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ABSTRACT Background Ewing Sarcoma is the second most frequent primary bone cancer, following Osteosarcoma in children. These tumors consist of small, round, or oval cells, which are believed to derive from parasympathetic autonomic nervous system. The common clinical presentations are pain, local tenderness, fever, palpable mass, and pathologic fractures. Methods and Materials This study describes 47 children affected by Ewing Sarcoma registered since 1991 to 2007. All data were extracted from hospital admission notes and outpatient clinical records. Results Twenty seven patients were male and 20 were female. It is slightly more common in boys. Pain, Local tenderness, fever, and Pathologic fractures were common presentation. Majority of patients were between 10-15 years old. Conclusion Local tenderness, pain, and limping are important symptoms in children that should be check-up for immediate diagnosis and also proper management.

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Abstract Background Thalassemia is one of the most common human genetic diseases in the world and it provides many problems for patients, families and health care system. This model helped the family with sick children to empower to face disease and its complications. To reach this aim, the knowledge and attitude of patients and their families about the disease should be increased. This study was aimed at determine the effectiveness of family-centered empowerment model on the mothers’ knowledge and attitudes about thalassemia disorder. Objective To assess the effect of family-centered empowerment model on the mothers knowledge and attitudes about thalassemia disorder in children with thalassemia. Materials and methods This semi-experimental study was performed on 86 children with thalassemia that were randomly divided into two groups. A questionnaire was filled with demographic information and knowledge and attitude of the mothers about the disease. These questionnaires were tested for content validity and reliability (internal correlation). Information was given to first group and second group did not receive any more information. After intervention final evaluation was performed one and half month later. Results Data analysis showed that before intervention, the average awareness and attitude of the mothers in test group were no significantly different with control group (p>0.05). However, after performing model in the test group, this averages were significantly higher in test group than control (p<0.05). Conclusions The results of this study indicated that implementation of the family-centered empowerment model are effective on knowledge and attitudes of mothers of children with thalassemia.

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Abstract Background Brucellosis is endemic in Iran, and is seen in all age groups, including children. Its diagnosis in childhood needs a high index of suspicion. The diagnostic methods currently in use need evaluation for analytical performance. Objective The present study tries to evaluate the hematological indices, serologic markers of inflammation and symptoms in patients suspected of brucellosis. Furthermore, the results of three routine methods are compared: PCR, blood culture and Wright agglutination test. Methods Symptoms of patients were asked by questionnaire in 48 children. Hematological indices of the CBC test as well as results of CRP, ESR, blood culture, Wright test and PCR were also recorded. Analytical performance of those 3 tests was calculated. Results Nine out of 48 patients were positive for brucellosis by PCR, seven of which being positive for Wright test and 2 for culture. Fever and arthralgia were seen in 88.8% and 77.7% of PCR-positive cases, respectively. According to hematological findings 3 of PCR-positive patients (33.3%) had anemia and 2 (22.2%) showed leukopenia. Elevation of ESR was observed in 5 (55.5%), and CRP was positive in 7 such cases (77.7%). Conclusions Clinical symptoms, CBC parameters and laboratory markers of systemic inflammation cannot be considered reliable criteria for diagnosis of childhood brucellosis. We suggest usage of PCR rather than blood culture and Wright test for diagnosis in suspected pediatric cases, due to low sensitivity of both culture and Wright test.

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Abstract Background Immune thrombocytopenic purpura (ITP) is a common autoimmune bleeding condition in children that is characterized by a decrease in the platelet count. The aims of this study were to define epidemiologic features of patients with primary ITP who were admitted to Mofid Children's Hospital, Tehran, Iran, in a 5-year period. Methods We retrospectively studied the records of patients aged from 1 month to 13 years, who were admitted with the diagnosis of ITP at our hospital. Demographic and clinical variables such as platelet counts, prescribed medicine and transforming to chronic ITP were studied. Results One hundred and seventy two patients were eligible to enter this retrospective study. Mean age was 41.5 (from 1 to 160 months), which 98 were boys (57%) and 72 were girls. 130 (75.6%) and 42 (24.4%) patients had a platelet count less than 25000 and 10000/mm3, respectively. Younger patients significantly had a more severe sign (P=0.04). There was a significant relationship between younger age and chronic ITP (P<0.001. Chronic ITP significantly happened more frequent in girls than boys (P=0.01). Treatment did not have any significant influence on the time to remission, platelet level after one month, or change to chronic ITP. Conclusion This study showed that age Male gender increased the risk of severe disease while female gender was risk factors for transforming into chronic ITP. However, together with others reported from different centers in Iranian may provide a good overview of the epidemiology of ITP in Iran.

