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Background: The "Iron Supplementation Project" for anemic toddlers in Iran has not been subject to scientific studies yet. Since daily consumption of iron drops by children could bring about physical and mental problems, the aim of this study was to determine whether weekly doses of iron drops would also improve the iron status of children significantly.

Materials and Methods: We determined the iron status of 12 to 21-month-old anemic toddlers receiving iron drops (ferrous sulfate) daily referred to health care centers in Shiraz. One hundred and four children were divided into two groups one group receiving iron drops (1 mg/kg) daily as before, and the other group receiving iron drops weekly (3 mg/kg).

Results: After three months children showed a significant increase in hemoglobin (Hb), mean corpuscular hemoglobin (MCH), and mean cellular hemoglobin concentration (MCHC) levels. Although weekly supplementation led to a significant increase in Hb levels, daily supplementation had a significantly greater effect than weekly supplementation on the levels of mean corpuscular volume (MCV) and MCHC.

Conclusion: We generally conclude that weekly iron supplementation is not suitable for anemic children.

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Non-Hodgkin lymphoma is very uncommon in infancy and skin as the primary site of involvement in Non-Hodgkin lymphoma is rarely encountered. We describe a 10-month-old infant with T-cell Non-Hodgkin lymphoma who presented with multiple skin nodules as the predominant feature of her disease. The clinical manifestations, treatment strategy and disease outcome are reviewed. Key words: Non-Hodgkin lymphoma, T-cell, skin nodules, infancy.

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Objective: Thrombotic thrombocytopenic purpura (TTP) is the most malignant variant of microangiopathy that usually presents by typical symptoms including thrombocytopenia, hemolytic anemia, neurological abnormalities, fever and renal impairment. Report of the Case: We report a 12-year-old male presented by cytopenia, fever, purpura on his extremities, seizure and lethargy. Peripheral blood smear revealed low platelet and increased schistocyte, but renal function tests were normal. Final diagnosis of TTP was confirmed by measuring ADAMTS-13 autoantibody (> 60). Conclusion: Atypical TTP can presents without renal impairment. In these cases the measurement of ADAMTS-13 activity as a specific test as well as ruling out secondary TTP should be considered. Key word: Renal dysfunction, thrombotic thrombocytopenic purpura, ADAMTS-13.

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Dear Editors: Adenocarcinoma of colon and rectum is the second most common cancer of the gastrointestinal (GI) tract in children. The development of carcinoma of colon in general appears to be associated with several predisposing factors such as familial polyposis, hereditary non-polyposis syndromes, ulcerative colitis, previous ureterosigmoidostomy or radiation therapy and dietary factors (high fat or low fiber diets) 1. Here we report three adolescents with colorectal cancer referring to Amir Oncology Hospital, Shiraz, southern Iran, presenting with various signs and symptoms including acute abdominal pain, painless rectorrhagia, and refractory iron deficiency anemia. They did not have any known predisposing risk factor. Patient 1 was a 14-year-old girl presented with acute abdomen. Abdominal sonography showed a target-like lesion on the thickened segmental bowel wall with a protrusion of the serosa which was surrounded by localized ascites in the lower abdomen. She was found to have a right-sided colon cancer at laparotomy. Histology showed stage 4 Duck. She was diagnosed to have a brain metastasis. Patient 2 was a 16 year-old boy presented with refractory iron deficiency anemia due to metastatic colorectal cancer without any underlying disease in the GI tract. The patient was treated by large amounts of iron supplement and was referred for evaluation of refractory iron deficiency anemia. Patient 3 was a 12 year-old girl presented with painless rectorrhagia without any abdominal complaints. Colonoscopic study revealed typical colon lesions in sigmoid, descending the colon and rectum. Family history was unremarkable for adenomatous polyps. Symptoms of colon cancer in children are nonspecific and include chronic persistent abdominal pain (90%), emesis, bowel habit changes, weight loss (77%), occult blood in the stool with chronic anemia (60%), tenesmus,2 and a palpable abdominal mass. Therefore early diagnosis of patients without predisposing factors is associated with better outcome and prevention of advanced stages and increased rate of successful treatment modalities such as adjuvant chemotherapy after primary surgery. Although this tumor is rare in children, physicians should be alert about the cardinal signs and symptoms and to improve patient’s outcome a high index of suspicion should be kept in mind. Likewise, infrequent signs and symptoms such as acute abdomen or refractory iron deficiency should increase suspicion. Primary diagnostic modalities such as fecal occult blood, complete blood count, abdominal ultrasound and/or invasive procedures such as colonoscopy should be carefully performed in children presenting with red flags for colon cancer including lower GI bleeding, acute abdomen, or iron deficiency anemia. Moreover, monitoring of carcinoembryonic antigen (CEA) levels is recommended during postoperative follow-up in pediatric colon cancers similar to adults 3. Another approach for early detection of this cancer in absence of red flags is routine screening in children predisposed to colorectal cancer as a way to increase overall prognosis. Stools may be tested or a barium enema, colonoscopy, sigmoidoscopy or virtual colonoscopy may be performed. Regardless of any test, a laboratory analysis of tissue ultimately determines existence of tumor. Therefore, cell biopsy, fluid or tissue in the colon needs to be examined to determine presence of tumor.

