Hematological Research Articles

Conversion of placental hemogenic endothelial cells to hematopoietic stem and progenitor cells

Hematopoietic stem and progenitor cells (HSPCs) are critical for the treatment of blood diseases in clinic. However, the limited source of HSPCs severely hinders their clinical application. In the embryo, hematopoietic stem cells (HSCs) arise from hemogenic endothelial (HE) cells lining the major arteries in vivo. In this work, by engineering vascular niche endothelial cells (VN-ECs), we generated functional HSPCs in vitro from ECs at various sites, including the aorta-gonad-mesonephros (AGM) region and the placenta. Firstly, we converted mouse embryonic HE cells from the AGM region (aHE) into induced HSPCs (iHSPCs), which have the abilities for multilineage differentiation and self-renewal. Mechanistically, we found that VN-ECs can promote the generation of iHSPCs via secretion of CX3CL1 and IL1A. Next, through VN-EC co-culture, we showed that placental HE (pHE) cells, a type of extra-embryonic HE cells, were successfully converted into iHSPCs (pHE-iHSPCs), which have multilineage differentiation capacity, but exhibit limited self-renewal ability. Furthermore, comparative transcriptome analysis of aHE-iHSPCs and pHE-iHSPCs showed that aHE-iHSPCs highly expressed HSC-specific and self-renewal-related genes. Moreover, experimental validation showed that retinoic acid (RA) treatment promoted the transformation of pHE cells into iHSPCs that have self-renewal ability. Collectively, our results suggested that pHE cells possess the potential to transform into self-renewing iHSPCs through RA treatment, which will facilitate the clinical application of placental endothelial cells in hematopoietic cell generation.

FL-W3S: Cross-domain federated learning for weakly supervised semantic segmentation of white blood cells.

Segmentation models for clinical data experience severe performance degradation when trained on a single client from one domain and distributed to other clients from different domain. Federated Learning (FL) provides a solution by enabling multi-party collaborative learning without compromising the confidentiality of clients' private data. In this paper, we propose a cross-domain FL method for Weakly Supervised Semantic Segmentation (FL-W3S) of white blood cells in microscopic images. We perform model training on multiple clients with different data distributions to obtain a global aggregated model using only image-level class labels for semantic segmentation of white blood cells. A multi-class token transformer model learns the relationship between patch tokens and class tokens during collaborative learning and generates class-specific localization maps for mask predictions. To rectify the localization maps, we use patch-level pairwise affinity obtained from patch-to-patch transformer attention. We evaluate performance of the proposed semantic segmentation method on two different datasets of white blood cells from different domains. Our experimental results show that for two datasets, there is 2.56% and 1.39% increase in performance of the proposed method over existing state-of-the-art methods. The combination of federated learning for collaborative model training while preserving data privacy, alongside white blood cell segmentation techniques for precise cell identification, enhances diagnostic accuracy and personalized treatment strategies in clinical applications, particularly in hematology and pathology. More specifically, it involves isolating white blood cell from blood smear for further analysis such as automated blood cell counting, morphological analysis, cell classification, disease diagnosis and monitoring.

Automatic Blood Disease Identification System Using Machine Learning Algorithms with Hemogram Reports

Objectives: The primary objective of this research is to create prediction models with machine learning algorithms that can detect blood illnesses in their early stages, including sickle cell disease, leukemia, anemia, and lymphoma. Methods: Reducing the amount of deaths linked to these illnesses and increasing the precision of disease detection. The study used machine learning algorithms: Decision Tree, Random Forest, and XGBoost classifier, and it used a dataset of complete blood count reports. Based on the characteristics of the total blood count, these algorithms were trained on the dataset to forecast the probability of blood diseases. Findings: According to the study, there is a better chance of a cure for blood problems since machine learning models can correctly detect them in their early stages. The findings imply that using predictive models can both lower the death rate and enhance the quality of life for those with these conditions. With a 99.10% accuracy rate, the Random Forest method outperforms other algorithms like Decision Tree, and XGBoost. Novelty: This research is unique because it uses a dataset of complete blood count reports results to use machine learning algorithms for blood condition prediction. Healthcare systems may detect blood problems early on and enhance patient outcomes by using classifier algorithms such as Decision Tree, Random Forest, and XGBoost. This opens up new avenues for illness identification. Keywords: Machine Learning, Decision Tree, Random Forest, XGBoost, Blood Diseases

