Association between small for gestational age and low birth weight with attention deficit and impaired executive functions in 3-6 years old children.

BACKGROUND: Behavioral disorders and attention deficit hyperactivity disorder (ADHD) symptoms are frequently reported among children with history of small body size at birth and disproportionate intrauterine growth retardation. The current study aimed to investigate some factors like executive functions and attention deficit in children with history of Small for gestational age (SGA) and/or Low Birth Weight (LBW) at birth. METHODS: A historical cohort study was done and 3-6 years old preschool children (with past history of SGA/LBW) from some kindergartens and health centers were selected. Control group was randomly selected among children with history of normal birth weight and appropriate for gestational age at birth. All children were interviewed by an expert psychologist. Variables related to their attention, development, and executive functions were assessed by ASQ, Conner's, and Wisconsin Card Sorting Test. Completed questionnaires related Attention deficit and indexes of executive functions were evaluated between children in case groups and their counterparts in controls. RESULTS: Based on inclusion criteria, 229 preschool children entered the study. With regard to size for gestational age, 124 cases were categorized in the SGA/LBW group and the rest were assigned in the appropriate for gestational age (AGA) group. In the case group, NPE and Percent Perseverative Errors (PPE) scores were significantly lower than normal birth weight group (p = .0001, p = .015). Scores related B item of Conner's was significantly different between cases and their controls (p = .039, p = .035). CONCLUSIONS: Our results indicated that children with past history of some risks at birth may suffer from complications related attention and executive functions in their childhood. Recommendations for further research are strongly suggested.

The Prevalence of fungal infections in children with hematologic malignancy in Ali-Asghar Children Hospital between 2005 and 2010.

BACKGROUND: A fungal infection represents a growing problem in children with hematologic malignancies, during chemotherapy induced neutropenia. Fungal colonization is considered a major risk factor for subsequent fungal infections. The aim of this retrospective study was to evaluate prevalence of fungal infection among children admitted to hospital between 2005 and 2010 in Tehran, Iran. MATERIALS AND METHODS: 617 hematological patients in the age range of neoteric to 19 years old were enrolled and 87 cases with invasive fungal infections were extracted from patients' files and documented. Diagnosis of fungal infections was based on the local biopsy and pathology for mucormycosis, blood culture, urine culture and clinical examination for candidasis and galactomannan for aspergillus. RESULTS: the mean age of cancer diagnosis was 6.33 years old and the mean age of fungal infection was 7.95 years old. The majority of the infections was caused by candidia spp (74.7%), followed by aspergillus spp (17.2%) and zygomycetes (11.5%). Among candidiasis patients, oral infection had the highest manifestation (92.3%) whereas in 10 of 15 patients with aspergillus, the infectious site was the lung. There was a significant association between mortality and the type of fungal infection (p <0.0001). CONCLUSION: Our finding suggests that there is a high rate of fungal infections in children receiving remission therapy for onco-hematology. These results help improve the management of these patients, however Further studies are needed.

Rituximab efficacy in the treatment of children with chronic immune thrombocytopenic purpura.

BACKGROUND: There are several medications for treatment of immune thrombocytopenic purpura (ITP), including corticosteroids, intravenous immunoglobulin, immunosuppressive drugs, and even splenectomy. In case of failure, Rituximab as one of the medications used in these patients should be considered. METHOD: This Case--series study was conducted prospectively in patients who were referred to Hematology & Oncology Clinic of Ali Asghar Hospital. Eighteen Patients were followed up for at least 3-5 years. RESULTS: Four weeks after treatment, only in 6 patients (33/3%) of 18 patients, complete response (Plt > 100,000) were obtained and most patients (67/66%) had no appropriate response. In subsequent surveys conducted at 6 and 36 months after treatment, the percentage of patients responding fell to 22/2% hit. CONCLUSION: The results of this study demonstrate proper safety of Rituximab in the treatment of chronic ITP. However, the drug had no significant effect on the expected improvement in platelet count of patients. It seems that monotherapy is ineffective in the treatment of chronic ITP and combination with other complementary therapies is recommended.

Quality of life in patients with thalassemia major.

BACKGROUND: With modern medical management, thalassemia major is now extending into adulthood and it is expected to have a negative impact on the quality of life (QOL) of the patients. The aim of this study was to evaluate quality of life in patients with thalassemia major. MATERIALS AND METHODS: This is an analytic case control study. Two hundred and fifty patients and 51 participants as controls were assessed using WHOQOL- BREF (Farsi version) questionnaire. All questions were answered based on the self-evaluated status in the past 2 weeks before enrollment and were rated on a five-point Likert scale. Therefore, the raw item score ranged from 1 to 5 and scaled in a positive direction and 6 dimensions including overall QOL, overall health, physical, psychological, social, and environmental relationship were assessed. RESULTS: Results showed that the QOL in all 6 dimensions was lower in patients compared to the controls (P< 0.05).Also age, higher education level, lower ferritin level and using oral iron chelator were associated with better QOL scores. On the other hand, cardiac disease, hepatitis C and history of psychiatric disorders were associated with impaired QOL scores. CONCLUSION: These findings were important for future refinement of national thalassemia program. So, we recommended regular screening for psychiatric disorders and facilitated access to oral iron chelators. Regular monitoring and treatment of complications especially cardiac disease and hepatitis along with strict quality control of blood products were also mandatory. Also, higher education of the patients may improve quality of life.

