Clinical Features and Treatment Outcomes of Primary Immune Thrombocytopenic Purpura in Hospitalized Children Under 2-Years Old.

BACKGROUND: Immune thrombocytopenic purpura (ITP) is the most prevalent cause of thrombocytopenia in children. Despite the importance of ITP in children under 2-years old, only a few publications are available in the literature.ITP usually presents itself as isolated thrombocytopenia and mucocutaneous bleeding. MATERIALS AND METHODS: This study was conducted on 187 under 2-year-old children diagnosed with ITP and treated at Dr. Sheikh Hospital from 2004 to 2011.In this retrospective study, clinical symptoms, laboratory findings, history of viral infections, vaccination history, and treatment efficacy in children under 2-years old with ITP were investigated.Patients were followed for one year after being discharged from the hospital. RESULTS: The risk of the disease developing into chronic form was higher in older children (0.001). ITP in children under 3-months old was significantly associated with vaccination (p=0.007). There was no significant differences between male and female patients in regards to newly diagnosed ITP, persistent, and chronic disease status (p = 0.21). No significant difference in bleeding symptoms was observed between patients under 3-months old and 3 to 24-months old (p=0.18). CONCLUSION: Infantile ITP respond favorably to treatment. The risk of the disease developing into chronic form is higher in 3-to-24-month-old children compared to under-three-month olds.

Evaluation of Nosocomial Infection in Patients at hematology-oncology ward of Dr. Sheikh children's hospital.

BACKGROUND: Infections in critical care unit are high, and they are serious hospital problems. Infections acquired during the hospital stay are generally called nosocomial infections, initially known as infections arising after 48 h of hospital admission. The mostfrequent nosocomial infections (urinary, respiratory, gastroenteritis and blood stream infection) were common in patients at hospital.The aim was to study, the current status of nosocomial infection, rate of infection among hospitalized children at hematology-oncology ward of Dr. Sheikh children's hospital, Mashhad, Iran. MATERIALS AND METHODS: Data were collected from 200 patient's records presented with symptoms of nosocomial infection at hematology-oncology ward of Dr. Sheikh children's hospital from March 2014 to September 2014. Descriptive statistics using percentage was calculated. RESULTS: Incidence of nosocomial infections inpatients athematology-oncology ward was 31% (62/200). Of which 69.35% (43/62) blood stream infection being the most frequent; followed by 30.64% (19/62) was urinary tract infection (UTI), and the most common blood culture isolate was been Staphylococcus epidermidis 18 (41.86%), andour study showed that large numbers ofnosocomial UTIs causing by Gram­negative bacteria. CONCLUSION: This study showed blood stream infection and UTI are the common nosocomial infections among patients athematology-oncology ward. Early recognition of infections and short term use of invasive devices along with proper infection control procedures can significantly decrease the incidence of nosocomial infections in patients.

Prevalence of transient hyperglycemia and diabetes mellitus in pediatric patients with acute leukemia.

BACKGROUND: The most common malignancy of children is Leukemia, accounting approximately one third of cancer diagnosis. Available data demonstrate improvement in survival of pediatric leukemia, so evaluation of side effects of treatment is very important. This study investigates hyperglycemia and diabetes mellitus prevalence in pediatric patients with acute leukemia. MATERIALS AND METHODS: This study was performed in children with acute leukemia. At the first admission, demographic data was collected and blood glucose and HbA1c levels were obtained. These tests examined at least two times during six months of follow up. Growth parameters and blood samples were obtained too. RESULT: Twenty nine patients were examined; three of them (10.3%) had diabetes mellitus and 5patients (17.2%) had transient hyperglycemia.Mean age of the patients was 6.26 years and nineteen Children (63%) were in preschool age. In preschool age children, incidence of hyperglycemia was meaningfully higher than school age children (p= 0.02). 24 of 29 patients (82.7%) were known case of acute lymphoblastic leukemia (ALL) and 5 patients (17.3%) were known case of acute myeloblastic leukemia (AML). No significant difference was found between sex groups. Also underweight was significant risk factor for hyperglycemia. CONCLUSION: The prevalence of hyperglycemia was in the range of other similar studies in different parts of the world. Underweight and preschool ages were significant predictors of hyperglycemia.

Comparison of oral recombinant erythropoietin and subcutaneous recombinant erythropoietin in prevention of anemia of prematurity.

BACKGROUND: Premature neonates are at risk for severe anemia and erythropoietin is the most important hormone in erythropoiesis. The aim of this study was to evaluate the influence of oral recombinant human erythropoietin (rhEPO) in proving erythropoiesis in neonates. METHODS: This was a randomized clinical trial study. Thirty neonates were enrolled from September 2007 to September 2008. The first group received oral rhEPO and Fe and the second, subcutaneous rhEPO and Fe. The patients' Hb, HCT and the need to blood transfusion were recorded. We included all infants with gestational age <34 weeks, birth weight <1500 gr, without respiratory distress (O2 Saturation> 85%, FiO2 of 30%), full feeding tolerance so that oral Fe can be administrated. RESULTS: In first group (oral=PO), 65% of neonates were female and 35% were male, mean weight was 1140 g and mean GA was 32.6 weeks. In the second group (subcutaneous=SC), 42% were female and 58% were male. The mean weight was 1245 g and mean GA was 31.2 weeks and this was not statistically significant. In the first group, the mean Hb and HCT were 9.7±1.9 and 29.6±5.9 g/dl. In the second group, the figures were 12.5±1.7 and 38.8±5.1 which were statistically significant. There was no difference in the weight gain between two groups. In the first group, 3 neonates (20%) and in the second one, 1 neonate (15%) needed blood transfusion. CONCLUSIONS: rhEPO administration either PO or SC could prevent anemia of prematurity but SC rout was more effective.

Effectiveness of mindfulness-based cognitive therapy on reduction of depression and anxiety symptoms in mothers of children with cancer.

BACKGROUND: Findings demonstrated that parents of children with cancer experience elevated levels of distress, depression, anxiety, posttraumatic stress symptoms, and subjective symptoms of stress. In this study, we determined effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) on reduction of depression and anxiety symptoms in mothers of children with cancer. METHODS: Four mothers whose children had cancer were diagnosed to have depression and anxiety symptoms, using Beck Anxiety Inventory, Beck Depression Inventory II, and Structured Clinical Interview for DSM-IV. They were selected through purposeful sampling to participate in this experimental single-case study. After the baseline was determined, subjects attended an eight-session program of Mindfulness-Based Cognitive Therapy. RESULTS: The comparison of baseline and post-test showed that depression and anxiety symptoms decreased through MBCT. Improvement quotient for depression and anxiety of each subject was good. CONCLUSION: Data showed that MBCT reduced depression and anxiety symptoms in mothers of children with cancer.