Background Aspergillosis of Central Nervous System (CNS) is a highly lethal infection in patients with leukemia and Stem Cell Transplantation (SCT). Methods Case reports of CNS aspergillosis in patients with leukemia and SCT published between 1990 and August 2020 were gathered using a structured search through PubMed/Medline. Results Sixty-seven cases were identified over the searches of the PubMed bibliographic database and then, 59 cases were included in the final analysis. Europe had the largest share of cases at 57.6% (34 reports), followed by Americas and Asia. Affected patients were predominantly males (58.6%) and the mean age of the patients was 36.1 years, while 62.7% of the patients were under the age of 50 years. The most common leukemia types include Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), and Acute Myeloid Leukemia (AML) at 43.4%, 27.4%, and 23.5%, respectively. Furthermore, stem cell transplantation was reported in 11 cases. The overall mortality was 33%; however, the attributable mortality rate of CNS aspergillosis was 24.5%. Altered mental status, hemiparesis, cranial nerve palsies, and seizures were the clearest manifestations of infection and lung involvement reported in 57% of the patients. Histopathologic examination led to the diagnosis of infection in 57% of the patients followed by culture (23.7%), galactomannan assay (8.5%), and molecular method (3.3%). Amphotericin B and voriconazole were the most frequently used drugs for infection treatment. Good results were not obtained in one-third of the patients treated by voriconazole. Finally, neurosurgical intervention was used for 23 patients (39%). Conclusion CNS aspergillosis is a rapidly progressive infection in leukemic patients. Thus, these patients should be followed up more carefully. Furthermore, management of induction chemotherapy, use of different diagnostic methods, and use of appropriate antifungal can lead to infection control.

Background: Red cell distribution width (RDW) is one of the standard parameters with blood cell counts. Studies have revealed that RDW could be used as a predictor of mortality in different contexts. However, data about the relation of RDW with hematologic malignancies is limited. In this research, we evaluated the relation of RDW with mortality in pediatric acute lymphoblastic leukemia (ALL).

Background: Acute lymphoid leukemia (ALL) is the largest subset of hematologic malignancies, accounting for approximately 70%–80% of childhood leukemia, and is most common at age 4 years. The aim of this study was to define the frequency of chromosomal abnormalities in pediatric ALL. Materials and Methods: In this 11-year retrospective study, we investigated 99 patients which referred to our department due to ALL from 2010 to 2020. The age group of the patients ranged from 6 months to 14 years with a mean of 6.71 ± 4.09 years. Clinical and diagnostic findings were extracted from patients’ medical records. Results: We showed cytogenetic abnormalities of 99 pediatric ALL patients, including 78 pre-B-ALL, 9 common B-ALL, and 12 T-ALL cases. The 5-year overall survival rate (OSR) and event-free survival (EFS) of all cytogenetic abnormalities ( n = 99) were 48% and 43%, respectively. There was a significant relationship between the two cytogenetic abnormalities, hypodiploidy and t(9;22), with death ( P < 0.05). On comparing the subjects with normal cytogenetics to the other cytogenetic abnormalities, EFS was significantly low for hypodiploidy ( P = 0.0163, hazard ratio = 0.5308) and t(9;22) ( P = 0.0131, hazard ratio = 0.4908), while other cytogenetic abnormalities did not have a statistically significant difference in EFS. Conclusions: Our results emphasized the importance of the cytogenetic findings in evaluating the survival outcomes, which allows identifying a variety of OSR and EFS, because some of the cytogenetic abnormalities may interfere with the death and prognosis.

Background: Iron deficiency is the most common micronutrient deficiency affecting nearly one-third of the population and is the leading cause of anemia worldwide. n this study, we evaluated the effectiveness of ferrous gluconate and ferrous sulfate supplements to identify the best iron supplement with the most effective and the least side effects in toddlers 6-24 months old. Methods: A randomized, single-blind clinical trial was performed. A total of 120 healthy toddlers aged 6 to 24 months old (two groups of 60) entered the study. Toddlers receiving ferrous sulfate (FS group) and ferrous gluconate (FG group) supplements. Blood indices such as hemoglobin & ferritin levels were evaluated at baseline and 6 months post- supplementation. Results: The FG group that received ferrous gluconate chelate iron showed approximately 2.4 g/dl higher Hb level in comparison to the FS group with ferrous sulfate supplementation 6 months post-supplementation (12.51±0.58 g/dL vs. 10.10±0.83, p = 0.045). Side effects were significantly more common in the FS group than the FG group (43.3 % vs. 16.7 %, P ≤ 0.001. Conclusion: The present study shows that educating mothers to feed toddlers with breast milk and iron supplements, including ferrous sulfate and ferrous gluconate, can be helpful in the prophylaxis of iron deficiency. Our results show that ferrous gluconate can be used in cases where ferrous sulfate causes unacceptable side effects.

Background: Renal insufficiency is one of the inevitable complications in patients with Wilms tumor (WT). The purpose of this study was to assess the renal function in children with WT at baseline and every 3 months to 2 years. Materials and Methods: In a descriptive-analytical study from 2018 to 2020, 48 children with WT were included in the study. Urine creatinine (U Cr ), serum calcium (S Cr ), blood pressure (BP), estimated glomerular filtration rate (eGFR), and urinary protein (U Pro ) were evaluated at baseline and every 3 months during the study. Spot U Ca /U Cr and spot U Pro /U Cr ratio were calculated. Kidney ultrasonography was used in all patients. Independent Sample t -test and Chi-square tests were utilized to compare age and sex, respectively. Results: The mean age of patients at follow-up was 7.3 years. There was no significant difference in mean U Cr , S Cr , eGFR, 24-h U Pro , U Ca /U Cr ratio, and spot U Pro /U Cr ratio at baseline and end of study ( P baseline > 0.05, P end of study > 0.05). Analysis of kidney size showed a statistical association with tumor stage ( P < 0.05). Comparison of the kidney size in patients showed that there is a statistically significant difference ( P < 0.0001) at baseline and end of the study. Conclusion: This study showed that as WT progressed, the size of the kidneys increases without any renal insufficiency. Therefore, it seems that urinalysis of patients with WT along with sonography is necessary to determine renal insufficiency and the use of ultrasound alone to determine kidney insufficiency is not recommended.