P0635 Degree of interest in using a cognitive-behavioral therapy application for fatigue management and related factors among outpatients with inflammatory bowel disease

Abstract Background Fatigue is a common symptom in patients with inflammatory bowel disease (IBD) and is associated with a diminished quality of life. Previous research has demonstrated the effectiveness of fatigue management programmes that use cognitive behavioural therapy (CBT) or other psychotherapies. CBT is often face-to-face and individually time consuming, and there are personnel challenges in its implementation in real-world clinical settings. This study aimed to understand the needs of Japanese patients with IBD regarding fatigue management and explore the characteristics of those willing to use CBT applications (apps). Methods This study involved secondary analysis of data from 488 patients treated at a specialised IBD clinic in Japan. Patient characteristics, such as sex, age, disease duration, interest in CBT programmes, and interest in CBT apps for fatigue management (each assessed on a 7-point ordinal scale from 0 for not interested to 6 for very interested), and the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F) scale score were included in the survey. Data on blood parameters and disease activity, as determined by Crohn’s activity index and the partial Mayo score, were obtained from medical records. Results Among the participants, 85% were in clinical remission, 58% had Crohn’s disease (CD), and 66% were male. Forty-five percent of the patients were affected by moderate or high levels of fatigue (FACIT-F score > 40). The mean score for interest in the CBT programme was 3.3 ± 1.9, with 69% expressing moderate or greater interest (scores ≥ 3). Interest in the CBT app averaged 2.5 ± 1.9, with 50% expressing a moderate level of interested or higher. Interest in the CBT programme was significantly higher among females and those with greater levels of fatigue (lower FACIT-F scores) or lower levels of emotional well-being. Significant factors associated with higher interest in the CBT app included female sex and greater levels of fatigue. Conclusion Interest in CBT for fatigue management among patients with IBD was moderate, with higher levels of interest observed in patients experiencing greater levels of fatigue, particularly among females. CBT apps offer a promising alternative for addressing fatigue, potentially enhancing accessibility and convenience in clinical settings. Future strategies incorporating CBT apps may help meet the needs of those with limited access to in-person therapies.

"Update on pediatric primary liver tumors".

Liver masses are common in children, however primary malignant neoplasms are rare, representing only 1% of all pediatric cancers. Hepatocellular neoplasms are the most common primary liver malignancies and hepatoblastoma (HB) is the most frequently diagnosed. The incidence of HB, which is increasing, is approximately of 2 cases per million in the United States, followed by hepatocellular carcinoma (HCC). Pediatric primary liver tumors of mesenchymal origin are less common, except for benign vascular tumors (hemangiomas). Malignant mesenchymal neoplasms represent approximately 10-15% of all, the most common being embryonal sarcoma and malignant rhabdoid tumor. Malignant vascular tumors are rare, but epithelioid hemangioendothelioma (EHE) and angiosarcoma can be seen in children. The development and adoption of consensus diagnostic, therapeutic and risk-stratifying approaches for pediatric patients with malignant liver tumors has been historically challenged by their rarity and by their diverse clinical and histological appearance. On-going collaborative efforts of international consortia including the Children's Oncology Group (COG) in North America, the German Society of Paediatric Oncology and Haematology (GPOH), the Societe Internationale d' Oncologie Pediatrique Liver Tumor Study Group (SIOPEL) in Europe and the Japanese Liver Tumor group (JPLT), have made significant contributions to understanding the clinical and histopathological features, as well as the underlying biology of pediatric liver tumors, in particular HB. A new classification of pediatric liver tumors drafted at the international consensus meeting held in Los Angeles, has been incorporated in the recent WHO classification and is currently used by the PHITT (Paediatric Hepatic Malignancy International Tumour Trial) and other therapeutic protocols.This manuscript provides an overview of salient diagnostic features and updates in classification and molecular characterization for the most common pediatric primary liver neoplasms. It also includes a brief overview of other less common but relevant tumors, which should be considered in the differential diagnosis.