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Patients with acute myeloblastic leukemia (AML) with monosomy 7 are a group of patients with refractory AML who have a very poor prognosis. Therefore, rationally designed new therapies, including metronomic chemotherapy regimen with histidine deacetylase inhibitors (Valporic acid, ATRA) are being investigated as potential treatments for the population of refractory cases of AML. Herein, we report a patient with primary refractory AML who was treated with oral low-dose chemotherapy after standard systemic chemotherapy.

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Background: Ischemic heart disease and acute myocardial infarction is one of the most dramatic manifestations in one of the most investigated fields in the past few decades. In this study, the prognostic value of white blood cells count in patients with myocardial infarction (MI) was investigated in a six months follow-up.
Methods: In this cohort study, 106 patients with MI were investigated. White blood cell counts were assessed 48 hours after MI and the location of MI was determined using ECG. Mortality rate was determined and their correlation with leukocytosis was analyzed up to 6 months of follow-up. Binary logistic regression analysis was applied between factors such as mortality rate, location of the myocardial infarction, sex, hemoglobin and WBC count.
Results: Mean age of the patients was 62.5±13.3 years. 76.4% were men. 26% of patients had leukocytosis. Leukocytosis was significantly correlated with mortality in a six-month follow-up period (P<0.001). Fifteen (14.2%) patients died during the first three months of follow-up, of which 13 (86.7%) had leukocytosis. It was also shown that mean age of the patients and anemia in deceased group were significantly more than the survived group.
Conclusion: High WBC count in the first 48-h after MI can be regarded as a poor prognostic factor and it has an independent role in determining prognosis of patients with MI for the next six months.

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Background: Nephrotoxicity secondary to doxorubicin (DOX) may be associated with high morbidity and mortality rates. We aimed to assess the efficacy of Deferoxamine (DFO) in preventing DOX-induced nephrotoxicity in pediatric malignancy.
Methods: This Parallel-group randomized clinical trial was done on 62 children aged 2-18 years who had new onset malignancy treated with DOX. They were randomly assigned in three groups; group 1 (no intervention, n=21), group II (DFO 10 times DOX dose, n=20), group III (DFO 50mg/kg, n=21). Patients in the intervention groups received DFO concomitant with DOX 8-hour intravenous infusion in each chemotherapy course. Blood urea nitrogen, serum creatinine, electrolytes, calcium, phosphorus, magnesium and albumin levels, urine microalbumin, urine protein/creatinine ratio, and urine N-acetyl-β-D- glucosaminidase (NAG) as well as findings of kidney ultrasonography were compared between the groups after the last course of chemotherapy. The primary outcome was to compare the radiologic and serologic markers of glomerular and tubular damage between the 3 groups.
Results: Sixty patients were analyzed. Patients treated with DFO 10 times the dose of DOX had significantly lower urine NAG level compared to the control group (P=0.032). No significant renal damage was reported in their ultrasonography in the 3 groups. DFO was safely tolerated without any adverse effect.
Conclusion: DFO with 10-times the DOX dose may effectively prevent DOX-induced nephrotoxicity at least at the molecular level. Increasing the dose of DFO is not accompanied by better efficacy.
Trial registration: IRCT2016021915666N3

