Benefits of Echinacea purpurea in boosting the immune system and decreasing tumor recurrence in cancer patients: A letter to editor

Patients with cancer consistently suffer from a decreased immune response that leads to opportunistic infections and increased morbidity and mortality in these patients. Boosting the immune system in these patients is accomplished by appropriate diet, psychological support and certain drugs such as granulocyte colony-stimulating factor in a clinical setting. Echinacea purpurea also can be used to boost the immune system in cancer patients. Theoretically, E. purpurea can boost the immune system through several mechanisms, including (1, 2)Activating phagocytosis and stimulating granulocytes;Increasing the production of cytokines, especially interleukin 1 and interleukin 6; andIncreasing the leukocyte activity.The leachate of E. purpurea aerial parts dramatically increases the percentage of phagocytic action of human granulocytes and increases the phagocytosis of yeast particles under laboratory conditions (in vitro) (1).Interruption of hyaluronidase activity, stimulation of cortex parts of adrenal glands, stimulation of the production of properdin (a serum protein that can neutralize the actions of bacteria and viruses) have also been reported after treatment with this plant (1,2).The pharmacological activity of E. purpurea is related to its compounds and volatile essential oils. The immune system-boosting effect of this plant is related to lipophilic amides, alkamides and caffeic acid derivatives, which is produced by stimulating the phagocytosis of multinucleated granulocytes (2,4).In several studies, E. purpurea effect on preventing or treating infections (3, 4) and on reducing the side effects of anti-cancer drugs was investigated. It was concluded that the products containing E. purpurea exhibit a definite and pronounced effect on stimulating the immune system.As a pediatric oncologist, I used to prescribe E. purpurea for my patients with different types of cancers (hematopoietic and solid malignancies) in recent years and I observed a decrease in opportunistic infections and better immune response in them. Regarding the improved immune system, this plant can probably inhibit the proliferation of malignant cells and tumor recurrence by stimulating NK cells (2) in these patients. This tentative argument should be investigated in future studies. If it is proven, we can use this plant as an adjuvant agent in chemotherapy protocols

Assessment of Pack injection cells and the relationship between hematocrit of pack cells and the increase in hematocrit in patients with thalassemia

Background and aims: The amount of injected blood in patients with thalassemia is of particular importance and the blood amount is calculated based on the exact volume of Pack cell as well as their hematocrit. The aim of this study was to evaluate pack cells and the factors affecting on the amount of their hematocrit and their association with increase in hematocrit after blood injection. Methods: This is descriptive-analytical study. Characteristics including age, size, type of anticoagulant hemoglobin and hematocrit were recorded and one CBC was taken before injection and as well, one and twenty four hours after injection to assessment hemoglobin and hematocrit. The data were analyzed by SPSS. Results: The bag containing the anticoagulant substance CPDA-1 has more hematocrit than bags containing anticoagulant CPD + SAGM. Bags of low leukocytes have more hematocrit than bags of conventional type (P> 0.05). With increase in Pack cell volume, hematocrit will be decreased (P<0.001). Besides, the amount of hematocrit is more 24 hours after the injection than one hour later (P<0.001). Hct changes had a significant difference in the time before, also 1 and 24 hours after injection (P<0.001). Conclusion: Packet cell volume, type of anticoagulant and type of cell pack of the most important factors in the amount of hematocrit in blood bags that affects the hematocrit amount after injection

Simultaneous occurrence of advanced neuroblastoma and acute lymphoblastic leukemia: a case report

Neuroblastoma is the most common extracranial solid tumor in children. The cooccurrence of neuroblastoma and acute lymphoblastic leukemia is rare. We report a rare case of advanced-stage neuroblastoma in a 3.5-year-old girl that was accompanied by acute lymphoblastic leukemia following treatment. Her leukemia may have been due to chemotherapy (secondary leukemia) or may have been de novo

Cerebellar Neuroblastoma in 2.5 Years Old Child

Neuroblastoma is the third most common malignancy of childhood, after leukemia and brain tumors. Only 2% of all neuroblastoma occur in the brain. Primary cerebellar neuroblastoma is an specific subset of Primitive Neuroectodermal Tumors (PNET). Meduloblastoma is a relatively common and well-established entity, consisting of primitive and multipotential cells that may exhibit some evidence of neuroblastic or gliad differentiation. But cerebellar neuroblastoma with ultrastractural evidence of significant neuroblastic differentiation is extremely rare. We report a rare case of neuroblastoma in the cerebellum. A 2.5-year-old Iranian boy presented with vomiting and nausea in the morning and ataxia. CT scan showed a tumor mass in the cerebellum and the report of radiologist was medulloblastoma. Light microscopic assay showed a small cell neoplasm with lobules of densely packed cells (lobulated pattern) and better differentiated cells. Neuron-Specific Enolase was positive. Pathologic diagnosis confirmed the existence of cerebellar neuroblastoma. Chemotherapy followed surgical removal. No relapse occurred 12 months after surgery