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Acute lymphoblastic leukemia (ALL) constitute a family of genetically heterogeneous lymphoid neoplasms derived from B- and T-lymphoid progenitors. ALL affects both children and adults. Diagnosis is based on morphologic, immunophenotypic, and genetic features that allow differentiation from normal progenitors and other hematopoietic and nonhematopoietic neoplasms. The aim of this study was to investigate the association between ALL and ABO blood group. Material and method This is a case-control study that was carried out in Amir Oncology Hospital in Shiraz during 2011 to2013. The case group consisted of 293 patients with acute lymphoblastic leukemia. And compared with 300 subject in control group ( the age in the case group was between 2-5 year, and the age in the control group was between 2-45 year) .Statistical analyzes was done performed by chi –square test. The results was considered significant when p value <0.05. (CI:0.95) Results The ABO blood group distribution was 82(A), 59 (B), 24 (AB) and 128(O) in patient with Acute Lymphoblastic Leukemia and the blood group of 300 participants in the control group include, 63% (25) A, 69% (25.6) B, 18 % 06.8) AB and 101% (42.6) O. The ABO blood group distribution showed that there is significant differences between ABO blood group and patients with acute lymphoblastic leukemia . Conclusion This study showed significant association between ALL and ABO blood group and showed that blood group AB was associated with a higher risk of All (p value<0.001).

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Background Cancer diagnosis among children can cause high stress and anxiety in parents, and they may lose their life expectancy. The present study investigated the effectiveness of Logo therapy on anxiety and depression among mothers of children with cancer. Materials and Methods This study was conducted by a semi-pilot method using pre-test and post-test with a control experimental group. Therapy sessions were held during 9 sessions of Logo therapy training for 90 minutes. The participants of this study were selected among 30 mothers of children with cancer and using sampling method in Yazd hospitals. The participants divided randomly into two groups: experimental and control. Participants in both experimental and control group completed questionnaires on Beck Anxiety Inventory and Beck Depression Inventory before and after training. Results The results showed that the index of depression and anxiety in control and experimental groups are 32.3, 6.63, 7.4 and 6.75, respectively. So, the level among the experimental group has been decreased after intervention of Logotherapy training and a significant difference occurred in the pre-post test stages. The results showed that Logo Therapy has a significant effect in reducing anxiety and depression among mothers of children with cancer (p<0.05). Conclusion Regarding the efficiency of this approach to reduce anxiety and depression among mothers, this treatment is recommended to be practiced beside other cancer therapies, so they can practice the treatment process with a better mood and mentality.

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Background Obese children are at the risk of micronutrient deficiency especially iron deficiency. Given the importance of iron deficiency in this age group and considering the existing discrepancies, present study was performed with the aim of evaluating iron deficiency in obese children. Material and Method This study was conducted, in the form of a case-control study, on 100 children aged between 5 to 15 during June and November 2013 in Kashan. Cases consisted of 50 obese children and controls were 50 children who were not obese.Blood sample was drawn to check for serum iron, total iron binding capacity (TIBC) by biochemistry method and plasma ferritin by ELISA method. The obtained data were entered into SPSS software version 16 and statistically analyzed. P < 0.05 was identified as statistically significance. Results The mean values of serum iron were 52.38 and 64.50 microg/dL for the case and control groups (P<0.02). TIBC levels in obese and non-obese Children were 434.80 and 382.28 microg/dL (P<0.008). The ferritin level in the study group was 70.56 versus 68.06 ng/ml in the control group (P=0.79). In the obese children group, 8.3% (n=2) of children with iron deficiency had ferritin levels less than 15 while in control group 100% (n=14) of iron deficient children had ferritin levels below 15 (P<0.001). Conclusion: In our study, mean serum iron levels were lower among obese children in comparison with control group. However, ferritin concentrations were similar in both groups. It is supposed that due to inflammatory state caused by obesity, serum ferritin levels are naturally higher in obese people. It is suggested that higher levels of ferritin considered as normal reference values in obese people.

