This authoritative reference is the single most comprehensive resource on the biology and genetics of childhood cancer as well as its diagnosis, multimodal treatment, as well as long-term management of young patients with cancer. Also addressed are a broad array of topics on the supportive and psychosocial aspects of care of children and families. Covering virtually every aspect of the breadth and depth of childhood cancer, this 7th edition provides expert guidance on state-of-the-art, multidisciplinary care for children and families.

Principles and Practice of Pediatric Oncology

Objective Do-not-resuscitate (DNR) orders in Saudi Arabia were first regulated by a fatwa on a national level in 1988, one that excludes the patient and their families from decision making. Although the core of this policy is taken up by all hospitals in Saudi Arabia, there is no homogeneity in implementation. Here, we appraise what interns and residents know of these policies and their attitudes toward DNR. Methods Interns and residents in four major hospitals in Jeddah, King Abdulaziz University Hospital, National Guard Hospital, King Fahad General Hospital, and King Fahad Armed Forces Hospital, were given a questionnaire in English with four blocks of questions. Results A total of 140 questionnaires were included in our study. From these questionnaires, we conclude a lack of familiarity with DNR's policies and the fatwa and also a lack of understanding when it comes to treating DNR-labeled patients. The majority opinion was to include the patient in the decision-making process who is excluded according to the fatwa. Participants considered patients' dignity, religious concerns, and legal concerns to be important in considering resuscitation. Conclusion We conclude a need to emphasize the issue of DNR and treatment of DNR patients in medical ethics classes in Saudi Arabia and put more effort to enact national DNR laws that include the patient in the decision-making process.

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Perspectives of interns and residents toward do-not-resuscitate policies in Saudi Arabia.

This case series study was performed for all 83 children below 14 years old suffering from cancer during 2010-2013 who were registered in Ardabil pediatric cancer registry (APCR). The required data were collected by questionnaire and analyzed with SPSS.19 statistical methods software. Some 51 (61.4%) of cases were male. The mean age of patients was 5.8 years. Of the total, 60 (72.3%) of cases were from urban areas. Results showed that leukemia with 54.2%, CNS with 12% and neuroblastoma with 8.4% were the most prevalent childhood malignancies in Ardabil province. Based on the under 14 year old population estimated from Ardabil province, the cumulative incidence rate was 95.4 patients per one million. The incidence rate was relatively high so that childhood cancers should be considered as an important issue in health policy making in Ardabil province of Iran.

http://koreascience.or.kr:80/article/JAKO201528551642491.pdf

Epidemiology of Childhood Cancer in Northwest Iran.

Background Physicians are responsible for making decisions about the do not resuscitate (DNR) order of patients; however, most of them are faced with some uncertainty in decision making and ethical aspects. Moreover, there are differences on decision making related to the DNR order among physicians, which may be related to the different attitudes toward this issue. Considering the lack of information, this study was performed to investigate doctors' attitude about DNR order for patients in their final phases of life. Methods In a descriptive-analytical study, 152 physicians were enrolled as quota sampling subjects from educational hospitals affiliated to the Kermanshah University of Medical Sciences. The tool used was a researcher-developed questionnaire. Data were analyzed using SPSS 16 software by descriptive and inferential statistics. Results The mean of attitude toward DNR was 3.22, for which the univariate t-test showed a significant positive attitude toward DNR (P=0.002); the mean of attitude number toward DNR was higher in physicians with higher education level (P=0.002). But this difference was not found in terms of age group, sex, and experiences in participating in DNR decisions. Conclusion Due to the positive attitude of doctors toward DNR orders and lack of identified guidance, clear guidelines that comply with the Iranian Islamic culture are necessary to be established. Implementing this directive requires comprehensive training to various groups, including patients, doctors, nurses, administrators, and policy makers of the health system.

The Iranian physicians attitude toward the do not resuscitate order.

Background: Although childhood cancer is a rare disease, 100,000 children younger than 15 years of age die from cancer each year, the majority of them in developing countries. More data need to be gathered and published particularly in developing countries to better understand the scale of the problem. Aims: This study aimed to describe the patterns of childhood cancers in Saudi Arabia over a period of ten years (1999-2008). Materials and Methods: This descriptive retrospective study was based on secondary data from the Saudi Cancer Registry from 1999 to 2008. All Saudi cases (both genders), under the age of 15 years, who were diagnosed with cancer during the study period, were included in this study. Results: Childhood cancer in Saudi Arabia, in the period between 1999 and 2008, accounted for about 8% of total cancer cases. The most common encountered cancers were leukemia (34.1%), followed by lymphoma (15.2%), brain (12.4%), and kidney cancers (5.3%). The overall incidence of childhood cancers increased from 8.8 per 100,000 in 1999 to 9.8 per 100,000 in 2008. The incidence rates of cancers per 100,000 in the years 1999 and 2008 were generally higher among males, (9.4 and 11.5 in males vs. 8.3 and 8.1 in females). The highest incidence rate in the surveyed years was apparent in the birth to age 4 years group. Conclusions: Cancer is an important public health problem in Saudi Arabia and a major ascending contributor to mortality and morbidity in children. More studies are required to describe the patterns of childhood cancers and related risk factors in Saudi Arabia.

http://koreascience.or.kr:80/article/JAKO201507964683070.pdf

Patterns of childhood cancer incidence in Saudi Arabia (1999- 2008).

