Iranian Journal of Pediatric Hematology and Oncology
Volume:5 Issue: 3, Summer 2015

Background Obesity is a medical problem in survivors of childhood acute lymphoblastic leukemia. Obesity is associated with many complications, so it is important to investigate the respective etiology. Leptin is a protein synthesized in the fatty tissue and is effective in the control of obesity. Survey of leptin in acute lymphoblastic leukemia (ALL) survivors could be helpful in controlling obesity. Materials and Methods In this prospective study, 53 pediatric patients diagnosed with ALL between 2006 and 2012 from Southern Iran, were enrolled. We examined body mass index (BMI) status and performed laboratory measuring tests including triglyceride, cholesterol, fasting blood sugar, leptin at diagnosis time and then every 6 months and in the last visit. Results patients. At the time of diagnosis, 5.66% were overweight or obese, whereas at the end of treatment, approximately 13 patients (24.53%) were overweight or obese. The median and interquartile range (IQR) for blood leptin level were significantly higher for obese patients than other patients (885, 1120 vs. 246, 494 pg/ml), (P=0.030). The median and IQR were also significantly higher in females than in males (861, 969 vs. 204, 267 pg/ml), (P=0.006). Conclusion Obesity is a complication of ALL treatment. It is associated with elevated blood leptin level. Hypothalamus leptin resistance in obese patients should be considered. In each visit, clinicians should weight and their patient’s BMI take into account.

BackgroundThe Years of Life Lost (YLL) due to cancer can be a more illustrative index. to promote preventive and therapeutic services, this study aimed to investigate the childhood cancer mortality and its trend over the past few years in Yazd to provide planners with baseline data. Material and Method Data obtained from death registration system of the healthcare center were used to calculate the age-specific standardized mortality for 5-year age groups. To calculate the YLL, the standardized expected YLL method was used with a discount rate of 0.03 for health gain in the future, the age weight of 0.04 for different years of age, and a constant age weight correction factor of 0.165. The collected data were analyzed using the Epi 6 and Excel 2007. Results 28 patients in Yazd aged 0-19 die annually due to cancer (male/female ratio 1.34). Leukemia and CNS tumors were the most common causes of death.The crude cancer death rate is 8.48 in boys and 6.72 in girls per 100000. Premature cancer deaths have caused 3,436 YLL in boys and 2,561 YLL in girls (4.92% of total YLL in both sex). The average death age did not have a significant relationship with sex, location of residence. Conclusion Childhood cancer mortality has had a decreasing trend. This study can help in the assessment of healthcare needs and improvement of the quality of healthcare services. It can also help in the design and prioritization of interventions to identify cancer risk factors which can facilitate early diagnosis.

Background This study aimed to compare sedative and analgesic effects of oral Midazolam and Ketamine on Bone Marrow aspiration (BMA) and Lumbar Puncture (LP). Material and Methods This study was a randomized clinical trial and was performed in Amirkola Hospital in north of Iran, Babol during 2011 and 2012. The study population consisted of 40 patients who underwent the first time of diagnostic BMA for any reason, patients were divided randomly in two groups: Oral Midazolam and combined Oral Midazolam and Ketamine. Each group consisted of patients with age of 3-7 years and over 7 years. Two methods of pain status and soothing were evaluated through CAMFORT scale checklist based on MAGNUSON National Institutes of Health Medical Center. Statistical analyses were done by Spss v.19. Results In our study, 17(42.5%) and 23(57.5%) were female and male, respectively. 28(70%) patients were aged between 3 and 7 years and 13(30%) older than 7 years. The obtained findings revealed that the difference between Midazolam sedation and combination of Midazolam and Ketamine sedation was significant (P= 0.00). The sedation in older patients was more than young patients in combination of Midazolam and Ketamine group. (P= 0.22). Conclusion These findings showed that Ketamine and Midazolam combination had more efficacy than Midazolam alone for decreasing pain and sedation.

Background Satisfaction evaluation is a good way to assess hospital conditions. In Health Care System, parentscan be also as children''s main supporters, thus they may act as patient''s viewpoints'' representatives.This study aimed to evaluate mother’s satisfaction of hospital care in hematology – oncology ward in Dr Sheikh hospital. Materials and Methods A Cross-sectional descriptive analytic study was conducted using Pediatric Family Satisfaction (PFS) questionnaire and interviewing with 164 mothers duringMarchto February2013. The obtained data were analyzed using SPSS -16 software and descriptive statistics. Results The mean age of mothers and children was31.2±5.8, and 7.95 4/66 years.The children were 64 % male and 36 % femael. A large number of mothers (%56 (describedtheir satisfaction about medical care as moderate,(%70.7) reported their satisfaction about nursing care at very high level and(36.5 %) reported satisfaction about welfare services at high level(59%)and describe overall satisfaction at very high level. The totals mean of mothers’ satisfaction ratewas 121.8 ± 10.8. The mean of medical care, nursing care, welfare services was 2.9±34.1,4.6±50 and4.8± 32.9 respectively. Conclusion Overall satisfaction with medical, nursing and welfare staff was acceptable. For more satisfaction, it is widely recommended to improve veinipuncture by nurses, Physicians should inform parents about the tests results, and finally disturbance in ward with noise should be controled.

