain can be observed.

Lymphadenopathy is an enlargement of a lymph node. Pathologic Lymphadenopathy is when there is a symptom of infectious and noninfectious abnormalities or malignant diseases. Most Lymphadenopathies are benign and are associated with a short period of symptoms. Concerning diagnosis and management of adenopathy, especially in the case of children, research is still underway. For this reason, our study investigated and analyzed the causes of lymphadenopathy in children.

This is a retrospective study conducted at the Pediatric Department of children's medical center of Tehran University of medical science. In this study, 130 children with cervical lymphadenopathy aged under 12 years underwent lymph node biopsy. Then under general anesthesia and evaluation of a senior pathologist, the lymph node was excised and biopsied.

During the study, twenty-five cases were excluded. Fifty-three patients (50.47%) demonstrated infection history, 22 cases (21%) had neoplasia, and reactive inflammatory changes with nonspecific origin were seen in 42 cases (40.0%). We observed chronic lymphadenitis in 3(2.9%) cases, and finally, 1(1.0%) case was metastatic. Mean lymph node size proved to be greater than two cm in metastatic (2.22cm), lymphoma (2.33cm), and granulomatous (3.17cm) lymphadenopathies. The average lymph node size turned out to be 1.53 cm in reactive lymph nodes (P =0.021). The diagnosis was obtained by excisional biopsy and histopathology.

Acute infections are the most common reason for lymphadenopathy in pediatric conditions. It is better to be suspicious of malignancy with a high index in cases of cervical lymphadenopathy, especially if the lymph node size is higher than 2 cm. History, clinical features, and paraclinical tests can be used for lymphadenopathy in children.

Microparticles (MPs) are small vesicles released from the cell membrane. Accordingly, these contain active molecules to mediate biological processes, including cell proliferation and cell cycle progression. The fusion of myeloma cell lines with immunized B lymphocytes is a critical step of hybridoma technology. MPs modulate lymphoproliferation, thereby facilitating B cell expansion and successful immortalization. Human alloimmune B cells are considered valuable sources of monoclonal antibodies, and peripheral blood is a pool of B lymphocytes. The present study aimed to investigate the role of myeloma-derived MPs in the proliferation of alloimmune peripheral blood mononuclear cells (PBMCs).

In the current experimental study, ultracentrifugation isolated MPs from three different myeloma cell lines, including U266, P3x63Ag8, and SP2/0. PBMCs were extracted from the whole blood of a patient with thalassemia alloimmune exposed to MPs. Thereafter, both the proliferation and cell viability were evaluated using inverted microscopy and the trypan blue staining method.

MPs derived from the P3X63Ag8 myeloma cell line were shown to have the most effects on cell proliferation and viability (p=0.0005). MPs of the SP2/0 cell line initially increased the proliferation of PBMCs, but viable cells were drastically reduced in the following weeks. As well, U266 cell-derived MPs increased the proliferation of PBMCs (p=0.0001), but it was half of the group receiving P3x63Ag8 derived MPs. However, the viability of treated cells remained almost constant for 5-weeks.

Altogether, the obtained data indicated that P3X63Ag8 and U266 derived MPs could increase the viability of PBMCs. If the complimentary examination is confirmed, these MPs could also be used as the potential agents in B lymphocyte proliferation, thereby helping in immortalization and antibody production.

Early detection of neonatal sepsis and categorization of patients based on clinical severity is not yet effectively achieved. Some hematological parameters are used to formulate a hematological scoring system (HSS) and a modified hematological scoring system (MHSS) to diagnose neonatal sepsis. A promising biomarker: Presepsin, or Soluble Cluster of Differentiation 14 SubType (sCD14-ST), is a proteolysis product of CD14 produced after immune activation during infections. The purpose of this research is to assess the performance of both hematological sepsis scores and serum presepsin level in neonatal sepsis and compare them to C-reactive protein (CRP) as diagnostic tools and predictors of mortality.

This case-control study comprised two groups, one group comprised 51 neonates who were further subgrouped into suspected & proved sepsis, along with 30 uninfected neonates as the control group. Both groups were subjected to the calculation of HSS and MHSS, serum presepsin levels, CRP measurement, and blood culture and assessed for clinical severity and mortality.

Hematological sepsis scores and presepsin levels were significantly higher in the sepsis group (P <0.001). Presepsin showed the best diagnostic performance at > 0.5 ng/ml (AUC 0.979; sensitivity of 94.1% and specificity of 100%). While HSS and MHSS at a cutoff value > 1 achieved comparable specificity, lower sensitivity, 72.6% for the former and 76.5% for the later was noted. Presepsin also was significantly higher in the dead group (P<0.004) with the best predictive performance over CRP at cutoff value >1.9 ng/ml (AUC 0.838; sensitivity of 85.7% and specificity of 79.6%).

