Iranian Journal of Pediatric Hematology and Oncology
Volume:4 Issue: 3, Summer 2014

Endemic goiter is present in most parts of Iran. Iron deficiency adversely affects the physiology of thyroid. The initial steps of thyroid hormone synthesis are catalyzed by thyroperoxidases and are dependent on iron. In many developing countries, children are at high risk of both goiter and iron deficiency anemia. In addition, iron deficiency may alter central nervous system control of thyroid metabolism; andalso Iron-deficiency anemia decreases plasma concentrations of thyroxine and triiodothyronine. We conducted a randomized, double-blind,controlled trial in 2-12-y-old children with euthyroid goiter and without iron-deficiency anemia.The children weredivided into two groups: The Patients who were under treatment with ferrous-sulphat and controls. active treatment consisted of iron supplementation was administered orally with a dose of 2 mg/kg day. The duration of active treatment was 12 weeks. In this study 40 children (female: 22, male: 18) were divided into two groups randomly. (20 patients in each group).There were no significant differences at baselines between groups with regard to gender, age and weigh.At the end of the study, the reduction of more than one grade of goiter was significant between iron-treated and placebo groups. In treatment group, 16 patients (80%) had decreased grade of goiter, while in the control group, 3 patients (15%) had grade reduction(P-value<0.001). At the end of the study, decrease of more than one grade of goiter had significant differences between iron-treated and control groups.

Neuroblastoma is the third most common malignancy in children with a very heterogeneous feature. In this study, the epidemiological and clinical characteristics of children with neuroblastoma treated in a referral oncology hospital in Shiraz, Southern Iran, were investigated. In this historical cohort study, the medical files of 36 children under 18 years old with neuroblastoma were reviewed, who were admitted to Amir Oncology Hospital in Shiraz, Iran from 2006 to 2013. Overall survival and event free survival (EFS) curves were demonstrated by Kaplan Meier methods. Also the effects of demographic and clinical characteristics of the patients on survival were evaluated by Cox regression model. The median age of diagnosis was 30 months (age range: from 4 to144 months), with M/F ratio of 63.9%. Over 70% of the patients had stage 4 of neuroblastoma at their initial presentations. Adrenal gland comprised 72.2% of the primary tumor site. The most common presenting symptoms were gastrointestinal and constitutional symptoms. The mean overall survival and EFS were 30.75 and 20.56 months, respectively. Among the different variables analyzed, only liver metastasis had an adverse effect on EFS (p=0.025 Hazard ratios 2.83, CI: 1.14-7.02). This study revealed that the majority of children suffering from neuroblastoma in our center are high stage with disseminated disease at the time of detection. It also warns us about an urgent necessity for holding a re-educational program for general practitioners and pediatricians to review the warning signs of common pediatric cancers such as neuroblastoma.

Ewing’s sarcoma family is a group of small round cells tumors. The aim of this study is to evaluate clinicopathologic characteristics and outcome of Ewing’s sarcoma in children and adolescents in Yazd, Iran.

All patients under 19 years with documented pathology of Ewing’s sarcoma family tumor who referred to Shahid Ramazanzadeh Radiotherapy center between 2002 to 2010 were enrolled in this retrospective study. Overall survival and disease free survival and prognostic factors were evaluated.

Among approximately 80,000 patients who referred to Shahid Sadoughi pathology department, over an 8-year period, the total number of patients with Ewing sarcoma was 32, of which, 18 cases were under the age 19. The mean age was 13.72 years. Five patients (27.8%) had metastatic disease at the time of diagnosis. Complete response had been achieved in 8 (44.4%) of the patients. Local recurrence occurred in 4 (22.2%) of the patients. During the follow up 13 (72.2%) of the patients showed metastases. The mean overall survival was 34.79 months (95% CI: 22.27-47.32). One, two, four and five year survival was 72%, 39%, 25% and 17% respectively. Complete remission occurred in 10 patients (63.6%). A trend of better overall survival was found in these patients (p=0. 55). When the brain and bone metastases occurred, the overall survival decreased significantly (p=0. 003).

The overall survival rate of Ewing''s sarcoma is very low in comparison with other parts of the world.

Anthracyclines are important components of many chemotherapeutic protocols. The present study aimed to evaluate the repolarization changes in electrocardiography (ECG) which may predict drug induced arrhythmia. In this cross-sectional study, the recorded ECGs were assessed for QT dispersion (QTd), QT corrected dispersion (QTcd), T peak to Tend dispersion (TPed), and P dispersion (Pd) in 12 ECG leads. The demographic information, including sex, age, and duration of drug consumption, were recorded, as well. In this study, 112 patients, including 58 females (52%) and 54 males (48%) with the mean age of 8.7±4.5 years, as the case group were compared with 43 children, including 17 males (40%) and 26 females (60%), in the control group. Most of our patients (88%) had received usual doses of anthracyclines; i.e., 330 mg/m2. QT dispersion of the patients and the controls was 0.054±0.02 and 0.05± 0.02 seconds, respectively. No significant difference was found between the patients and the controls regarding corrected QT dispersion (P> 0.05). However, P dispersion time had increased in the patients'' group. Our study showed that the duration of anthracyclines therapy did not cause any significant increase in ventricular re-polarization parameters. Anthracyclines may show their cardiac toxicity through increasing P dispersion.

