Background Childhood cancer is a highly curable disease when timely diagnosis and appropriate therapy are provided. A negative impact of the coronavirus disease 2019 (COVID‐19) pandemic on access to care for children with cancer is likely but has not been evaluated. METHODS A 34‐item survey focusing on barriers to pediatric oncology management during the COVID‐19 pandemic was distributed to heads of pediatric oncology units within the Pediatric Oncology East and Mediterranean (POEM) collaborative group, from the Middle East, North Africa, and West Asia. Responses were collected on April 11 through 22, 2020. Corresponding rates of proven COVID‐19 cases and deaths were retrieved from the World Health Organization database. Results In total, 34 centers from 19 countries participated. Almost all centers applied guidelines to optimize resource utilization and safety, including delaying off‐treatment visits, rotating and reducing staff, and implementing social distancing, hand hygiene measures, and personal protective equipment use. Essential treatments, including chemotherapy, surgery, and radiation therapy, were delayed in 29% to 44% of centers, and 24% of centers restricted acceptance of new patients. Clinical care delivery was reported as negatively affected in 28% of centers. Greater than 70% of centers reported shortages in blood products, and 47% to 62% reported interruptions in surgery and radiation as well as medication shortages. However, bed availability was affected in <30% of centers, reflecting the low rates of COVID‐19 hospitalizations in the corresponding countries at the time of the survey. Conclusions Mechanisms to approach childhood cancer treatment delivery during crises need to be re‐evaluated, because treatment interruptions and delays are expected to affect patient outcomes in this otherwise largely curable disease.
Background: Febrile seizures are prevalent in children aged between 6 months and 5 years with an incidence of 2-5%. Iron deficiency is the most common hematologic disease of infancy and childhood with a period of incidence that coincides with the time of febrile seizures. Although the most common manifestation of iron deficiency is anemia, it is frequently the source of a neurologic disorders in pediatrics, including developmental delay, seizure, stroke, breath-holding episodes, pseudo tumor cerebri, and cranial nerve palsies. Objective: To investigate the association between iron deficiency and febrile seizures. Methods: Two groups (80 for each) of 6 months to 5 years old febrile children were subjected to the study between 1st of Oct. 2017 to 1st of Oct. 2018. The first group, cases, included children with febrile seizures admitted to the Pediatric Ward in Al-Imamein Al-Kadhimein Medical City, whereas the control group, included febrile children, visited the hospital during the same period for febrile illness. History was taken, physical examination was done. Blood count indices, serum iron, total iron binding capacity and serum ferritin were estimated. Lumber puncture was done in some of the patients. Statistical Analysis was done using t-test and Chi-square test (x2), P-value was considered significant if less than 0.05. Percentages and Odds ratio were estimated. A prevalence of 20-25% among cases is considered clinically relevant. Results: Both groups were comparable for age and gender (17.5±8.81) and (17.6±8.54) months, male: female ratio was (1.75:1 and 1.2:1). Family history of febrile seizure were seen in 25% and 13.75% respectively. Simple febrile seizure was found in (72.5%). The blood indices were lower in patients than the control group and statistically have significant difference in hemoglobin, hematocrit, mean corpuscular volume, serum iron and serum ferritin level with a P-value less than 0.05. A total of 36 (45%) of the cases had iron deficiency, compared to 12 (15 %) of control respectively with P-value less than 0.05. Conclusion: Iron deficiency was more frequent among children with febrile seizure than those with febrile illness alone. The results suggest that iron deficiency may be a risk factor for febrile seizure. Keywords: Febrile seizure, infants, children, iron deficiency anemia Citation: Shaheed AH, Abbas SA. The association between iron deficiency and febrile seizures in children below 5 years. Iraqi JMS. 2020; 18(2): 110-116. doi: 10.22578/IJMS.18.2.4