Serum Lactic Acid: A Predictor of Septic Shock in Childhood Cancers with Febrile Neutropenia in a Tertiary Care Hospital in Bangladesh

Background: Febrile neutropenia (FN) is a common and life-threatening complication in children undergoing treatment for cancer, often leading to septic shock. Early identification of septic shock is critical. Serum lactic acid levels have emerged as a potential biomarker for predicting septic shock. This study aimed to determine the implications of serum lactic acid levels as a predictor of septic shock in childhood cancer patients with febrile neutropenia. Methods: This cross-sectional study was from June 2023 to July 2024. One hundred pediatric oncology patients with neutropenia who were admitted to the Department of Pediatric Hematology and Oncology at Bangabandhu Sheikh Mujib Medical University (BSMMU) were enrolled in the study. Clinical examinations and laboratory investigations were conducted for all participants, and the relevant information was recorded. Data were analyzed using SPSS 24.0. Results: Shock patients exhibited significantly higher initial serum lactic acid levels (3.52±0.81 mg/dl) compared to non-shock patients (1.93±0.75 mg/dl). The ROC curve analysis yielded an AUC of 0.934, with a sensitivity of 100.00%, specificity of 81.6%, and a cut-off value of 2.50 mg/dl. The diagnostic performance test demonstrated a PPV of 63.16%, NPV of 100.00%, and overall accuracy of 86.00%. Conclusion: This study demonstrates the potential utility of serum lactic acid levels as a predictive biomarker for identifying febrile neutropenic patients at risk of developing septic shock within 48 hours. Serum lactic acid level >2.5 mmol/L could be considered as a threshold for early risk stratification.

Surviving prematurity: retrospective longitudinal study of multisystem consequences in preterm-born individuals from infancy to adolescence

BackgroundPrematurity is linked to diverse and significant health outcomes, but a comprehensive understanding of its long-term multisystem impacts remains limited.MethodsRetrospective longitudinal cohort study on 417 preterm children born between 2000 and 2015 explores the incidence, dynamics, and interrelationships of health conditions from infancy to adolescence. Data on 1818 diagnoses, categorised by birth weight (BW) and gestational age (GA) and documented according to ICD-10, were analysed using non-parametric tests and negative binomial regression models.ResultsMost diagnoses occurred by age 7, with eye diseases, congenital malformations, and infections most prevalent, but the greatest disparities with the general population were in blood, nervous system, mental, and neoplastic diseases. Lower BW significantly correlated with higher mean disease counts and greater diversity of health conditions across various ICD-10 chapters, while GA showed less pronounced associations. Children in "Extremely and very low," "Low," and "Sub-optimal" BW categories exhibited 1.77, 1.50, and 1.34 times more diseases, respectively, than those in the "Normal" BW category. Unique and highly individual patterns of disease co-occurrence were observed, increasing in complexity as BW decreased.ConclusionsThe highest disease burden for preterm-born individuals occurred by age 7, with lower BW linked to greater health complexity and unique comorbidities.

Impacts of Ethical Dilemmas and Moral Distress in Pediatric Hematology Oncology Nurses.