The impact of N-myc amplification on median survival in children with neuroblastoma

Background: Neuroblastoma is the most common extracranial malignant solid tumor in children under 5 years, and it is characterized by wide clinical and biological heterogeneity. N-myc oncogene amplification is considered to be one of the most important prognostic factors used to evaluate survival in these patients. Objectives: The aim of our study was to determine amplification of the N-myc oncogene using real-time quantitative polymerase chain reaction (PCR) and to show the influence of N-myc amplified tumors on the overall survival rate. Patients and Methods: This study is an analytical historical cohort study of forty children with neuroblastoma admitted to the Shafa Hospital, Iran from 1999 to 2010. Paraffined blocks of tumoral tissue were analyzed for N-myc amplification by a PCR. The degree of N-myc amplification was derived from the ratio of the N-myc oncogene and the single copy reference gene, NAGK. In the statistical analysis, a Kaplan-Meier survival analysis was used. Results: We found a variable degree of N-myc amplification, from 3 to 2 200, in 32 of the 40 neuroblastomas (80%). NMYC amplification was seen more frequently in patients older than 2.5 years (71.9%), stage 4 (65.6%) and female (53.1%). Median survival time in the males was significantly longer than in the females (P = 0.03). The overall median survival for N-myc amplified tumor patients was 20 months, and 30 months for the non amplified tumors. Conclusions: The N-myc amplified tumors may increase the probability of more aggressive behavior and rapid tumor progression, especially in advanced stages of neuroblastoma. This study confirmed the importance of obtaining correct measurements of oncogene amplification in the early evaluation of neuroblastomas in order to target more aggressive therapies in patients with a higher risk of cancer progression

Association between splenectomy and pulmonary hypertension in patients with major beta- thalassemia

Background and purpose: Increased pressure in the pulmonary circulation is of the major factors causing cardiac disorders in patients with thalassemia. The aim of this study was to investigate the relationship between splenectomy and pulmonary arterial pressure in individuals with beta- thalassemia major. Materials and methods: A cross-sectional study was carried out in patients with beta-thalassemia attending Hajar Hospital Shahrekord, Iran, 2015. All patients underwent echocardiography and the hemoglobin levels, platelet count, ferritin, pressure, pulmonary arterial pressure, etc. were measured. Data analysis was done in Stata 13. Results: Among the variables measured, the average age, hemoglobin level, platelet count, nucleated RBC, lactate dehydrogenase, tricuspid regurgitation flow, pulmonary arterial pressure, right diameter, main pulmonary diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter were found to be higher in patients with splenectomy, compared to those of the patients without splenectomy (P> 0.05). Significant correlation was observed between platelets, NRBC and the time of splenectomy with pulmonary artery pressure (P 0.05). Conclusion: The results showed that splenectomy could increase the susceptibility to pulmonary artery pressure in patients with beta thalassemia major or lead to the progression of pulmonary hypertension in this disease

In vitro effect of iron chelators on the growth of Escherichia coli, Staphylococcus epidermidis, Staphylococcus aureus, Yersinia enterocolitica, and Pseudomonas aeruginosa Strains

Background and aims:Thalassemia patients are predisposed to septicemia due to iron overload. The iron chelators have a potential role in the treatment of septicemia. This study was conducted to investigate the in vitro effect of iron chelators, deferoxamine (DFO), deferiprone (DFP), and deferasirox (DFS) on the growth of effective bacteria (Staphylococcus aureus, Yersinia enterocolitica, and Pseudomonas aeruginosa) and their synergistic effect with each other and antibiotics. Materials and Methods: Five bacterial strains were incubated in the presence of seven chelators in Mueller Hinton agar and the number of colonies was recorded for each sample. Antibiotic discs were placed in the plates. Susceptibility to antibiotics was assessed by disc diffusion method (Kirby-Bauer test) and also the zone inhibition around the disc was measured in mm after incubating the relevant plate at 37°C for a day. Results: The growth of all the studied bacteria increased in the presence of iron and was inhibited in the presence of different chelators. Chelators and antibiotics had synergistic effects on growth inhibition of Escherichia coli, S. aureus, and P. aeruginosa in culture medium, while the growth inhibition of Y. enterocolitica was seen in the presence of deferiprone and deferasirox combination. Conclusion: Chelators in combination with antibiotics exert synergistic effects on growth inhibition of prevalent bacteria (except for Y. enterocolitica). Keywords: E. coli, S. epidermidis, S. aureus, Y. enterocolitica, P. aeruginosa, Iron chelator