The aim of the study was to evaluate the depression levels in mothers of children with leukemia. This single centred, cross-sectional study was conducted among mothers of children with leukemia at the Hematology and Oncology research center, Baghaie-Pour clinic in Yazd City during February through December, 2013. The study sample included 58 mothers with 1-12 year old children with the diagnosis or treated at the Shahid Sadoughi hospital. Socio-demographic characteristics were gathered using a socio-demographic form and Beck Depression Inventory (BDI) was applied to all mothers to assess symptoms of depression. All variables that could potentially impact dependent outcome measures of the BDI were analyzed. These factors were mothers'' age, mothers'' education, and socioeconomic status of the family, gender of child. The analysis revealed that mothers of children leukemia had a severe level of depression (p=0.01). 41 participants (70.6%) indicated their current depressive symptoms as being in the severe range, 12 participants (20.6%) in the moderate range, and 5 participants (8.6%) in the mild range or no depression. There was an inverse correlation between the educational level of the mothers and the heads of household, their occupational status, their marital status, their socio-economic condition and depression (p≤0.05). The depression scores of the mothers of patients were higher than those of the controls. Depression ideation is common among mothers of children with leukemia. There are strong associations with socio-economic condition and high depression levels.

Sickle hemoglobin is the most common abnormal hemoglobin in the United States. Hemoglobin S arises as a result of a single amino acid substitution (glutamic acid to valin at position 6 of the β-globine chain).The presence of fetal hemoglobin (HbF) plays a relatively protective role since a significant amount of HbF interferes with HbS polymerization, the pathogenesis mechanism of the vaso-occlusive symptoms that are the major contributor of the morbidity and mortality of this condition Thalassemia major and thalassemia intermedia have no specific molecular correlate but encompass a wide spectrum of clinical and laboratory abnormalities.Hydroxyurea (HU), an s-phase-specific and non-DNA-hypomethylating chemotherapeutic agents is capable of inducing HbF synthesis. This study was done on 56 patients, 28 patients with sickle cell anemia (SCA) and 28 patients with intermediate or major β-thalassemia. Start dose of HU was 10 mg/kg per day and increased by 5 mg/kg per day every 4-6 weeks until toxicity or according to clinical response. The side effects were dermatologic in 39.28%, neurologic 23.2%, gastrointestinal 17.5% and hematologic 10.71% of patients. the statistical analysis didn''t show significant relationship between variables such as history of blood transfusion, duration of HU treatment, age of start HU, age of diagnosis, dose of HU and ethnic with occurrence of HU adverse effects. The HU therapy in our patients tolerated well and side effects were minor to moderate, benign and transient.

Acute lymphoblastic leukemia (ALL) is one of the most prevalent hematologic malignancies in children. Although the cure rate of ALL has improved over the past decades, the most important reason for ALL treatment failure is multidrug resistance (MDR) phenomenon. The current study aims to explain the mechanisms involved in multidrug resistance of childhood ALL, and introduces ATP-binding cassette transporterA2 (ABCA2) as an ABC transporter gene which may have a high impact on MDR.Benefiting from articles published inreputable journals from1994 to date and experiments newly performed by our group, a comprehensive review is written about ABCA2 and its role in MDR regarding childhood ALL. ABCA2 transports drugs from the cytoplasm into the lysosomal compartment, where they may become degraded and exported from the cell. The aforementioned mechanism may contribute to MDR. It has been reported that ABCA2 may induce resistance to mitoxantrone, estrogen derivatives and estramustine. It is resistant to the aforementioned compounds. Furthermore, the overexpression ofABCA2 in methotrexate, vinblastine and/or doxorubicin treated Jurkat cells are observed in several publications. The recent study of our group showsthatthe overexpression ofABCA2 gene in children with ALL increases the risk of MDR by 15 times.ABCA2 is the second identified member of the ABCA; ABC transporters'' subfamily. ABCA2 gene expression profile is suggested to be an unfavorable prognostic factor in ALL treatment. Better understanding of the MDR mechanisms and the factors involved may improve the therapeutic outcome of ALL by modifying the treatment protocols.

Hemangiomas, usually, present at the first few Hemangiomas, usually, present at the first few months of life and are the most common benign tumor in children. There are various therapeutic methods for hemangioma. Capillary hemangioma is a type of hemangiomas. The steps of treatment of a child with capillary hemangioma in Taleghani Hospital of Gorgan, Iran, are reported. Case report: In this report, it is described an 18-month-old child with capillary hemangioma on the right side of face. She was presented to the hematologic clinic of Taleghani Hospital of Gorgan. Three drugs, including prednisolon, propranolol and interferon alpha-2b (IFN-α-2b), were used for treating this patient. At the end of treatment, good results were obtained. After that, laser therapy was performed for fading the lesions. Prescription of drug was our first choice for treating capillary hemangioma and it had a positive result without any complications. We used propranolol and IFN-α-2b for treating capillary hemangioma because of their better effect on this patient.