elnaz sheikhpour

Cancer continues to pose a substantial global health burden and remains one of the leading causes of mortality worldwide. Encouragingly, survival rates have consistently improved, largely due to advancements in diagnosis and treatment. The development of anticancer drugs, including cytotoxic chemotherapy, hormonal agents, and targeted therapies, has significantly enhanced the efficacy of cancer treatments. Chemotherapy-induced ocular toxicity encompasses a wide range of disorders, influenced by the eye's unique anatomical and physiological characteristics. The mechanisms of these drugs can lead to systemic and ocular side effects, including cytotoxicity, inflammation, and neurotoxicity. While ocular side effects from targeted therapies are less common, they can be severe, disabling, and potentially irreversible. In some cases, immediate discontinuation of the drug may be necessary to prevent vision-threatening complications. Understanding these ocular side effects is crucial for early recognition and intervention by ophthalmologists and oncologists to prevent blindness. Additionally, anticipating treatment-related toxicities enables pharmacists to develop strategies that minimize or mitigate these side effects. This review focuses on the ocular toxicity associated with the most significant anticancer chemotherapeutic agents.

Cancer is as the second leading cause of death among children in the United States. The mortality rate for cancer has witnessed a decline, dropping from 6.5 per 100,000 in 1970 to 2.3 per 100,000 in 2016. Second malignant neoplasms (SMNs) represent novel primary malignancies emerging after the initial cancer diagnosis, particularly prominent as late effects of cancer therapy in children. The incidence of SMNs sees a substantial increase over time, reaching nearly 10% even a decade after the initial diagnosis. A comparative analysis between the general population and child cancer survivors reveals a six-fold higher risk of developing SMNs among the latter. Various factors contribute to the elevated risk of second cancers, with age, lifestyle, environmental influences, primary cancer treatment, and genetic predisposition playing pivotal roles. Noteworthy risk factors for SMNs in children encompass radiation therapy, chemotherapeutic agents, topoisomerase inhibitors, genetic factors, hematopoietic stem cell transplantation, and ionizing radiation, as elucidated in the present study. Despite these findings, further research is imperative to accurately quantify the risks associated with etiological factors, enabling the identification of individuals at a heightened risk for second cancers and facilitating proactive screening and preventive measures.

Osteosarcoma (OS) is the most common type of primary malignant bone tumor. The onset of OS is associated with local pain and swelling as well as joint dysfunction, occasionally. The most common location for OS is around the knee joint.  These patients often tend to receive medical attention following physical exercise and trauma. The affected population is mainly teenagers, children, and young adults with age range of 10-30 years. OS can be diagnosed via different approaches. The main serum markers for pediatric OS are insulin‑like growth factor (IGF‑1 and IGFBP‑3), anti‑ki57 antibody, tumor necrosis factor (TNF)‑β and sTNF‑R, T3, CD44, vascular endothelial growth factor, serum amyloid A, CXC chemokines, bone alkalin phosphatase, Interleukin (IL‑2, IL‑4, IL‑8), interferon gamma (IFN-γ), TNF‑α, and free polyamines. Given that there is no comprehensive review literature regarding OS management in our country, this study aimed to assess a survey on the management and approach of OS in children. In this regard, we have discussed the epidemiology, etiology, type, clinical feature, diagnosis, and OS therapy.

The efficacy of echinacea products to treat upper respiratory tract infections (URTI) has been shown in some studies, however, there are few studies considering the efficacy of echinacea to prevent URTI. Therefore this study aimed to assess the effect of echinacea in the prevention of URTI in these children.
Materiala and

This retrospective cross-sectional study was conducted on 60 children with ALL in Shahid Sadoughi hospital from September 2020 to September 2021. These Children were divided into two groups (n=30). The case group received immunogen syrup, containing echinacea purpura root extract (200 mg/ml). This syrup was prescribed in the intervention group as 2 ml for children in the age range of 2-8 years and 0.5 ml for children in the age range of 1-2 years old for 3 months. The control group did not receive echinacea syrup. These patients were followed for 3 months regarding URTI.

The frequency of URTI in the case and control groups was 40% and 66.7%, respectively, and a significant difference was noted between the two groups in terms of the frequency of URTI (P<0.05). Moreover, 23.3% of patients who received echinacea developed a second URTI, while 53.3% of patients who did not receive echinacea developed a second URTI (P<0.05). The mean time for the second URTI in the case and the control groups was 42.3±13.93, and 48.3±13.96 days, respectively (P=0.086). Regarding reducing the duration of URTS symptoms, there was no significant difference between the two groups (P>0.05).

