Iranian Journal of Pediatric Hematology and Oncology
Volume:13 Issue: 1, Winter 2023

The efficacy of echinacea products to treat upper respiratory tract infections (URTI) has been shown in some studies, however, there are few studies considering the efficacy of echinacea to prevent URTI. Therefore this study aimed to assess the effect of echinacea in the prevention of URTI in these children.
Materiala and

This retrospective cross-sectional study was conducted on 60 children with ALL in Shahid Sadoughi hospital from September 2020 to September 2021. These Children were divided into two groups (n=30). The case group received immunogen syrup, containing echinacea purpura root extract (200 mg/ml). This syrup was prescribed in the intervention group as 2 ml for children in the age range of 2-8 years and 0.5 ml for children in the age range of 1-2 years old for 3 months. The control group did not receive echinacea syrup. These patients were followed for 3 months regarding URTI.

The frequency of URTI in the case and control groups was 40% and 66.7%, respectively, and a significant difference was noted between the two groups in terms of the frequency of URTI (P<0.05). Moreover, 23.3% of patients who received echinacea developed a second URTI, while 53.3% of patients who did not receive echinacea developed a second URTI (P<0.05). The mean time for the second URTI in the case and the control groups was 42.3±13.93, and 48.3±13.96 days, respectively (P=0.086). Regarding reducing the duration of URTS symptoms, there was no significant difference between the two groups (P>0.05).

According to the results, echinacea can be effective in decreasing the occurrence of URTI in these children. Therefore, regarding the efficacy of echinacea in decreasing URTI, it is recommended to use echinacea in the prevention of URTI.

Given that no comprehensive study was conducted regarding the effect of sodium chloride on the prevention of mucormycosis fungal infection in acute leukemia patients during treatment, this study aimed the investigating the effect of sodium chloride  on the prevention of mucormycosis fungal infection in acute lymphocytic leukemia patients during treatment.

This retrospective study was conducted on children with ALL who were undergoing chemotherapy in the induction phase and were susceptible to fungal and infectious diseases. Then 84 patients were randomly divided into the two groups. One group (n=46) received nasal drop containing sodium chloride (NORMONIX, 0.65%, three times a day) as the intervention group during treatment and another group did not receive sodium chloride (control group)(n=38). If the symptoms of mucormycosis was observed and detected (positive test), the injection of amphotrypsin B was started.

In the current study, 84 patients entered the study.  The mean age of patients in the control group and the intervention group was 7.84±3.45, and 6.45±3.4 years, respectively (P>0.05). Positive mucormycosis was seen in 24 (63.2%) patients in the control group and 16 (34.78%) patients in the intervention group (P=0.01).

According to the findings of this study, the frequency of patients with positive mucormycosis in the NaCl group was significantly lower than the control group.  Therefore, it seems that NaCl drop can be effective regarding reducing the incidence of mucormycosis fungal infection and can decrease the need to amphotrypsin B, but further studies should be conducted in this regard.

DNA microarray is a useful technology that simultaneously assesses the expression of thousands of genes. It can be utilized for the detection of cancer types and cancer biomarkers. This study aimed to predict blood cancer using leukemia gene expression data and a robust ℓ2,p-norm sparsity-based gene selection method.

In this descriptive study, the microarray gene expression data of 72 patients with acute myeloid leukemia (AML) and lymphoblastic leukemia (ALL) was used. To remove the redundant genes and identify the most important genes in the prediction of AML and ALL, a robust ℓ2,p-norm (0 < p ≤1) sparsity-based gene selection method was applied, in which the parameter p method was implemented from 1/4, 1/2, 3/4 and 1. Then, the most important genes were used by the random forest (RF) and support vector machine (SVM) classifiers for prediction of AML and ALL.