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Background: Educational evaluation is a broad concept that is related to all elements of the educational system. This concept is the result of the interaction of all values that are implemented with different titles and forms inside and outside the educational system to increase the performance of the educational system. The field of pediatric hematology and oncology is one that is constantly evolving due to extensive and numerous researches in various fields. These changes must be in line with changes in the health care delivery system. In this study, among the decision models, the CIPP model which is an evaluation model for curriculum evaluation given by Stufflebeam in 1983 which includes four elements: C- Context, I- Input, P- Process and P- Product., was selected to evaluate the educational curriculum of Iranian pediatric hematology and oncology fellowship.
Methods: The present study has two quantitative and qualitative aspects and a quantitative cross-sectional, descriptive-analytical study. This analysis was conducted in 2021 by the strategic group of the Iranian pediatric hematology and oncology association. Its statistical population consisted of members of this association. Most members have a degree in pediatric hematology and oncology. The research was conducted by census method. Data were collected using a researcher-made questionnaire. In general, the training course was examined in 4 areas of education and research, hardware facilities of the training and current environment, and professional abilities other than the content of the course. The efficacy of the evaluation questionnaire of the Pediatric hematology and oncology fellowship course was a combination of open and closed questions based on the “Kirk Patrick evaluation model”. This questionnaire had 20 questions. The internal evaluation based on Cronbach’s alpha was 0.92. The items surveyed in the questionnaire were: learning modern medical principles such as evidence-based medicine and clinical reasoning, learning the principles of medical ethics, study skills, understanding of legal procedures, ability to electronically research and adequacy of educational subjects. Satisfaction of the faculty members, students ‘satisfaction and the need for supplementary courses, the current method of evaluating students’ communication skills, the scientific ability of the eligible faculty in teaching current topics and participation in educating the students were among the other items of the questionnaire.
Results: In the internal validity study, Cronbach’s alpha coefficient of 0.92 was obtained for the current situation and 0.96 for the optimal situation. Descriptive statistics (mean and standard deviation) and one-group and independent t-test were used to analyze the data. Findings indicated that there was a significant difference between the current and desired status of free and absentee university exams in the areas of purpose, design, implementation, modification and feedback and the three components of each of these axes. According to the obtained results, changing the current educational curriculum of the subspecialty fellowship in pediatric blood and cancer is necessary and inevitable.
Conclusion: Corrective suggestions for writing a new curriculum in accordance with modern sciences and medical needs of the country were extracted and applied in the new curriculum.

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Thalassemia minor (MT), either β or α, is the most frequent single gene mutation in human beings affecting 6% of population worldwide. It is more frequent in the Mediterranean region, Africa and South-East Asia. On the other hand Iron deficiency anemia (IDA), either nutritional or secondary to gastrointestinal or menstrual bleeding, is the most frequent cause of acquired anemia. Differentiation between these two types of anemia is important because both of them present themselves as microcytic anemia.2-6 However, in the thalassemia belt, some patients may have mixed IDA and TM.Therefore discrimination indexes should discriminate three categories from the normal population and each other.

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Background: This study aimed to investigate the protective role of deferoxamine (DFO) in the prevention of doxorubicin (DOX)-induced hepatic fibrosis in children.
Methods: In this prospective randomized controlled trial, 61 treatment-naïve children (2-18 years) with different types of cancer who referred to a tertiary teaching hospital in the South of Iran were enrolled. They were randomly assigned to 3 groups; group 1 (control, n=21), group 2 (DFO 10 times DOX dose, n=20), group 3 (DFO 50mg/kg, n=20). DFO was administered as an 8-hour continuous intravenous infusion during and after DOX infusion in each chemotherapy cycle. Non-invasive serum markers of liver fibrosis, including AST-to-platelet ratio index (APRI), Fibrosis-4 (FIB-4) score and Fibro Test were measured in each individual. Besides, hepatic Fibro Scan was used after the last course of chemotherapy to estimate the fibrosis degree.
Results: Alanine aminotransferase was mildly increased after treatment compared to before treatment. The treatment with DFO 10 times DOX dose was associated with a significant decline in post-treatment APRI (adjusted odds ratio 0.17; 95% confidence interval 0.03- 0.84. P-value=0.015). The METAVIR fibro scores were in the F0-F1 zone in all participants, and the results were comparable in study groups. No adverse drug effects were reported in the treatment groups.
Conclusion: DOX may not lead to severe liver fibrosis if the maximum cumulative dose allowed is not exceeded. DFO at the dose of 10 times of DOX dose may have a potential protective role against liver fibrosis. More studies with longer follow-up are needed to further assess this issue.