Consequences of delayed diagnosis in treatment of retinoblastoma

One of the primary factors in managing patients with retinoblastoma is early diagnosis. The main idea of this study was to recognize the consequences of delay in diagnosis on therapy of the disease. A retrospective review of all children with proven retinoblastoma, who had presented to MAHAK hospital in Tehran, from April 2007 to Dec 2011, was performed. Grouping of intraocular tumors was applied as A to E according to International Classification of Retinoblastoma. There were 157 [91 boys] children eligible for study. The mean age was 1.21 +/- 0.11 years with average delay in diagnosis of 3.4 +/- 0.53 months. Classification of D group in both unilateral [93 patients] and bilateral tumors was the largest category. A significant relation [P=0.05] between delayed diagnosis time and tumor grouping was evident. The most frequent symptoms were leukocoria and strabismus. Age was significantly lower in the subgroup of bilateral tumors than in unilateral retinoblastomas [0.6 +/- 0.12 year vs 1.6 +/- 0.15 years]. The diagnosis was delayed in subgroup of extra ocular retinoblastoma more than in intraocular tumors [8.7 +/- 2.9 months vs 2.9 +/- 0.52 months]. The authors recommend early referring of suspected cases to ophthalmologists and pediatric oncologists and to organize educational programs to publisize signs and symptoms of the disease such as leukocoria, strabismus and ocular inflammatory disorders through national media. In conclusion, early diagnosis of retinoblastoma can be the primary factor in managing the patients as the delay in diagnosis accounts for highly advanced disease and poor prognosis

Intramuscular midazolam for pediatric sedation in the emergency department: a short communication on clinical safety and effectiveness

Procedural sedation in children continues to be a problem in the emergency department [ED]. Midazolam is the first water-soluble benzodiazepine and it has been widely used for procedural sedation in pediatric patients. The aim of this study was evaluation of clinical safety and effectiveness of intramuscular Midazolam for pediatric sedation in the ED setting. We performed a self-controlled clinical trial on 30 children who referred to the Baqiyatallah Hospital ED between 2009 and 2010. They received intramuscular Midazolam 0.3 mg/kg for procedural sedation and then they were folio wed for sedative effectiveness and safety. Vital signs and O2 saturation were also observed. The findings were I compared using SPSS ver. 16 software. I The mean age was 5.50 +/- 2.70 years, the mean weight was 19.50 +/- 6.63 kilograms and 16 patients [53.3%] were females. The most common adverse effect was euphoria [66.66%] and vertigo [6.7%]; 27.7% did not show any side effects. There was an overall complication rate of 72.3%. The vital signs including heart rate, respiratory rate, systolic and diastolic blood pressure and O2 saturation decreased significantly during sedation [P value < 0.05]. Midazolam is an effective and relatively safe sedative for pediatric patients in the ED. The patient should be observed closely and monitored for psychological and hemo-dynamic side effects

[Effects of L-asparginase administration on anticoagulant proteins and platelet function in patients with acute lymphoblastic leukemia]

Acute lymphoblastic leukemia is one the most common malignancies in children and adolescents. L-asparginase [L-ASP] is one of the leading medications in treatment of ALL. L.ASP interferes with the synthesis of some coagulation proteins and therefore causing disturbance in normal coagulation. In this study, the effects of L-ASP on anticoagulant proteins [protein C, protein S, and antithrombin III] and platelet function were assessed. This was a before-after study on 41 patients with ALL who refered to Mahak hospital [Tehran, Iran]. Before and after the injection of L.ASP, a bleeding time test was performed based on Ivy method. Protein C and protein S performance was assessed by turbidometry and antithrombin III performance was evaluated by chromogenic method. 48.8% of patients were female. Mean [ +/- SD] of age was 4.0 +/- 7.2. A significant reduction in the mean amount of protein C, antithrombin III and bleeding time was recorded. However, the reduction in protein S was not significant. No patient showed the symptoms of thrombosis. The results of this study showed that L. ASP drug reduced coagulation proteins [except the protein S]. This decrease along with other concomitant genetic factors can lead to thrombosis in some patients with ALL during induction therapy