Hematological sepsis scores and presepsin were useful diagnostic tools in neonatal sepsis, with presepsin as a good predictor of mortality comparable to CRP.

This study aimed to assess cutoff of ferritin for evaluation of osteoporosis in patients with Thalassemia Major (TM).

This analytic cross-sectional study was conducted in17 Shahrivar children's hospital, Rasht, Iran, from November 2017 to November 2018. The inclusion criteria were indicated as the presence of  TM in patients aged 12-19 years old with records of their regular visits. The exclusion criteria were noted as the presence of any chronic bone diseases such as osteomalacia or osteogenesis imperfecta, delayed puberty, hypothyroidism, parathyroid dysfunction, renal failure, liver failure, and growth hormone deficiency. Ferritin level was assessed, and bone densitometry was performed for all patients with TM.

In this study, 53 females (54.6%) and 44 males (43.4%) were enrolled. Results showed that 36 (37.1%), 49 (50.5%), and 12 (12.4%) patients had a normal bone density, osteopenia, and osteoporosis, respectively. Comparing these three groups showed that despite higher mean serum level of ferritin in TM patients with osteoporosis than patients with osteopenia and normal bone density, no significant statistical difference was noted in these three groups (P >0.05). Besides, the mean ferritin level in patients with abnormal bone densitometry (osteopenia and osteoporosis) was higher than in patients with normal ones. A significant difference was noted between abnormal and normal densitometries (p=0.03). The Area under the Curve for ferritin was 0.708, and the cutoff point was indicated for ferritin was 2006 ng/ml.

  Regarding the results, there was a high frequency of osteoporosis and osteopenia in teenagers with TM. As bone density abnormality formation is time-consuming, and prevention is the primary strategy for management, it is highly recommended to assess bone mineral density regularly starting from early childhood.

Sleep habits may play a role in the onset of sleep disorders. Several factors affect sleep habits. This study aimed to investigate sleep habits and related factors in childhood cancer survivors (CCS).

This cross-sectional study was performed on 400 children (age range: 5-15 years) who recovered from cancer in Tehran, Iran, in 2020. A 35-item Children's Sleep Habits Questionnaire (CSHQ) was used to determine children’s sleep habits. Correlation coefficient test, independent t-test, and one-way analysis of variance (ANOVA) were used to determine the correlation between results.

Participants’ mean age was 10.45± 12.3 years (49% males vs. 51% females). The mean total score of the CSHQ was 58.53±7.8. There was a negative and significant relationship between age and the total score of CSHQ (P=0.009). Independent t-test showed that the subscales and the total score of the CSHQ were not significantly different between males and females (P=0.834). There was no significant relationship between the total score of the CSHQ and the duration after recovery (P=0.08).

  The CCS are at higher risk of sleep disorders and the possibility of sleep disorders is higher in younger patients. Girls and boys who have survived cancer are equally prone to sleep disorders. There is a possibility of developing sleep disorders at any time during the recovery period. Factors such as the family’s socioeconomic status, level of physical health, duration of cancer, and the age of the children should be considered when assessing and treating sleep problems in CCS.

Coronavirus pneumonia has been detected in Wuhan City since December 2019. Today, coronavirus 2019 (COVID-19) has become an epidemic worldwide. Although this disease is not fully understood, it can show different symptoms over time. One of the components involved in the body by this virus is platelets that communicate directly with several different types of viruses, including the SARS-CoV virus family, via integrins, P-selectins, and pseudo-receptors. Mechanism of action includes the virus's direct effect on bleeding and maturation of megakaryocytes, increased adhesion and activation of platelets, and platelet consumption in abscesses of damaged lung tissue. Therefore, Covid-19 disease can affect platelet function, which in itself can directly or indirectly affect thrombocytopenia. Pathology of bone marrow aspiration from three patients with Covid-19 thrombocytopenia indicates abnormal megakaryocyte maturation. In addition, it can be associated with the severity and mortality of the disease. In other words, thrombocytopenia can be used as a prognostic factor in patients with progressive Covid- 19, which has been reported in 5 to 40% of COVID-19 patients. This study attempts to gather information and recent reports on thrombocytopenia in patients with Covid-19.

Pulmonary schwannoma is a rare neoplasm that arises from peripheral nerve sheath, Schwann cells, in the lungs and mostly remains asymptomatic for months. This report presents a seven-year-old female patient with an occasional cough and fever. She was hospitalized due to the lack of response to outpatient treatments, including antibiotics and antifebrile. A biopsy was taken from the mass by bronchoscopy, and the pathology report indicated the presence of a low-grade spindle cell, Verocay body, and Antoni B areas. Based on the pathologic findings, immunohistochemical (IHC) analysis was requested. The results indicated diffusely positive for S-100 protein, and accordingly, the diagnosis of schwannoma was confirmed. Thoracotomy and lobectomy were performed. Tracheobronchial schwannoma can be treated with surgical resection or bronchoscopy.