Background Thalassemia patients that are conventionally treated by a regular transfusion regimen are exposed to blood born viral infections.The aim of this study was to investigate the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and human Immunodeficiency virus(HIV) among all multitransfused thalassemia patients in west north of Iran. Material and methods A retrospective study was conducted in February 2014, on 32 patients in Urmia, suffering from transfusion dependent thalassemia were admitted to Motahari and Emam Khomeini hospitals. Patients’ medical records were studied for HBs antigen and seropositivity for HCV, and HIV antibodies. Results Out of 32transfusion dependent thalassemia patients aged between 5-17years, 18 (56.25%) and14 (43.75%) were male and female, respectively. All of them were found seronegative for HBs antigen, HCV, and HIV antibodies. Conclusion It seems that screening of blood products is efficient in Urmia, capital of West Azarbaijan, Iran for prevention of blood born viral infections.

Background Beta-thalassemia patients receive blood products from blood transfusion centers repeatedly. Blood transfusion can transmit Cytomegalovirus (CMV) and Toxoplasma gondii. The aim of this study was serological evaluation of these two infectious agents in thalassemia patients. Materials and Methods In a cross-sectional study, the enzymelinked immunosorbent assay (ELISA) testing was performed to detect IgM and IgG antibodies against CMV and Toxoplasma gondii in 96 thalassemia patients (under 18 years) and 144 healthy people. Data were analyzed by SPSS software and Chi-square test. Results A significant difference was observed in CMVIgM antibody levels between test group and control group in women (p<0.05). The prevalence of CMV IgM, CMV IgG, Toxo-IgG, and Toxo IgM antibodies in thalassemia patients were 5.2%, 95.9%, 16%, and 0%, respectively. In all thalassemia patients, Cytomegalovirus IgG is higher than healthy people. In addition, CMV IgM antibodies are higher in female patients. Antibody screening (IgM) on blood products for detecting Cytomegalovirus is necessary, but for Toxoplasma gondii is not necessary in the Yazd transfusion center. Conclusion In all thalassemia patients, Cytomegalovirus IgG is higher than healthy people. In addition, CMV IgM antibodies are higher in female patients. Antibody screening (IgM) on blood products for detecting Cytomegalovirus is necessary, but for Toxoplasma gondii is not necessary in the Yazd transfusion center.

Background B cells play an important role in the immune system due to production of the immunoglobulin and secreting several cytokines. It has been shown that B cells produced successfully in the presence of stem cell factor (SCF) and Flt3 ligand (Flt3L). IL2, IL7, and IL15 cytokines as  -common family have an essential cytokines may support either synergistically or in an additive manner to B cell proliferative activity. Thus, the present study focused specifically on IL2, IL7, and IL15 cytokines that may play a critical role in B cell proliferation in cord blood. In this study, we evaluated the generation of B cells from CD34+/- cord blood mononuclear cells by using IL-2, IL- 7, and IL-15. Material and Methods Cord blood mononuclear cells were cultured for 21 days in presence of different combination of IL-2, IL-7, and IL-15. Harvested cells were analyzed by flow cytometry at days 0, 7, 14 and, 21. Results Present study showed that B cell differentiation from CD34+ cord blood mononuclear cells was increased by using IL-2 and IL-7 at different time points; however, IL7 was more effective (P value < 0.0001). In contrast, IL-15 didn’t increase significantly B cell expansion from CD34+ cord blood mononuclear cell. Conclusion These findings showed that IL-2 and IL-7 significantly increased B cell generation from cord blood CD34+ cells; probably this cytokines may be used in ex vivo generation of B cells from cord blood mononuclear cells.

Background Iran is one of the countries located on the “thalassemia belt” and a thalassemia prevention program was approved in our country in 1995. Many different researchers have studied the success of this program with no unanimous findings. Material and Methods A comprehensive literature search was performed using PubMed, Web of Science, and Google Scholar databases in Farsi and English languages for relevant articles published up to March 2015. Results A total of 46 articles regarding thalassemia prevention were identified. After screening the titles and abstracts, 27 articles were excluded because they were the same articles, review articles, and case reports. Finally, 16 articles about the success of the Iranian thalassemia prevention program were selected for the evaluation. Conclusion The findings show that the program has been significantly successful in the reduction of the new thalassemia births, though not in a few provinces like Sistan and Baluchestan. The role of the network of genetic labs has been also indispensable in the reduction of the new births. However, there is ambiguity over the impact of the program on the attitude and awareness of people across the country about the prevention of inherited diseases. However, with the success of the Iran thalassemia prevention program, it needs to be modified to be more compatible with the relevant social textures of different provinces.

Background Solid pseudo-papillary tumor of the pancreas (SPTP) is a rare disease with a low malignant potential. Though it shows low malignant potential 10% to 15% of the cases show aggressive behavior with metastatic involvement of the liver. The symptoms include abdominal discomfort and abdominal pain. It is very rare in early years of age. This is the case of a 10 year old girl with abdominal pain and her evaluation revealed solid pseudo-papillary tumor of pancreas. In family history, her grandmother died because of pancreas cancer. The mass was excised and in her 6-month follow up she didn’t have any problems. This case is presented to point out physicians that more attention to pseudo- papillary tumor can bring us significant improvement in the diagnosis of this pathology, though pseudo- papillary tumor is a rare pathologic condition in children.