Prognostic factors in children with acute lymphoblastic Leukemia: a ten year study

Acute lymphoblastic leukemia [ALL] is the most common cancer in the pediatric population. With modern treatments, the chance of the complete recovery is nearly 100%. The most important prognostic factors are appropriate treatment protocol and determination of patient risk factors based on clinical, morphological, immunological and cytological characteristics. In this study we reviewed frequency of these factors, like as age, gender, the primary white blood cell number, sub- group on the base of FAB classification, immunophenotype and the clinical progress. In this retrospective study, we reviewed 877 pediatric patients with the diagnosis of ALL between the years of 1994 and 2004. In these patients the age, gender, primary WBC count, sub-group based on the FAB classification, immunophenotype and the clinical progress in 177 patient with acute lymphoblastic leukemia at Imam Khomeini Hospital between the years of 1994 to 2004 were determined. Of these patients, 1.6% was younger than one year, 24.8% more than ten years old and 73.6% were between the ages of one and ten years; 63.8% were male. WBC counts were above 50,000/ul in 28.8% of the patients. FAB classifications included L1 in 80.2%, L2 in 17.5% and L3 in 2.3% of the patients. Immunophenotypes included pre-B cell in 63.8%, early pre-B cell in 23.1%, T cell in 12.3% and mature B cell in 0.8% of the patients. Marker CD10+ was detected in 88.1% of the B cell cases. In this study group, 74% of the patients recovered, 16.3% died and 16.5% relapsed. The prevalence of FAB-L1 and pre-B cell cases in this study is greater than a previous study, while the prevalence of FAB-L2 and early pre-B cell cases is less than that of the previous study

[Evaluation of the cause and predisposing factors in neonatal mortality by using international coding diseases version 10 in Valiasr Hospital]

According to the fact that the reduction of Neonatal Mortality Rate is correspondent to improvements in health and hygienic status of the society, understanding the major neonatal mortality causes will help the society to plan better prenatal and neonatal care systems. On this retrospective study, the major causes of the mortality of the dead neonates were extracted from files of Vali-Asr hospital according to the International Coding of Disease Ver 10 [ICD[10]]. Data were analyzed in proportion to gestational age, birth weight, gender and neonatal age. Mortality rate was higher during the first week of life [78%]. Generally five main causes of death were; prematurity, respiratory distress syndrome, intra cerebral hemorrhage, multiple congenital anomalies and air leak syndromes. It was also revealed that the causes of death of low birth weight neonates were similar to those of premature neonates [respiratory distress syndrome, prematurity, intra cerebral hemorrhage, septicemia and air leak syndromes]. Similarly there was no difference between the causes the of death in mature neonates and appropriate for growth age neonates. The main causes of death in these two groups were; congenital disease, infections [septicemia and Pneumonia], asphyxia, diffuse intra vascular coagulation, intra cerebral hemorrhage, meconium aspiration and complications of pregnancy. Data analysis indicated significant relationships between death and gestational age, neonatal age and birth weight [P=0.001] but it was not related to gender. With due attention to the easy application of ICD 10 for determining the major and underlying causes of death of neonates and the fact that autopsy is not routinely applicable in neonatology wards, routine using of ICD 10 for classifying the causes of death in death certificates is highly recommended

Prevalence of dyslipidemia in children and adolescents with diabetes mellitus type I

Dyslipidemia is frequently observed in patients with diabetes mellitus and has led to development of screening programs and intervention studies. Dyslipidemia has been identified as an important risk factor for coronary heart disease. 128 patients with type I diabetes attending a single pediatric endocrine clinic underwent anthropometric and biochemical assessment. Anthropometric measurements followed WHO criteria. Blood samples were analyzed for glycated hemoglobin [HbA1C], cholesterol [chol], triglycerides [TG], low density lipoprotein [LDL] and high density lipoprotein [HDL], and blood pressure was recorded. Patients' mean age was 12.6 +/- 4.1 years. Patients' mean age at the onset of diabetes was 7.1 +/- 2.8 years. Mean duration of diabetes was 6.9 +/- 3.2 years. 48.5% of patients had some form of dyslipidemia. 21.4% had isolated hypertriglyceridemia, 11.6% isolated hypercholesterolemia and 15.5% mixed hyperlipidemia. Factors associated with dyslipidemia included longer duration of diabetes, higher mean age, higher mean HbA1C [p 0.001]. Hypertriglyceridemia was more frequent in female patients and subjects with higher BMI [p<0.05]. The mean value of TG 199.9 +/- 74.1 mg/dl, TC 178.5 +/- 29 mg/dl and LDL 141.2 +/- 37 were significantly higher in patients with poor metabolic control [mean value of HbA1C 9.3 +/- 1.8] than the diabetic patients with better control [mean value of HbA1C 7.1 +/- 0.77], TG 156.8 +/- 55.9 mg/dl; TC 143.5 +/- 37.6 mg/dl and LDL 108 +/- 21.2. Our findings indicated that type I diabetic patients with poor metabolic control are at higher risk of developing dyslipidemia. However, given the well documented problems of lifestyle regulation and compliance in optimizing control especially in this age group, we need to develop alternative and simple interventional strategies to improve outcome. Monitoring of lipids should be extended and yearly screening of patients for dyslipidemia recommended