Hepcidin and HFE Polymorphisms and Ferritin Level in β-Thalassemia Major

Background: Thalassemia patients need repeated transfusion that lead to increased blood ferritin level and iron overload in the heart and liver. Because the roles of hepcidin antimicrobial peptide (HAMP) and hemocromatosis protein (HFE) in iron metabolism have been confirmed, this study investigated the effects of these gene's polymorphisms on blood ferritin levels and iron overload in the heart and liver in patients with beta thalassemia major Materials and Methods: This cross-sectional study was conducted on 91 patients referring to the Hajar Hospital in Shahrekord, Iran in 2015. After the blood samples were collected, the ferritin levels were measured, DNA was extracted from the blood cells, and the types of polymorphisms were determined using PCR-RFLP. Data of MRI T2* in the heart and liver were drawn from the patients' medical files. Data analysis was conducted by t-test, chi-square test, Fisher's exact test, and Pearson correlation coefficient. Results: There was no significant correlation between blood ferritin level and c.-582 A>G polymorphisms of hepcidin gene (p=0.58), and H63D of HFE gene (p=0.818). In addition, there was no significant association between the polymorphisms and heart and liver MRI, but there was a significant association between blood ferritin level and qualitative heart and liver MRI (r=-0.34, p=0.035 and r=-0.001, p=0.609, respectively). Conclusion: In patients with β-thalassemia major, the presence of c.-582A>G HAMP and H63D HFE polymorphisms is not effective on blood ferritin level and iron overload in the heart and liver in the studied region. KEYWORDS: Ferritin; HFE* Iron overload; Hepcidin; Thalassemi

The Potential Association between the Risk of Post-Surgical Adhesion and the Activated Local Angiotensin II Type 1 Receptors: Need for Novel Treatment Strategies

Background: Post-surgical adhesion bands (PSABs) are a common complication after abdominal or pelvic surgeries for different reasons like cancer treatment. Despite improvements in surgical techniques and the administration of drugs or the use of physical barriers, there has only been limited improvement in the frequency of postoperative adhesions. Complications of PSAB are pain, infertility, intestinal obstruction, and increased mortality. The most important molecular mechanisms for the development of PSAB are inflammatory response, oxidative stress, and overexpression of pro-fibrotic molecules such as transforming growth factor beta. However, questions remain about the pathogenesis of this problem, for example, the causes for individual differences or why certain tissue sites are more prone to post-surgical adhesions. Summary: Addressing the pathological causes of PSAB, the potential role of local angiotensin II/angiotensin II type 1 receptors (AngII/AT1R), may help to prevent this problem. Key Message: The objective of this article was to explore the role of the AngII/AT1R axis potential to induce PSAB and the therapeutic potential of angiotensin receptor blockers in the prevention and treatment of PSAB

Comparison of Polyethylene Glycol Powder and Polyethylene Glycol 40% Syrup in Treatment of Chronic Idiopathic Constipation in Pediatrics

Introduction: Constipation is one of the most common gastrointestinal complaints in children that can lead to many complications. The aim of this study was to compare the efficacy of polyethylene glycol powder and polyethylene glycol 40% syrup to treat constipation. Materials and Methods: This study was a nonrandomized semi-experimental clinical trial. The current study was conducted on 80 patients with constipation, referring to Imam Ali (PBUH) Clinic, Shahrekord randomly assigned to two groups of 40 each. Subjects were children under 15 years old with functional constipation selected by simple sampling since 2015. Group 1 was treated with polyethylene glycol powder and Group 2 was treated with polyethylene glycol 40% syrup for two months. During the treatment, the patients were examined five times with 2-week intervals and their symptoms consisting of defecation frequency, stool consistency, painful defecation, bloody defecation, and stool incontinence were registered in a checklist. Data were analyzed using SPSS24. Results: The comparison of patients' total status before and after intervention shows that two groups were assessed in the weak level in the polyethylene glycol powder group 28(0.70%) cases and syrup group 36(0.90%), while after intervention, polyethylene glycol powder group was assessed in the high level 35(87.5%) cases and syrup group 37(92%) cases and most of patients after intervention promoted from weak and intermediate level before intervention to High level. Conclusion: The findings indicated similar efficacy and treatment response of the PEG powder and syrup. However, the PEG syrup can be used instead of its powder because of pleasant taste and ease of use. Keywords Author Keywords:Constipation; functional constipation; polyethylene glycol KeyWords Plus:CHILDHOOD CONSTIPATION; FUNCTIONAL CONSTIPATION; CHILDREN; DISORDERS; LAXATIVES; SPECTRU