A fetal hemolytic anemia in a child with cytomegalovirus infection.

BACKGROUND: Autoimmune hemolytic anemia is a hematologic disorder that is rarely observed in infants and young children. Most of the cases are associated with viral or bacterial infections. In some cases, AIHA can be characterized by a chronic course and an unsatisfactory control of hemolysis, thus requiring prolonged immunosuppressive therapy. CASE REPORT: Especially in children younger than 2 years of age, the clinical course of the disease may show either resistance to steroids or dependence on high-dose steroids. We report here an infant fatal autoimmune. CONCLUSION: This case suggests that investigation for the presence of CMV infection in infantile AIHA should be considered. Severe hemolysis is rare but could be a potentially life-threatening complication of CMV infection described mostly in immune compromised adults and children.

Study of Aging and Hepatoprotective Activity of Vitis vinifera L. Seeds in Albino Rats

Objective: Present study was conducted to investigate in liver of rats from 8-12 weeks old to 20 weeks old, the age dependent changes, carbon tetrachloride mediated changes, and the hepatoprotective effect shown by the seeds of Vitis vinifera L. Method: The hepatoprotective activity was studied by observing the effect of 100 mg/kg dose of ethanolic extract of grape seeds on carbon tetrachloride induced hepatotoxicity in albino rats and results were compared with those of the aged group results. Results: 100 mg/kg b.w. of ethanolic extract of Vitis vinifera seeds produced highly significant decrease in AST, ALT, ALP, bilirubin, albumin levels and significant decrease in the TSP levels compared to the toxic group levels. The levels of AST, ALT, ALP, bilirubin and albumin in aged control rats were found to be significantly higher than the levels in young control animals. MDA levels were slightly higher while GSH levels were lower in aged control rats as compared to young control rats. MDA levels in the toxic group showed highly significant increase compared to the young control levels. Ethanolic extract of seeds of Vitis vinifera significantly lowered the MDA levels. Histopathology results reveal that 100mg/kg/day dose of ethanolic extract of seeds of Vitis vinifera L. cured the hepatic damage to a great extent which was induced by CCl4. Conclusions: Aging leads to the changes in the hepatic structure which are comparable to the changes induced by low doses of a hepatotoxin and the ethanolic extract of seeds of Vitis vinifera L. was effective in bringing about functional improvement of hepatocytes exposed to free radical attack, which was confirmed by biochemical and histological observations.

CML Developing Three Years after Therapy Completion in a Child with Ph(-) Pre-B-ALL.

We report a girl with a history of Ph(-) pre-B-ALL and three years of disease-free survival admitting to our hospital for regular end of treatment checkup with an increased white blood cell count which in follow-up studies and molecular detection of BCR-ABL (p210) fusions gene had been diagnosed as a Ph(+) typical CML. The upcoming question in this case scenario is whether developed CML is a secondary leukemia due to previous ALL chemotherapy or just a relapse case of primary leukemia.

Efficacy of combined metformin-letrozole in comparison with metformin-clomiphene citrate in clomiphene-resistant infertile women with polycystic ovarian disease.

BACKGROUND: Adding metformin to clomiphene citrate in clomiphene-resistant polycystic ovary syndrome (PCOS) patients increases ovulatory response. However, because of anti-estrogenic effects of clomiphene it may be associated with lower pregnancy rate, offsetting the ovulation rate benefit. Letrozole is an aromatase inhibitor which induces ovulation without anti-estrogenic effects. METHODS: Infertile women with PCOS were randomly divided into metformin-letrozole (29 patients) and metformin-clomiphene groups (30 patients). After an initial 6-8 weeks of metformin, they received either letrozole (2.5 mg) or clomiphene (100 mg) from day 3-7 of their menstrual cycle. Estradiol (E2) levels, number of follicles, pregnancy rates and endometrial thickness were measured on the day of HCG administration. RESULTS: Mean total E2 and E2 per mature follicle were significantly higher in clomiphene group without a difference in mean number of mature follicles >18 mm and ovulation rate. Endometrial thickness was significantly higher in letrozole group. The pregnancy rate in letrozole group (10 patients, 34.50%) as compared with clomiphene group (5 patients, 16.67%) did not show significant difference, whereas full-term pregnancies were higher in letrozole group [10 patients (34.50%) versus 3 patients (10%)]. CONCLUSION: In clomiphene-resistant PCOS patients, the combination of letrozole and metformin leads to higher full-term pregnancies.