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Background Recent studies suggest an association between H. pylori infection and disorders such as iron deficiency anemia and growth delay. Considering the high prevalence of H. pylori infection and iron deficiency anemia, this study was performed in order to evaluate their relevance in children undergoing an upper endoscopy. Materials and Methods In this case-control study, children aged 2 to 16 years old, undergoing endoscopy from March 2012 to March 2013 at Besat Hospital of Hamedan, were selected. Participants were divided in H.Pylori infected and non-infected groups. Then the two groups were compared in terms of body mass index (BMI) and the incidence of iron deficiency anemia. The presence of Helicobacter pylori infection in children was confirmed by Giemsa staining of gastric biopsy specimens. Collected data was analyzed by SPSS 17.0 (SPSS Inc., Chicago, IL) and t-test and chi-square. Results In this study, 200 children (94 male and 106 female) were evaluated. The most common presenting symptom in both groups was abdominal pain. 8.2 % (9 cases) of the infected patients and 10.5% (10 cases) of the non-infected patients had iron deficiency anemia which this difference was not statistically significant (p=270). Also, no statistically significant difference was noted between the two groups in terms of gender (p=0.32), hemoglobin (p=0.35), Ferritin levels (p= 0.275) and body mass index (p= 0.273). Conclusion The results of this study not showed an association between H. pylori infection and iron deficiency anemia or body mass index in studied children

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Background A fungal infection represents a growing problem in children with hematologic malignancies,during chemotherapy induced neutropenia.Fungal colonization is considered a major riskfactor 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 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.

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Abstract Background Cancer diagnosis may cause deep emotional and affective problems in patients and their families.Nowadays, however, despite its rising prevalence,cancer is no longer synonymous with death. Given the significance of emotional well-being in cancer patients, we decided to assess the frequency of psychological problems in seven to seventeen yearolds with acute lymphoblastic leukemia. Methods Our sample included 42 children and adolescents with ALL referred to pediatric hematology department of Dr. Sheikh hospital, who were put under maintenance course of the treatment.Psychiatric disorders such as anxiety, depression and behavioral disturbances were examined by using RCMAS, CDI and SDQ questionnaires respectively. Results The entire population showed depressive symptoms.59.5% of patients (25 person) suffered from anxiety and 26.2% (11 person) had behavioral problems. No significant relation was found between depressive symptoms, and age (p=0.77), sex (p=0.97), length of disease (p=0.50), and type of treatment (p=0.064). Anxiety did not show any significant relation with age (p= 0.63), sex (p= 0.32), length of disease (p= 0.16) and treatment type (p= 0.064).Similarly behavioral disturbances did not indicate any suggestive relation with age (p= 0.20), sex (p= 0.56), length of disease (p= 0.81) and type of treatment (p= 0.19). Conclusion Our findings suggest a high prevalence of psychiatric disorders in children and adolescents with ALL. It is strongly recommended, therefore, that besides somatic symptoms, careful attention be paid to psychological disorders. This can prevent rapid development of the disease reduce treatment costs, and improve the quality of life for both patients and their families.

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Abstract Background Malaria is an acute and chronic illness characterized by paroxysms of fever, chills, sweating, fatigue, anemia, and splenomegaly. Most malarial deaths occur in infants and young children.Anemia in malaria has diverse pathophysiologic mechanisms such as direct invasion of Red cells, In the following, we presented comparison of hematological aspects: children with Malaria and healthy children. Materials and Methods This was a lab trial study. Patients were referred and admitted to the pathobiology laboratory along with physical examination. Then, they underwent a complete blood count and the result of complete blood count was compared with healthy person in the same age. Out of 30 patients, with equally falciparum, vivax, and healthy .The hematological examination was performed. Finally, the data was analyzed using SPSS version 19 software. Results The levels of HGB (P=0.001), HCT (P=0.001), MCV (P= 0.001), MCH (P=0.001), WBC (P=0.001), and Plt (P= 0.02) decreased significantly in children with falciparum and vivax malaria compared to healthy controls. The levels of RBC (P=0.49) increased significantly in children with falciparum and vivax malaria compared to controls. Blood culture at two times. To investigate malaria blood smears taken after microscopic study of Plasmodium falciparum ring was observed. Conclusion Malaria is a multisystem disorder which can lead to many diseases. Physicians, especially those in endemic areas, should be aware of the varied manifestations and maintain in a high index of suspicion for the disease in order to that diagnose and treat timely and, morbidity and mortality.