According to the results, echinacea can be effective in decreasing the occurrence of URTI in these children. Therefore, regarding the efficacy of echinacea in decreasing URTI, it is recommended to use echinacea in the prevention of URTI.

Over-expression of CD117 and cytokeratin 20 (CK20) is seen in many malignancies. Given that few studies have been conducted regarding the role of these biomarkers in the etiology of bladder tumours, this study aimed to evaluate the prognostic value of CD117 and CK 20 biomarkers in the benign and malignant tumours of urinary bladder carcinoma.

This case-control study was conducted on 62 bladder tumours (17 benign tumours and 45 malignant tumours). The immunohistochemistry technique was used to assess CK20 and CD117 biomarkers in tumour samples.

There is no significant difference between benign and malignant groups in terms of CD117 (p=0.094). No significant difference was observed between expression of CD117 in terms of grade (p=0.184). However, a significant difference was observed between benign and malignant groups in terms of CK20 expression (p=0.022). Moreover, a significant difference was observed between CK20 expression in terms of grade (p=0.009). In addition, a significant difference was observed between the age of patients considering grade (p<0.047).

The results of the current study supported the role of CK20 in the carcinogenesis of urinary bladder carcinoma. Moreover, it seems that CK20 expression may be considered as a poor prognostic parameter in transitional bladder carcinoma. Furthermore, these findings indicated that patients with higher age had higher grade. In addition, assessment of CD117 expression did not play a main role in tumour progression. Therefore, it is not recommended for bladder tumours.

β-thalassemia is the most common hereditary disease in Iran, and more than 2 million carriers of β-thalassemia live in Iran. On the other hand, our country is located in the thalassemia belt, and no comprehensive study has been conducted regarding the effect of erythropoietin on blood parameters in thalassemia intermedia patients in our region. Therefore this study aimed to investigate the effect of erythropoietin on blood parameters of thalassemia intermedia patients.

This prospective cross-sectional study was conducted on all patients suspected of thalassemia intermedia in Shahid Sadoughi hospital from March 2021 to M 2022.  In the case of diagnosis of microcytic anemia, an electrophoresis test was performed, and people diagnosed with thalassemia intermedia entered the study. Then patients were divided into two groups (the intervention and control groups). The erythropoietin dose was 50-100 units/ kilogram (body weight) three times a week for six months. The measurement of hematocrit and hemoglobin were done using CBC cell counter (Sysmex KX21). Other data were extracted from medical records.

Result

In the current study, the mean age of patients in the intervention and control groups was 9.15±1.53 and 8.35± 6.90 years old, respectively (p=0.9). The mean hematocrit level in the intervention and control groups was 28.05± 4.06 and 23.45± 3.22 %, respectively (P<0.001). The mean hemoglobin level in the two groups was 9.15± 1.53 and 7.65± 1.23 g/dL respectively (p=0.002). The mean hematocrit level before and after the intervention was 25±3.71 and 28.05±4.06 %, respectively. The mean hemoglobin levels before and after therapy were 7.9±1.52 and 9.15±1.53 g/dL, respectively.

According to the findings, hemoglobin and hematocrit increased in thalassemia intermedia patients taking erythropoietin. Therefore it seems that recombinant erythropoietin can be helpful in these patients.

Given that various types of cancer are major causes of death among children and there is no comprehensive study investigating the simultaneous effect of ifosfamide and mesna in the treatment of patients with various types of cancer in our country, this study aimed to assess the effect of ifosfamide and mesna in the treatment of children with various types of cancer.

In the retrospective study, 46 patients with cancer were divided into two groups. In the first group, patients were treated with ifosfamide (800 mg-1g/m2/day) with 500 cc of normal saline and mesna (equivalent to the amount of ifosfamide) in the serum. In the second group, the patient received ifosfamide through serum and mesna at 0, 4, 8, and 16 hours after the ifosfamide injection. This injection continued for three days. Then blood count, hemoglobin, and kidney tests in both groups were examined.

White blood cells in both methods decreased significantly (P<0.01). In the second group, there was a significant difference before and after intervention, regarding hemoglobin level (P<0.01). In addition, more people in the second group showed gastrointestinal complications (P<0.01). There was no significant difference before and after intervention in the the two groups, regarding creatinine and urea levels (P>0.05).