To assess the level of moral distress (MD) and perceptions of ethical climate among pediatric hematology/oncology (PHO) nurses and to identify bioethics topics where increased education was desired. In this cross-sectional study, we administered the 26-item Swedish Moral Distress Scale-Revised (sMDS-R), specifically revised and validated for pediatric oncology, in conjunction with the Clinical Ethics Needs Assessment Survey (CENAS). Electronic surveys were sent to inpatient and outpatient PHO nurses. Analysis included descriptive statistics, Spearman correlation, and the Mann-Whitney U test. Of 123 nurse respondents, the overall mean MDS-R score was 2.75 (range: 0-16). Distressing encounters occurred infrequently (frequency mean 0.96, range: 0-4), resulting in relatively low distress (mean 2.24, range: 0-4). The scenarios resulting in the highest overall MD included performing painful procedures on children (2.46), lack of meaningful conversations due to time constraints (2.41), and poor team communication (2.68). Inpatient nurses reported higher levels of MD compared to outpatient nurses (p = 0.0002). The overall CENAS score was greater than 3 (range: 1-4), suggesting a positive ethical climate. There was a moderate negative relationship between sMDS-R combined scores and CENAS scores (p<0.0001). Inpatient nurses reported a less positive ethical climate compared to outpatient nurses (p = 0.01). Nurses expressed a need for additional ethics education around withholding/withdrawing of life-sustaining treatments, providing end-of-life care, and working with challenging patients/families. Although the ethical climate was overall positive, several clinical situations appear to result in higher moral distress despite their infrequency, especially on inpatient units. Additional resources and education in navigating ethical dilemmas were requested by the nurses.

Autologous haematopoietic stem cell transplantation for treatment of multiple sclerosis and neuromyelitis optica spectrum disorder - recommendations from ECTRIMS and the EBMT.

Autologous haematopoietic stem cell transplantation (AHSCT) is a treatment option for relapsing forms of multiple sclerosis (MS) that are refractory to disease-modifying therapy (DMT). AHSCT after failure of high-efficacy DMT in aggressive forms of relapsing-remitting MS is a generally accepted indication, yet the optimal placement of this approach in the treatment sequence is not universally agreed upon. Uncertainties also remain with respect to other indications, such as in rapidly evolving, severe, treatment-naive MS, progressive MS, and neuromyelitis optica spectrum disorder (NMOSD). Furthermore, treatment and monitoring protocols, rehabilitation and other supportive care before and after AHSCT need to be optimized. To address these issues, we convened a European Committee for Treatment and Research in Multiple Sclerosis Focused Workshop in partnership with the European Society for Blood and Marrow Transplantation Autoimmune Diseases Working Party, in which evidence and key questions were presented and discussed by experts in these diseases and in AHSCT. Based on the workshop output and subsequent written interactions, this Consensus Statement provides practical guidance and recommendations on the use of AHSCT in MS and NMOSD. Recommendations are based on the available evidence, or on consensus when evidence was insufficient. We summarize the key evidence, report the final recommendations, and identify areas for further research.

Pediatric Hematology-Oncology or Pediatric Hematology and Pediatric Oncology: A Need for Further Discussion.

Pediatric Hematology-Oncology or Pediatric Hematology and Pediatric Oncology: A Need for Further Discussion.

The correlation between heavy metal ions in blood and metabolic dysfunction-associated steatotic liver disease from 1999 to 2018 based on NHANES data.

Metabolic-associated steatohepatitis and liver fibrosis (MASLD) is a growing public health concern, with environmental factors potentially playing a role in its development. This study aimed to investigate the associations between serum cadmium and mercury levels and the risk of MASLD in a nationally representative sample from the United States. Data from the National Health and Nutrition Examination Survey from 1999 to 2018 were analyzed. Serum cadmium and mercury concentrations were measured, and MASLD was defined based on established criteria. Logistic regression models were used to assess the associations between serum metal levels and MASLD, with adjustments for potential confounders. Stratified analyses and restricted cubic spline curves were employed to examine subgroup differences and nonlinear relationships. The study revealed significant inverse associations between serum cadmium and mercury levels and the likelihood of MASLD. Individuals in the highest quartiles of cadmium and mercury had lower odds of MASLD compared to those in the lowest quartiles (Model 3: Cadmium Q4 vs. Q1, Mercury Q4 vs. Q1). Stratified analyses showed stronger inverse associations in older adults, males, and never smokers for cadmium, and in females and individuals without diabetes for mercury. Nonlinear dose-response curves indicated critical thresholds beyond which the risk dynamics changed. Higher serum levels of cadmium and mercury were associated with a lower risk of MASLD, with notable variations across subgroups. These findings challenge the conventional understanding of these heavy metals as universally harmful and highlight the need for further research to unravel the complex interplay between environmental exposures and MASLD pathophysiology.