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Background Satisfaction evaluation is a good way to assess hospital conditions. In Health Care System, parentscan be also as children's main supporters, thus they may act as patient's viewpoints' representatives.This study aimed to evaluate mother’s satisfaction of hospital care in hematology – oncology ward in Dr Sheikh hospital. Materials and Methods A Cross-sectional descriptive analytic study was conducted using Pediatric Family Satisfaction (PFS) questionnaire and interviewing with 164 mothers duringMarchto February2013. The obtained data were analyzed using SPSS -16 software and descriptive statistics. Results The mean age of mothers and children was31.2±5.8, and 7.95 4/66 years.The children were 64 % male and 36 % femael. A large number of mothers (%56 (describedtheir satisfaction about medical care as moderate,(%70.7) reported their satisfaction about nursing care at very high level and(36.5 %) reported satisfaction about welfare services at high level(59%)and describe overall satisfaction at very high level . The totals mean of mothers’ satisfaction ratewas 121.8 ± 10.8. The mean of medical care, nursing care, welfare services was 2.9±34.1,4.6±50 and4.8± 32.9 respectively. Conclusion Overall satisfaction with medical, nursing and welfare staff was acceptable. For more satisfaction, it is widely recommended to improve veinipuncture by nurses, Physicians should inform parents about the tests results, and finally disturbance in ward with noise should be controled.

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Despite development of new approaches for the treatment of cancer disease, it is the second cause of mortality in world. Annually, 30000 persons die in Iran due to cancer diseases. Eighty percent of cancer patients are children which about 50% children lead to death. Given the high rate of cancer-related death, the new approaches for prevention, control, early diagnosis, and treatment of this disease seem necessary.  Investigation of new strategies is the major challenge for scientists at recent century. Nanotechnology as a new scientific field with novel and small compounds utilized different fields over the past ten years especially in medicine. This science has come to the forefront in the areas of medical diagnostics, imaging, and therapeutic scheduls. Therefore, it has the potential applications for cancer detection and therapy. This review will discuss the therapeutic applications of different nano-materials in diagnosis, imaging, and delivery of therapeutic agents for the treatment of cancer with a major focus on their applications for the treatment of cancer and cancer- related diseases in children. The advancements in established nanoparticle technologies such as liposomes, polymer micelles, and functionalization regarding tumor targeting and controlled release strategies as well as drug delivery were discussed. It will also review the blood toxicity of used nanostructures.

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Background
Oral mucositis is an adverse effect of chemotherapy. Type of chemotherapy regimen is the most important factor causing
mucositis. Oral mucositis is usually associated with transient decrease in saliva production. The goal was to study effects of
gum consumption on oral mucositis in children undergoing chemotherapy.
Materials and Methods
This randomized controlled trial was done in Amir Kabir Hospital, Arak, Iran. 130 children 5 to 15 years of age were studied.
Control group was composed of 65 children who received mucotoxic drugs. Test group was made up of 65 patients received similar drugs in addition to sugar free gums. Patients consumed 6 pieces of gums per day for 15 days. A standardized follow up form and World Health Organization (WHO) grading system for oral mucositis were used for evaluation of patients during 15 days of treatment.
Results
Severe oral mucositis occurred in 30 (46%) of 65 patients in the test group and in 26 of 65 (40%) patients in the control group.
Difference was not statistically significant (P > 0.05). Rate of mild to moderate mucoitis (grade 1 and 2) was significantly lower in patients who used gums (15 % vs. 35%, P < 0.05).
Conclusion
Our study showed that stimulation of saliva flow by chewing gum could decrease mild to moderate inflammatory injuries of the
oral mucosa during chemotherapy. However, it was not effective to subside severe mucositis.

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Abstract

Background:

In addition to child, families can be influenced traumatically by the leukemia and hospitalization. Adopting the philosophy of a family-centered care approach can maximize the well being of pediatric patients and their family. The philosophy is based on the collaboration of the family, nurses and hospital staff to plan, provide and evaluate care to establish the best plan of care for leukemic child and improve family stability as well, nurses should support the family. The current study was conducted to compare the opinions of mothers with nurses regarding the availability of nursing support for mothers of hospitalized leukemic children in a pediatric oncology ward.

