Interferon-beta in pediatric multiple sclerosis patients: safety in short-term prescription

None of the approved immunomodulatory drugs in adults Multiple Sclerosis [MS] patients have been officially approved for the pediatric patients and are currently used off-label in this population. In this study, we evaluated the effectiveness and tolerability of intramuscular interferon beta1-a [Avonex[registered]] and subcutaneously injected interferon beta1-b [Betaferon[registered]] in children with definite relapsing-remitting MS [RRMS]. Thirteen patients aged younger than 16, who were recently diagnosed with definite RRMS according to the McDonald's criteria, were enrolled in this study. Six patients were treated with Avonex[registered] 30 micro g, intramuscularly every week, and seven patients were treated with Betaferon[registered] 250 micro g, subcutaneously every other day. All patients were treated with adult doses; initially interferon-beta was prescribed with half dose, and it was increased to full adult dose steadily. Eleven girls and two boys, mean [SD] age of 14.7 [1.9] years, were studied. Following nine months of using interferon-beta, nine patients [69.2%] had no relapses and the remaining four, experienced only one relapse. The mean EDSS score was decreased significantly after the study period. The present study provides reasonable data for the use of interferon-beta in Pediatric MS due to lack of short-term complications and safety. Studies with larger sample size and longer follow up duration are required to shed light on the long term impact of the interferon-beta therapy in children

Pharyngeal-cervical-brachial variant of Guillain-Barre syndrome in a patient with Thalassemia intermedia

Here, we present the first instance of Guillain-Barr‚ syndrome variant in a patient with beta thalassemia and iron overload who had a history of transfusion before the onset of symptoms. Our patient was a 50- year-old Persian woman with history of intermediate thalassemia who had been treated with pack cells because of low hemoglobin level. Ten days after transfusion, she developed numbness of arms, left sided ptosis, and afterwards dysarthria, dysphagia, and bilateral ptosis. Electrodiagnosis on day 12 revealed reduced repetition of f-waves in the upper limbs and reduced recruitment with 1+ fibrillation in facial muscles. Electromyography and nerve conduction velocities in the limbs were normal. After excluding other causes and according to electrodiagnosis, the pharyngeal-cervical-brachial variant of Guillain- Barre syndrome was considered and plasma exchange began. Following exchanges, significant clinical improvement was attained. Iron overload and possible transmission of infections from blood products might have contributed in the development of syndrome

Analysis of the related factors in hepatitis C virus infection among hemophilic patients in Isfahan, Iran

Patients with hemophilia are at high risk of post-transfusion hepatitis because of widespread use of plasma-derived products. As a consequence, hepatitis C virus [HCV] is the most common cause of chronic liver disease among hemophilic patients. The objectives of this study are to determine HCV prevalence, and analyze the effective agents in HCV infection in hemophilic patients. All patients with inherited coagulation disorders registered in hemophilia center of Isfahan [553 persons] were checked for HBsAg and anti-HCV, using enzyme-linked immunosorbent assay [ELISA] test. Positive tests for anti-HCV were confirmed by RT-PCR. Clinical history, laboratory and treatment data of all cases were studied in January 2006. From 465 men and 88 women with inherited coagulation disorders with the mean age of 23.4 +/- 12.9 years, 125 patients [22.6%] were HCV positive, 2 [0.4%] were HBV positive and one [0.2%] was both HCV and HBV positive. Odds ratio between HCV infection and cryoprecipitate usage was 3 [CI 95%: 2-4.5] and between HCV and factor usage was 0.21 [CI 95%: 0.07-0.7]. Considering the high chance of HCV infection after transfusion of cryoprecipitate and, a more careful pre-transfusion screening of blood for anti-HCV must be introduced in all blood banks. The usage of FFP less chance of HCV infection, instead of cryoprecipitate in patients who do not have volume restrictions may be preferable