The RF and SVM classifiers correctly classified all AML and ALL samples. The RF classifier obtained the performance of 100% using 10 genes selected by the ℓ2,1/2-norm and ℓ2,1-norm sparsity-based gene selection methods. Moreover, the SVM classifier obtained a performance of 100% using 10 genes selected by the ℓ2,1/2-norm method. Seven common genes were identified by all four values of parameter p in the ℓ2,p-norm method as the most important genes in the classification of AML and ALL, and the gene with the description “PRTN3 Proteinase 3 (serine proteinase, neutrophil, Wegener granulomatosis autoantigen” was identified as the most important gene.

The results obtained in this study indicated that the prediction of blood cancer from leukemia microarray gene expression data can be carried out using the robust ℓ2,p-norm sparsity-based gene selection method and classification algorithms. It can be useful to examine the expression level of the genes identified by this study to predict leukemia.

Acute lymphoblastic leukemia (ALL) as the most common malignancy in children is associated with high mortality and significant relapse. Currently, the non-invasive diagnosis of pediatric ALL is a main challenge in the early detection of patients. In the present study, a systems biology approach was used through network-based analysis to identify the key candidate genes related to ALL development and relapse.

In this systems biology (experimental) study, main and validating datasets were retrieved from a gene expression omnibus (GEO). Gene expression analyses were done using a bioinformatics array research tool (BART) and ExAtlas. Gene ontology and pathway enrichment analysis were also performed via Database for Annotation, Visualization and Integrated Discovery (DAVID). Furthermore, the Search Tool for the Retrieval of Interacting Genes (STRING) and cytoscape V.3.9.1 were used to network construction and analysis. The MCODE and NCMine Plugin of cytoscape were applied to find clusters and a functional module in the network. The Kaplan Myer curve was applied in order to survival analysis of the validated candidate genes. A P-value of < 0.05 was considered as significant.

A total of 671 differentially expressed genes (DEGs) mainly involved in transporter/channel activity functions, cell communication/signaling processes and fatty acid transport/PPAR signaling/eicosanoid metabolism pathways were identified (P-value < 0.05). The main cellular compartments were plasma membrane, cell periphery and cell surface (P-value <0.05). The network analysis revealed 68 hub genes, 29 of which were candidate genes. Five candidate genes were also validated in two independent experiments. These genes were considered as key candidate genes, and three of them (BCL2L11, IGF1, PDE5A) were predictors of pediatric ALL patients survival (P-value < 0.05). 

BCL2L11, IGF1 and PDE5A genes, as key candidate genes, are potentially good diagnostic biomarkers and therapeutic targets for pediatric ALL.

Families are willing to spend their entire lives improving their children due to emotional attachments, which, in turn, increases their exposure to catastrophic health expenditures (CHEs). The present study aimed to estimate the level of exposure to CHEs and its determinants among households with pediatric cancer and oncology disorders.

This cross-sectional study was performed on 101 households with pediatric cancer and oncology patients who referred to Shahid Sadoughi Hospital of Yazd in 2021. The CHE in this regard was defined as the out-of-pocket payments for hypertensive care that equaled or exceeded 40% of the household capacity to pay. The data on each household were collected with reference to the patient's electronic file and through a questionnaire completed during an interview with the head of the household. The data were also analyzed with descriptive statistics and logistic regression in Excel (2019) and STATA ver.15.

Out of 101 households in the study, 43 (42.6%) incurred CHEs (based on a threshold of 40% of disposable income). Regarding the job of the heads of households, manual workers were vulnerable to CHEs up to 11.7 times more than employees and self-employed individuals (OR=11.7, p<0.05). Also, the lower the education level of the head of the household, the higher the risk of facing CHEs (OR=10.45, p<0.05). Similarly, the lower his or her income, the higher the CHE.

The results showed that households with pediatric cancer and oncology disorders were significantly exposed to CHEs. Due to the limited resources of the health system in the treatment of cancer patients and the need for expenditure control programs, it seems better to focus on cost control strategies for this group of patients.

Atherosclerosis is an important cardiovascular disorder in beta-thalassemia major patients. The present study aimed to predict factors of atherosclerosis in children with beta-thalassemia major.

This cross-sectional study was conducted on 36 patients with beta-thalassemia major and 36 healthy children as the control group. The carotid intima-media thickness (CAIMT) and osteoprotegerin (OPG) were compared between groups.