Background: Hodgkin lymphoma (HL) is a malignant process involving the lympho-reticular system that accounts for 6% of childhood cancers. Infectious agents may be involved, such as human herpes virus 6, cytomegalovirus, and Epstein-Barr virus (EBV). Infection with EBV confers a 4-fold higher risk of developing HL. Objective: To have an idea about the mode of presentation, pathological subtypes, treatment applied and outcome in one center in our country. Methods: A retrospective study was done whereby twenty cases were collected from the Pediatric Oncology Clinic in Al-Imamein AL-Kadhimein Medical City over a period of ten years from the first of January 2007 – end of December 2016. Information was taken from the patient’s records in the Pediatric Oncology Clinic including age at presentation, sex, physical finding, histopathological subtypes, staging , treatment applied and outcome. Results: Among the studied group, 14 cases (70%) were males and 6 cases (30%) were females, male: female ratio equal to 2.3:1, rang of age was between 5-12 years with a peak age at presentation was between 5-7 years, 12 cases (60%). The initial presentation was an enlarged cervical lymph node in 19 of them (95%), histopathologically, most of the patients had mixed cellularity subtype, 9 cases (45%), stage II and stage III comprise the majority of cases 9 cases (45%), 6 cases (30%) respectively, B symptoms were reported in 7 cases (35%). Chemotherapy was the mainstay of treatment with good response and remission, 17 cases (85%). Three cases refractory to treatment (15%) with no response, no death was reported. Conclusion: Male predominance was noticed with younger age group at presentation. The majority presented with enlarged cervical lymph node. Although mixed cellularity was encountered in most of the patients, the response to chemotherapy was good. Rituximab can be used along with chemotherapy for refractory cases and for lymphocyte predominant Hodgkin lymphoma. Keywords: Hodgkin Disease , Children Citation: Abbas SA, Ali RH. Hodgkin disease in Children. Iraqi JMS. 2018; 16(4): 424-429. doi: 10.22578/IJMS.16.4.10
Background: β-Thalassemia occurs in higher frequency in the Mediterranean area and the Middle East. Classically serum ferritin and liver biopsy have been needed to monitor patient's response to chelation therapy. Magnetic resonance imaging (MRI) has been proved effective in detecting and quantifying iron in the heart and liver. Objective:To assess the value of MRI T2* procedure in assessment of hepatic (LIC) serum ferritin level and MRI T2* of liver and myocardium in patients with BTM. Methods: A cross -sectional study was conducted at Al-Imamein Al-Kadhimein Medical City in Baghdad, from September 2016 to September 2017, 45 patients with BTM were collected from the Thalassemia center in Ibn AL-Baldy Hospital. Hepatic and myocardial T2* MRI results were taken from the file records of the patients from the same center.The results of hepatitis B and C and serum ferritin were taken from the file records. Results: The total number of patients was 60, 15 patients were excluded because of heart failure and hepatitis B and C, the mean age was (19.95±6.85 years), male: female ratio equal to 1:1. Fifty-one patients (85%) were on Deferasirox and 19 patients (31.76%) were splenectomized. Serum ferritin ranged between (1009-10600 ng/l). Liver T2* MRI ranged from (0.5-17 ms) with a mean of (3.66±3.13 ms). Mild-moderate severity found in the majority, 18 cases (40%), 13 cases (28.9%) respectively, with strong inverse correlation between liver MRI and serum ferritin level. Myocardial T2* MRI ranged from (1.88-33.2 ms) with a mean of (13.16±7.81 ms). Moderate-severe degree of severity in the majority, 12 cases (26.67%), 19 cases (42.22%) respectively, with significant inverse correlation between serum ferritin and myocardial MRI. There is no positive correlation between myocardial T2* MRI nor liver T2* MRI with mean age of the patients. Conclusion: The study shows that MRI is an accurate and non-invasive method to assess iron overload in liver and heart in β-thalassemia patients with regular transfusion. Keywords: β-Thalassemia major, blood transfusion, serum ferritin, cardiac MRI, hepatic MRI Citation: Yaseen AK, Abbas SS, Abdulhadi AMA. Correlation between cardiac and hepatic T2* MRI and serum ferritin level in patients with transfusion dependent β-thalassemia major. Iraqi JMS. 2019; 17(1): 66-73. doi: 10.22578/IJMS.17.1.10
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