Delays in Blood Work and Disease Burden: A Cross-Sectional Analysis of Unmet Blood Work Need and Seven Key Health Conditions Across 21 Countries.

This study analyzes survey data across 21 countries to explore correlations between delays in blood testing and the prevalence of seven health conditions: thalassaemias, sickle cell disorders, malaria, HIV, high fasting plasma glucose, impaired kidney function, and high LDL cholesterol. We analyzed Pandemic Recovery Survey data via multivariable logistic regression to compare blood test delays between individuals with and without medical conditions, while adjusting for sociodemographic factors. We also examined the disease burden using disability-adjusted life years (DALYs) and summary exposure values (SEV) rates. Our findings indicate profound disparities, with over 60% of respondents in Egypt, Nigeria, and India reporting they have never undergone blood tests. Individuals with existing medical conditions are significantly more likely to experience delays in blood work. There is a pronounced gap in blood work accessibility, particularly in countries with high disease burdens. Findings suggest an urgent need for interventions to improve routine blood test access for high-risk populations to reduce the underdiagnosis of significant medical conditions. Prioritizing timely and accessible blood testing can serve as a step towards mitigating healthcare disparities.

Development of Proton Density Fat Fraction Micro-MRI for Non-Invasive Quantitative Assessment of Bone Marrow Changes with Age and Radiation in Mouse Models.

Bone marrow (BM) adipocytes are critical in progressing solid tumor metastases and hematological malignancies across pediatric to aging populations. Single-point biopsies remain the gold standard for monitoring BM diseases, including hematologic malignancies, but are limited in capturing the full complexity of loco-regional and global BM microenvironments. Non-invasive imaging techniques like Magnetic Resonance Imaging (MRI), could offer valuable alternatives for real-time evaluation of BM diseases in both preclinical translational and clinical studies. We developed a preclinical proton density fat fraction (PDFF) MRI technique for quantitative BM composition assessment, focusing on fat fraction (FF) within mouse femurs. We validated this method using aging mice and young mice subjected to 10 Gy X-ray irradiation, compared with young unirradiated mice as controls. Water-fat phantoms (0% to 100% fat content) were used to optimize the imaging sequence, and immunohistochemical (IHC) staining with H&E validates equivalent adipose content in the femur BM regions. Significant differences in FF were observed across age groups (p = 0.001 for histology and p = 0.0002 for PDFF) and between irradiated and control mice (p = 0.005 for histology and p = 0.002 for PDFF). A strong correlation (R 2 ∼ 0.84) between FF values from PDFF and histology validates the accuracy of the technique. These findings demonstrate the potential of PDFF MRI as a non-invasive real-time imaging biomarker for quantifying BM fat fraction in preclinical mice model studies, particularly in evaluating the effects of aging, disease progression, and irradiation therapy in pediatric and translational oncology research.

Developing A Hybrid Machine Learning Algorithm for Anemia Diagnosis

The utilization of artificial intelligence (AI) algorithms has significantly transformed the field of blood disease diagnosis, enabling enhanced capabilities in prediction, categorization, and optimization. However, there is still a lack of research exploring the advancement of hybrid machine learning models that combine qualitative and quantitative datasets to address issues associated with blood diseases. To tackle this gap, we evaluate algorithmic combinations using datasets that include key characteristics from complete blood count (CBC) examinations. This manuscript presents an evaluation of prominent deep learning models, such as CNN, RNN, and RCNN, as part of our methodology. The assessment identified XGBoost as the optimal machine learning algorithm, and RCNN as the best deep learning model. Consequently, we propose a hybrid model named ‘RCNNX,’ which integrates Robust Scaler, SelectKBest feature selection, RCNN, and the XGBoost algorithm. The hybrid model, ‘RCNNX,’ achieves exceptional testing accuracy levels of 100% and 95.12% on the Anemia Diagnosis Dataset and a second dataset, respectively. Additionally, it demonstrates recall rates of 100% and 94.64% for the same datasets. These findings highlight the superiority of the proposed model, as it effectively utilizes feature selection to reduce the number of input variables, minimizing the risk of overfitting. Moreover, XGBoost enhances the predictive accuracy of RCNN.