The mean age of the patients in the case and control groups were 13.5 ± 3.7 and 13 ± 3.1 years old, respectively. Significant differences in CAIMT in the right (P = 0.001) and left (P = 0.001) arteries were recorded between the two groups. The mean serum OPG in the beta-thalassemia group was significantly higher than the control group (3.9 ng/ml and 1.4 ng/ml, respectively, P=0.001).

CAIMT is a non-invasive method for diagnosing atherosclerosis. According to the significant difference between groups, serum OPG could be helpful in the diagnosis of early atherosclerosis in beta-thalassemia major.

Beta-thalassemia intermedia (BTI) is a type of hemoglobinopathy with an increased risk of cerebrovascular accidents, and transcranial cerebral Doppler ultrasonography (TCD) through determining the mean cerebral blood flow velocity (CBFV) can serve to predict the risk of a developing stroke. This study aims to compare patients with beta-thalassemia intermedia and healthy individuals in terms of the cerebral blood flow velocity.

This research was a case control study on 35 BTI patients and 25 healthy subjects. The patients were categorized into three age groups including 7-10, 11-15 and 16-20 years old. The mean CBFVs were compared between the two groups. The factors of age, gender, serum ferritin level, hemoglobin level, spleen size, thrombocytosis, and thalassemia genotypes were evaluated for their effects on CBFVs.

Mean CBFVs were significantly higher in all the intracranial arteries of BTI patients compared to normal subjects (p-value < 0.05). The hemoglobin levels showed a negative correlation between the left and right vertebral arteries of BTI patients in terms of blood flow velocity (p-value < 0.05). The mean CBFVs in the left vertebral and basilar arteries were negatively correlated to age in BTI. There was no correlation among ferritin level, thrombocytosis, splenomegaly, splenectomy, XmnI polymorphism, and cerebral blood flow velocity in the BTI patients group (p-value > 0.05).

This study showed that cerebral blood flow velocities of BTI patients were higher than normal control group. In addition, CBFVs were not affected by factors such as gender, serum ferritin, platelet count, size of spleen and XmnI genotype, however, there was negative correlation between age and hemoglobin level with CBFVs.

In 40-80% of children undergoing chemotherapy, oral mucositis is an acute complication which imposes significant financial and physical burdens on patients. In this article, a systematic review of published studies is conducted to investigate the role of nursing intervention in reducing oral mucositis.

This systematic review investigated, critically appraised, and rated the evidence on nursing intervention to manage oral mucositis (OM) in children undergoing chemotherapy. The review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist in 2018. A search was conducted through the literature using international databases (e.g., PubMed, Scopus, the Cochrane Database of Systematic Reviews and the Web of Science). Only English-language trials published from January 2007 to December 2019 were selected to consider. There were eleven studies relevant enough to review.

A total of 127 articles were extracted in an electronic search. The excluded studies were combined research works on adults and children, descriptive studies, observational studies, and those about adults’ endurance of chemotherapy, mucositis produced by other cancer treatments, and cohorts. Finally, eleven studies were deemed eligible for inclusion in this review. Based on them, honey, olive oil, ice chips and chewing gum have been used to prevent, reduce and treat chemotherapy-induced mucositis.

This review made a comprehensive examination of the available treatment options for nursing. Nurses can use one of the treatments depending on the child's conditions.

Few data are available about hydatid cysts in patients with malignancy; however, these have rarely been described in association with leukemia. The purpose of this report was to present an unusual case of coexisting leukemia and pulmonary hydatid cysts.This study presented a 13-year-old boy with acute myeloid leukemia who was diagnosed with bilateral pulmonary hydatid cysts after the completion of chemotherapy and successfully treated with surgery and albendazole. Managing hydatid cysts in patients with leukemia is difficult, and these individuals are also at risk of developing ruptured and infected cysts during chemotherapy. Based on our experience with this case, an oncologist could postpone surgery until the chemotherapy was completed and begin albendazole if hydatid cysts were detected.