In both groups, a decrease in white blood cells was observed, while kidney toxicity was not observed in any group. The decrease in hemoglobin in the second group was more than in the first group.

Inflammation plays a critical role in the progression of cancer in children. On the other hand, children with cancer experience abnormal activation of the inflammatory system. Moreover, it is known that these patients have a predisposition to depression. According to studies, moderate to severe depression was observed in about 63% of children with cancer and acute illness. Therefore, identifying inflammation-related biomarkers and targets in this regard is essential. The inflammation changes are related to cytokine deregulation, which in turn may influence the expression of depressive symptoms. Studies have reported that the deregulation of serum inflammatory cytokines, such as interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α may influence depressive disorder in pediatric cancer patients.  In addition, determining the risk of severe bacterial infection complications in pediatric cancer is essential to reduce the cost of therapy and hospitalization. However, the role of cytokines as an infection marker in these children is still a debate. Determining these plasma cytokine levels may have diagnostic value in assessing febrile neutropenia, although their crucial role in systemic inflammation is known. Given that evidence regarding the role of pro-inflammatory cytokine levels and relation to clinical parameters, including depression and infection in pediatric cancer patients is limited, we assessed the role of cytokine and its relation to depression and infection complications in pediatric cancer.

The global spread of COVID-19, due to its pathogenesis and high mortality rate, has caused high levels of stress among various levels of societies. Hence, it is necessary to investigate social support interventions concerning their effectiveness and accessibility.

The study aimed to determine the association between coping strategies and social support in survivors of COVID-19.

Following a descriptive-correlational design, using the census method, 158 discharged cases with a definitive diagnosis of COVID-19 in 2020 were recruited. Data collection tools included the demographic characteristics questionnaire, CISS-48 stresscoping methods, and Wax’s social support questionnaire. Data were analyzed using descriptive and inferential statistics of Pearson correlation coefficient and multivariate regression in SPSS version 22.

The most and least frequent stress coping strategies used by patients were problem-oriented (48.49±9.99) and avoidanceoriented stress strategies (24.48 ± 4.11), respectively. Family support (39.02 ± 4.20) was the major source of support. There was a significant correlation between the score of social support and the total score of stress, problem-oriented, and avoidance-oriented stress. According to the regression analysis, there was a significant association between the score of coping strategies and educational level.

By increasing the awareness of COVID-19 patients about problem-based coping strategies, their stress can be reduced. Also, due to the high level of social support provided by the family, planning for family-centered nursing interventions and engaging family members in the care of COVID-19 patients are important.

The previous published data on the association between interferon regulatory factor 6 (IRF6) polymorphisms and non-syndromic Cleft Lip/Palate (NSCL ± P) risk remained inconclusive. The aim of this study was to conduct a meta-analysis to further assess the associations.

A comprehensivesearch in PubMed, EMBASE, Web of Science, and CNKI for all eligible studies up July 2021.

A total of 23 studies with 6,161 cases and 8,919 controls were selected for this meta-analysis. Overall pooled analysis suggest a significant association between IRF6 rs2235371 polymorphism and CL±P risk under all the five genetic models, i.e., allele (A vs. G: OR=0.754, 95% CI 0.628-0.905, P=0.002), homozygote (AA vs. GG: OR=0.621 95% 0.405-0.953, P=0.029), heterozygote (AC vs. GG: OR=0.619, 95% CI 0.485-0.791, P≤0.001), dominant (AA+AG vs. GG: OR=0.550, 95% CI 0.381-0.794, P=0.001) and recessive model (AA vs. AG+GG: OR=0.583, 95% CI 0.423-0.804, P=0.001). Subgroup analysis by ethnicity showed that rs2235371 was associated with NSCL±P risk in Asians.

This meta-analysis provides strong evidences that IRF6 rs2235371 might be associated with risk of NSCL ± P.

Acute Kidney Injury (AKI) occurs if the kidneys suddenly lose their ability to remove waste products. When the kidneys lose their ability to filter, dangerous levels of waste products can accumulate, which can upset the chemical composition of the blood and urine. Chemotherapy is one of the methods used to treat or temporarily reduce cancer by using certain medications. The main task of this treatment is to kill cancer cells without seriously damaging the surrounding tissues. However, this type of treatment also has destructive effects on healthy cells and tissues in the body. Researchers studying cancer patients undergoing chemotherapy found that people undergoing this type of treatment may develop serious kidney problems and be forced to use treatments such as dialysis and kidney transplants. Research showed that people with more severe cancers and advanced tumors are more likely to have acute kidney injury than those with early-stage cancer. AKI biomarkers can be selected from the patientchr('39')s serum, urine, or body imaging components. Various studies showed that urine is a source of the best markers in AKI. Biomarkers in plasma and urine, such as N-acetyl-β-glucosaminidase, Cystatin-C, β2-microglobulin , Cysteine-Rich Protein, Osteopontin, Fetuin-A, Kidney Injury Molecule-1, Liver-type fatty acid-binding protein, Netrin-1, Neutrophil gelatinase-associated lipocalin, and interleukin-18 are effective tools for early detection of AKI. In this review study, an attempt was made to collect biomarkers related to AKI disease.