Diagnostic accuracy and safety of ultrasound-guided percutaneous core needle biopsy among children with extra cranial solid masses at a tertiary care hospital in Karachi, Pakistan.

To determine the diagnostic accuracy and procedure safety of ultrasound-guided core needle biopsy of extra cranial solid masses in the pediatric population. A cross-sectional survey was conducted by the Department of Pediatric Hematology /Oncology and Radiology at Indus Hospital and Health Network Karachi from August 2022 to April 2023. A total of 118 pediatric patients, from age one month to 18 years, with extra cranial solid masses were studied. Data was analyzed using SPSS version 24. The median age of study participants was six years with IQR = 7.2 years. Among all study participants 62.7% (n=74) were male while 37.3% (44) were female. Out of all biopsies 94.07% (n=111) were conclusive and provided an accurate diagnosis of the tumor while only 5.63% (n=07) biopsies remained inconclusive. No serious post-procedure complication was reported. Pain on the site of biopsy was the most post-procedure complain reported by 34.7% (n=41) of all the study participants. Forty-two percent of the study participants never reported any post-procedure complaints after ultrasound-guided biopsy. The diagnostic accuracy was significantly higher for malignant lesions as compared to non-malignant lesions. Ultrasound-guided percutaneous core needle biopsy had high diagnostic accuracy and a good safety profile among children with extra cranial solid masses in private tertiary care hospital in Karachi Pakistan.

Therapeutic drug monitoring of posaconazole oral suspension in paediatric hematology patients under 13 years of age

Therapeutic drug monitoring of posaconazole oral suspension in paediatric hematology patients under 13 years of age

Investigating the Multidomain Impact of Palliative Care on End-of-Life Patients: A Comprehensive Evaluation.

Background: Palliative care is recognized for its holistic approach in improving the quality of life for patients and their families, focusing on pain relief, symptom management, and addressing emotional, social, and spiritual needs. However, the field is evolving due to increasing demand for these specialized services, emphasizing the need for the ongoing research into palliative care practices. Research Purpose: Is to investigate the multidomain impact of palliative care on end-of-life patients and evaluate their effectiveness on these domains. Method: A quantitative descriptive design was adopted for conducting the current study. Approval obtained from a designated hospital in Amman, Jordan, and official permission to carry out the study. The study's participants consisted primarily of physicians and nurses who were involved in providing care to terminally ill patients. The research tool employed in this study is a standardized palliative care assessment that was used in Australia, with modifications based on the literature review. The validity and reliability of the adapted tool have been ensured through rigorous testing procedures. Results: Findings indicated that the implementation of standardized practical palliative care exhibited an average level across all domains, specifically, the spiritual domain received the highest mean score (1.80), while the structural domain had the lowest (1.69). There were significant differences in palliative care provision across specialized work sites, with radiotherapy and blood disease sites scoring higher (M = 2.04 and M = 1.87, respectively). Educational levels significantly influenced care perceptions, favoring BSc holders. Age did not significantly affect palliative care provision, probably because of standardized care protocols and sample size. In addition, nurses rated palliative care higher than physicians, likely due to their more direct patient involvement. Conclusion: In light of the results, it is evident that there is a pressing need to consistently evaluate the healthcare services offered to meet the needs of the increasing population of terminally ill patients.

Tissue sodium in patients with rheumatoid arthritis: a novel potential driver of hypertension in autoimmunity

Patients with rheumatoid arthritis (RA) have increased hypertension. Tissue sodium may contribute to development and progression of hypertension through immune cell activation. This study aimed to determine if skin sodium content is: 1) higher in RA versus control participants, and 2) associated with blood pressure and disease activity. This cross-sectional study included 32 patients with RA and 33 control participants. Lower leg skin sodium content was measured using magnetic resonance imaging. Ambulatory 24-h blood pressure measurements were obtained, and disease activity was assessed by Disease Activity Score-28 for RA with CRP (DAS28-CRP). Skin sodium content was higher in RA versus control participants (14.22 [12.82, 18.04] vs 12.41 [10.67, 14.55] mmol/L), p = 0.005. Every 1 mmol/l increase in skin sodium was associated with a 1.05 mmHg (95% CI 0.29, 1.82 mmHg, p = 0.009) increase in average 24-h systolic blood pressure in patients with RA, but this relationship was not present in control participants. Skin sodium was not associated with DAS28-CRP or its components. Skin sodium is increased in RA versus control participants and is correlated with 24-h and diurnal systolic blood pressure in patients with RA but not in control participants. Skin sodium content may help explain increased hypertension in patients with RA.