Materials and Methods:

This comparative descriptive study was conducted on all mothers with leukemic children who were hospitalized in a pediatric oncology ward (n=89) of Shahid Sadoughi Hospital, Yazd, Iran and all nurses (n=21) in this ward during 2015. Data were collected through the NPST( Nurse-parent Support Tool) and demographic questionnairs. The obtained data were analyzed with SPSS (version 22).

Results:

The most important dimensions in terms of mothers' opinions were "emotional" (3.34±0.56) and "quality of care" (3.26 ±0.55) and considering nurses' opinions were "emotional" (3.22± 0.47) and "informational-communicational" (3.22± 0.43). Mann-Whitney test showed no significant differences between mothers' and nurses' opinions regarding four subscales of nursing support (p < 0.21).

Conclusion:

The opinions of mothers and nurses in the pediatric oncology ward did not differ regarding the availability of nursing support. However with respect to the overall mean of nursing support from mother's perspective, it is necessary to provide further support for mothers by the nurses. The results of this study may be useful for improving nursing care in oncologic wards. 

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Conclusion:  

Regarding the obtained results, it can be concluded that varicella vaccination can have an acceptable effectiveness on pediatric patients with ALL. Varicella vaccination can be recommended for protecting these patients against VZV in order to decrease the morbidity rate caused by this infection. 

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Background: In the process of cancer treatment, mothers of children with cancer experience burden of care as a result of these conditions. Early detection of burden of care has an important role in promoting health care. The aim of this study was to evaluate burden of care in mothers of children with a malignancy.
Materials and Methods: This cross sectional study was done on 70 mothers of children with cancer in Oncology Department of Shahid Sadoughi Hospital, Yazd, Iran, during December 2015-March 2016. The required data were collected demographic information and burden of care questionnaire. Statistical analysis was performed using T-test, ANOVA, Pearson and Spearman correlation coefficient.
Results: In this study, the mean age of mothers and children was 47.5 ± 8.54 and 5.3 ± 3.2 years old, respectively. Moreover, 12.9٪of mothers had low burden of care and 71.4٪ and 15.7٪of them experienced moderate to severe burden of care, respectively. An inverse relation (R=-0.322)was found between emotional burden of care and education as well as age of mothers(p<0.05).There was significant difference between burden of care in mothers who received aid from government institutions and those who didn’t receive help from state institutions(p<0.05).Moreover, significant difference was seen between burden of care in mothers with special disease and mothers without special disease, and between mothers whose children had surgery and
those didn’t have surgery. Moreover, burden of care was observed in mothers who take care of affected child lonely and mothers who were not alone (p<0.05).
Conclusion: The result of this study showed that the majority of mothers of children with a malignancy had moderate to severe burden of care. Therefore, effective interventions are recommended to medical team members to reduce burden of care in mothers

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Background: Cardiac dysfunction is one of the major causes of morbidity and mortality in thalassemia patients. This study aimed to compare the effect of Brain Natriuretic Peptides (BNP) and Calcitonin Gene-Related Peptide (CGRP) with echocardiographic findings in early diagnosis of cardiac disease in major thalassemia patients.
Materials and Methods: This study was performed on 80 patients among 500 major thalassemia patients and 80 healthy people. Those with metabolic, endocrine disorder, hypertension, heart failure, and valvular disease excluded from the study. These two groups were matched based on age and sex. Essential heart findings were analyzed using Mylab 60. After blood sampling, levels of CGRP and BNP were measured by use of ELISA kit from extracted plasma. Mann-Whitney test, independent t-test, and Pearson correlation were used to analyze data and P< 0.05 was considered significant.
Results: The results showed that mean age of all participants was 17.581±5.344 years when distributed between case and control as 18.21 ±5.14 and 16.95 ±5.49 respectively without significant difference. Means of weight, length, hemoglobin, systolic and diastolic pressure were lower in patients group. The majority of echocardiography findings of left and right heart were higher in case group. The average of CGRP and BNP level were more in case group (p<0.05). A positive correlation was observed between BNP (R=0.229, P=0.041) and right MPI. There was also correlation between PEP(R=0.0238,P=0.035) , PEP/ET(P=0.005) of right heart and peak A velocity of left heart (R=0.245,P=0.03) with CGRP.
Conclusion: Findings of this survey showed that systolic and diastolic function of left heart would be changed in patients with major beta thalassemia. Therefore, monitoring BNP and CGRP in symptom free thalassemia patients as well as serial echocardiography is recommended.