Given that few studies regarding the effect of Aloe vera (A. vera) on prevention of fever and neutropenia on acute lymphoid leukemia (ALL) disease, the aim was to evaluate the effect of A.vera on prevention of fever and neutropenia in children with ALL.

This randomized clinical trial study was conducted on 60 children with mean age 5.6± 2.9 years in Oncology department of Shahid Sadoughi hospital during 2018-2019. All these children were underwent chemotherapy. Then, the patients were randomly classified into two groups. The first group received 10 ml A. vera syrup (0.5 mg/ml) for 30 days (case group) and the second group did not receive A. vera syrup (control group). Complete blood count (CBC) tests and frequency of fever, infection, neutropenia, and hospitalization were evaluated in case and control groups before and after intervention. Wilcoxon, T test, and Chi Square test were used for data analysis.

Significant reduction was observed in case group in comparison with control group regarding the frequency of fever (0.19 ±0.107 vs 1.07±0.206), infection (0.81 ±0.2 vs 1.87± 0.236), hospitalization (0.37±0.178 vs 1.33 ±0.187), and neutropenia (0.11± 0.062 vs 0.80 ± 0.2) (p<0.01). Moreover, significant increase was observed in case group in comparison with control group considering neutrophil count (2597.5±243.1 vs 1106.53±161.6) and white blood cell (WBC) (4062.96 ± 276.6 vs 2566.67 ±175.5) (p<0.01). In addition, recovery of appetite was significantly greater in case group than control group (p=0.023). Furthermore, significant difference was observed in case group before and after intervention regarding these parameters (p<0.05).

According to findings, A. vera consumption decreased frequency of infection, neutropenia, fever, and hospitalization and increased WBC and neutrophil count.  Moreover, appetite was improved in these patients. Therefore, it seems that A.vera can be used for improving quality of life in children with ALL

Red blood cells transfusion is a useful practice for preterm infants. Large amount of blood is usually wasted in the infants. Considering that few studies have been carried out on infants, the aim of current study was to investigate the frequency of packed red blood cells transfusion in preterm infants admitted to NICU of Shahid Sadoughi Hospital in Yazd during 2016 This retrospective descriptive-analytical study was conducted on infants admitted to Neonatal intensive care unit (NICU) of Shahid Sadoughi Hospital, Yazd, Iran during 2016. Variables including fetal age, sex, birth weight, delivery method, Apgar score, infant status, premature birth complications and transfusion information were extracted from medical records of patients. Current study was conducted on 335 premature infants. Among them, 85 cases were received packed red blood cells transfusion (25.4%). Of the infants receiving packed red blood cells, 59 cases (69.4%) were alive and 26 (30.6%) dead. Distribution of preterm complications in infants including respiratory distress syndrome, sepsis, respiratory failure and Pneumothorax was observed in 66 (77.6%), 19(22.4%), 52(61.2%) and 14 patients (16.5%), respectively. There was significant difference between mean age and mean Apgar score in terms of transfusion (p<0.01). The mean volume of consumed blood was 34.20 ± 27.44 ml. The mean volume of wasted blood was 488.39±355.88 ml. Minimum and Maximum volume of wasted blood was 220 and 1873 ml. According to results of current study, the mean age and mean Apgar score in patients undergoing transfusion was lower than those did not have transfusion. Moreover, total volume of wasted blood was 14.2 times more than consumed blood. Therefore, optimal usage of blood products and the use of smaller blood bags are proposed in order to improve the health of infants in intensive care units and lessen complications of blood transfusion in newborns.