Endocrine impact of transfusion therapy: parathyroid status in pediatric thalassemia major

Background: Thalassemia major, a severe form of inherited anemia, requires lifelong blood transfusions to manage the condition and sustain hemoglobin levels. However, these repeated transfusions often lead to iron overload, which can deposit in various organs, including endocrine glands and disrupt normal hormone production. One such affected gland is the parathyroid, responsible for regulating calcium and phosphate balance through parathyroid hormone (PTH) secretion. This study aimed to assess the parathyroid status in children with thalassemia major. Methods: This case-control analytical study design was considered to assess the parathyroid status in children with thalassemia major. The study was carried out at the Department of Pediatric Hematology and Oncology, Dhaka Medical College Hospital, Dhaka, from July 2012 to June 2013. A total of 40 children with thalassemia major (termed as case) and another 32 normal children (termed as control) were included in the study. Data were analyzed using SPSS (Statistical Package for Social Sciences) version 16. Results: The study found that children with thalassemia major had significantly lower parathyroid hormone (PTH) levels and higher phosphate levels compared to healthy controls, though calcium levels were similar between groups. Thalassemia patients, primarily receiving blood from professional donors, underwent transfusions for an average of six years, with limited use of chelation therapy (15%). Hypoparathyroidism was significantly more common in thalassemia patients (10%) compared to controls, with 25% also showing hyperphosphatemia. No significant differences were observed in age or sex distribution between the groups. Conclusions: It can be concluded children with thalassemia possess significantly low serum PTH and high phosphate levels. The serum calcium level does not alter significantly compared to healthy children of similar age and sex. The findings call attention to the critical need for early intervention, regular endocrine screening and diligent chelation therapy in managing thalassemia major.

Cancer Stage Geospatial Analysis to Optimize Educational Activities in Pediatric Oncology and Hematology: A Retrospective Cohort Study.

Enhancing therapy outcomes in pediatric oncology and hematology relies on robust epidemiological surveillance. This study aimed to estimate cancer stage-related survival in pediatric patients with lymphoma and solid tumors by assessing changes over time and identifying spatial clustering of patients diagnosed at advanced stages. This retrospective observational cohort study included pediatric cancer patients treated in a single Greater Poland center, constituting 9% of Polish children from 2004 to 2017. The incidence, cancer stage, and patient coordinates were analyzed. The follow-up period ranged from 5 to 18years. Survival differences across tumor stages were evaluated using Kaplan‒Meier curves, log-rank tests, and trend analysis. Geographical analysis was performed with Kulldorff's scan statistics and the Bernoulli model. Among 1094 diagnosed patients, 511 with lymphoma and solid tumors were eligible. There was a decreasing trend in advanced-stage diagnoses (p = 0.0001), with a nearly twofold increase in low-stage diagnoses (OR = 1.98 [1.22; 3.24], p = 0.0061) from 2009-2011 to 2015-2017. Hazard ratios for neuroblastoma and sarcoma patients were more than fourfold greater, while survival differences were not significant for patients with nephroblastoma, germ cell tumors, or lymphoma. This study shows cancer stage-related survival dynamics. A substantial decrease in advanced-stage diagnoses over time emphasizes improved early detection. Geographical analysis pinpointed clusters with prevalent late-stage diagnoses, offering a practical tool for targeted educational interventions. The study underscores the pivotal impact of cancer stage on survival outcomes, emphasizing the need for ongoing surveillance and tailored interventions to further optimize pediatric oncology and hematology care.