Background: Cancer in infants younger than one year of age represents a unique problem with distinct epidemiological, clinical and genetic characteristics compared with older age groups No report is yet available from Iran regarding epidemiological and survival rate of cancers diagnosed in this age group Materials and Methods: The population under study comprised of patients which were diagnosed and admitted to Ali-Asghar hospital between years 1996-2005 In total, 287 infants were included in the retrospective descriptive survey Patient files were evaluated for age of patient at the time of diagnosis, sex, geographical residence, consanguinity of parents, histological diagnosis, site of cancer involvement, type of therapy, date of last follow-up and cause of death (if applicable) Results: The average age at the time of diagnosis was 72 months old The most frequent malignancy was retinoblastoma (44%), followed by leukemia (19%) and neuroblastoma (10%), with five-year overall survival rates of 777%, 41% and 90%, respectively Parents of 40 infants (139%) had consanguinity relationships Conclusions: Although we cannot make any conclusions regarding the incidence of infant cancer subtypes based on this study, survival rates for major types were similar to the developed countries, which signifies strict adherence to standards of care in Ali-Asghar hospital, the main infant cancer care centre in Iran A Childhood Cancer Registry with high-resolution data collection and also advanced genetic testing is advocated for in-depth analysis of variation in incidence and survival

Epidemiologic survey of infantile cancer in Iran based on the data of the largest pediatric cancer referral center (Ali- Asghar Children Hospital), 1996-2005.

Objective: To study the attitudes of Iranian medical students towards the do-not-resuscitate (DNR) decision

Methods: In this cross-sectional study, 220 medical students (110 interns and 110 residents) of Tehran University of medical sciences were selected They asked to answer to the questionnaire which included two items: first item consisted of demographic questions (age, sex, and level of education); second item included questions about DNR Orders which derived from a previous study conducted by Hosaka et al

Results: A total of 185 questionnaires returned (Response rate (RR=84%)) Ninety five were residents and ninety were interns Seventy four percent of residents and 53% of interns felt that DNR order is sporadically necessary Near 30% of interns and 40% of residents had participated in DNRs in their study period and the most case was the patient with terminal cancer The most common person who decided DNR orders were physicians

Most participants believed that DNR cards are useful for establishing in clinical settings

Conclusion: As DNR is definitely a medical decision, it should be clearly discussed with patients and their families So, it should be provided in standard format in medical situations

Perspectives of Iranian medical students about do-not-resuscitate orders.

Thyroid hormones play an important role in regulating different metabolism functions and multiple organs' performance Changes in the thyroid hormone axis can lead to profound effects on the stability of vital organs and systems, especially the cardiovascular system Hypothyroidism is classified according to the clinical presentation as overt and subclinical There is some evidence supporting the benefits of thyroxine hormone replacement for subclinical hypothyroidism on cardiovascular mortality outcomes However, the clinical relevance of measuring and treating high thyroid-stimulating hormone (TSH) levels in newly diagnosed heart failure patients with preserved ejection fraction requires further study In this report, we review the current evidence regarding the prognostic significance of subclinical hypothyroidism in heart failure patients with preserved ejection fraction

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Subclinical Hypothyroidism and Its Association with Increased Cardiovascular Mortality

Melioidosis is a frequently fatal infection caused by the Gram-negative bacillus Burkholderia pseudomallei endemic to Southeast Asia and Northern Australia. It is a rare imported pathogen in the United States and is a potential bioterror agent. We report the case of an 82-year-old previously healthy man who presented with 2 weeks of fever and epigastric pain after he returned from the Philippines. A diagnosis of nondissecting mycotic aneurysm in the descending thoracic aorta was made with the help of CT angiogram and positive blood cultures. The patient completely recovered with a 6-month antibiotic therapy followed by surgical repair of the aneurysm. Given the slight increase in the number of melioidosis cases reported by CDC since 2008, melioidosis might be considered an emerging infectious disease in the United States. The purpose of this report is to raise awareness of the disease among clinicians as well as travelers.

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Burkholderia Aortic Aneurysm: A Case Report and Review of the Literature

Tumor-like formation of thrombus in the right atrial cavity is rare. It may be mistaken for a myxoma. The exact pathophysiology of an isolated thrombus in the heart is still unclear. Management to prevent complications such as pulmonary thromboembolism depends on the clinical judgment of a cardiologist. This report describes a 76-year-old woman with right atrial thrombus causing subsequent pulmonary thromboembolism in right lung. She initially presented to us with pulmonary embolism, and later, an incidental finding of a mass in her right atrium revealed an association of thrombus in heart with thrombus in lung. The challenging management was to resect this thrombus which was fixed to atrial septum, and a trial of anticoagulation did not resolve it. Exact management of such incidental findings in right heart cavities is not well established. Some cases may benefit from resection of such formed fixed thrombus.

https://journals.sagepub.com/doi/pdf/10.1177/1179547617698460

Roshanak Habibi

Papers

Epidemiologic survey of infantile cancer in Iran based on the data of the largest pediatric cancer referral center (Ali- Asghar Children Hospital), 1996-2005.

Perspectives of Iranian medical students about do-not-resuscitate orders.

Subclinical Hypothyroidism and Its Association with Increased Cardiovascular Mortality

Burkholderia Aortic Aneurysm: A Case Report and Review of the Literature

Clot in Lung, Clot in Heart: A Case Report of Tumor-Like Thrombus in Right Atrium.