Context: Pelvic masses are a prevalent cause for referral to gynecologic oncology departments to evaluate the possibility of benign or malignant conditions. Pelvic mass often was found in pelvic examinations among females with ovarian. Tumor markers are advantageous biomarker in tumor diagnosis. Evidence Acquisition: We performed a computerized search in Medline/PubMed databases and Google Scholar with key words: “Cancer antigen 125 (CA125), Human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), Risk of malignancy index (RMI), and Pelvic mass”. The usage of tumor marker CA125 alone is associated with serious limitations like low sensitivity for early or stage I disease and lack of specificity especially in pre-menopausal women. Serum HE4 is a good biomarker for discriminating ovarian cancer from benign pelvic disease, but could be affected by several factors including pregnancy, age, and smoking. ROMA has a high sensitivity, specificity, and negative predictive value to predict the presence of ovarian cancer in women with a pelvic mass. RMI could differentiate between benign and malignant pelvic masses, but RMI expression was higher in women with 55 years or more. According to the results of this study, combination of these biomarkers or at least 2 or 3 biomarkers are suggested for early stage diagnosis of pelvic mass with high sensitivity and specificity.

Breast cancer is the most common cancer in women. Histological grade and type of tumor are morphological findings that play a main role in breast cancer classification. Markers including Estrogen receptor (ER), progesterone receptor (PR), and Her 2 can be used in routine clinical labs to predict response or resistance to treatment for using new drugs. The aim of this study was to evaluate the differences in tumor characteristics in estrogen and progesterone receptor status (ER+/PR+, ER+/PR-, ER-/PR-, ER-/PR+) in patients with breast cancer. In this study, 130 patients with primary invasive ductal breast carcinoma were chosen from Shahid Sadoughi hospital, Yazd, Iran from 2014 to 2016. The histological grade of tumor was detected according to Bloom and Richardson grading method. Her-2, estrogen receptor, and progesterone receptor were analyzed by immunohistochemistry (IHC) method through primary anti-body. In this study, 73 (56.15%) and 23 patients (17.69%) were double receptor positive (DRP) and double receptor negative (DRN), respectively. ER+/PR- and ER-/PR+ were found in 30 (23.84%) and 3 (2.3%) tumors. Moreover, 65.63% and 60.52% of tumors were Her-2 negative and low grade, respectively. Significant difference was seen between Estrogen receptor/progesterone receptor according to age, Her-2 expression, and grade (P < 0.05). The result of this study showed that hormone receptor expression is different according to age, grade, and Her-2 expression. Moreover, ER+/PR+ tumors had lower grade and more Her-2 negative than other hormone receptors.

Farber disease is a very rare autosomal recessive disease of lipid metabolism caused by deficient activity of lysosomal acid ceramidase. Symptoms can begin in the first year of life by a triad of painful and swollen joints and subcutaneous nodules, progressive hoarseness and variable central nervous system involvement.

A5 monthsold girl with subcutaneous nodules in limbs, pain and swelling in her fingers, Knees, elbow and hoarseness was referredto our clinic. She had neurodevelopment delay in walking and talking. Genetic analysiswas reported homozygosity for a c.830C>A mutation in exon 11 of N-Acylsphingosine Amidohydrolase 1 (ASAH1)gene. She diagnosed with Farber disease and treated with bone marrow transplantation. After that her signs and symptoms were improved and she could to walk.

Farber disease is associated with characteristics including swollen joints, subcutaneous nodules, progressive hoarseness and variable CNS involvement. Moreover, bone marrow transplantation improved these symptoms.

Interleukin (IL)-10, a multifunctional immune-regulatory cytokine with both immunosuppressive and anti-angiogenic functions, is produced by immune cells including macrophages, T lymphocytes, and natural killer cells. Among other effects, IL-10 promotes tumor cell proliferation and metastasis via immunosuppression. Interleukin-10-mediated immunosuppression is aided by synthesis of tumor necrosis factor, IL-1, IL-12, and chemokines, and down regulation of the surface co-stimulatory molecules CD80 and CD86 on tumors. Interleukin-10 also promotes IL-6 expression and synthesis, which causes cell proliferation via B cell lymphoma-2 (Bcl-2) upregulation and changes the proliferation/apoptosis equivalence toward neoplastic cell proliferation. Moreover, IL-10 inhibits tumorigenesis via down-regulation of VEGF, IL-1b, TNF-α, IL-6, and MMP-9. Interleukin-10 also inhibits nuclear factor-κB (NF-κB) translocation. Interleukin-10 has been reported to have both tumor-promoting and -inhibiting properties. It seems that IL-10 agonists and antagonists may have therapeutic effects via different mechanisms. Moreover, IL-10 gene polymorphisms may determine breast cancer susceptibility.