Side Effects In Children Research Articles

A Double Blind Randomised Clinical Trial to Prevent Serious Side Effects of Dexamethasone during Pediatric Acute Lymphoblastic Leukemia Treatment

Background/Objectives: Dexamethasone is highly effective in the treatment of pediatric acute lymphoblastic leukemia (ALL), but can induce serious metabolic and neuropsychological side effects. Recent studies have led to the hypothesis that neuropsychological side effects could be due to cortisol depletion of the cerebral mineralocorticoid receptor. We therefore studied whether adding a physiological dose of hydrocortisone to dexamethasone treatment reduces neuropsychological and metabolic side effects in children with ALL.Design/Methods: We performed a multicentre double-blind, randomised controlled trial with a crossover design. Patients (3-16 years) treated with dexamethasone pulses according to the DCOG ALL protocols were included. Patients received hydrocortisone 10 mg/m2/day in a circadian rhythm during one dexamethasone course and placebo during another dexamethasone course in a randomised order. The primary outcome measures were mood and behavior (parent-reported Strenght and Difficulties Questionnaire- Dut (SDQ)). Secondary outcome measures included sleep (Sleep Disturbance Scale for Children (SDSC)), neurocognitive function, and metabolic parameters.Results: 50 subjects were enrolled, of which 48 patients completed both courses. For the total group no significant effects were found. However, in the subgroup of children with clinically significant behavioral side effects, adding hydrocortisone resulted in a significant reduction of side effects on overall stress (-4.9 (=0.9 SD), P =0.00), mood (-1.8 (=0.9 SD), P =0.03), behavior (-1.0 (=0.7 SD), P =0.01), and impact (P <0.05). The subgroup with dexamethasone-related sleeping problems did benefit on total sleeping problems (-4.3, P< 0.05). In contrast, hydrocortisone addition did not affect metabolic parameters.Conclusion: This randomised controlled trial provides evidence that addition of a physiological dose of hydrocortisone in circadian rhythm during dexamethasone treatment in pediatric ALL patients reduces side effects on behavior, mood and sleep. This novel and simple intervention may be valuable for all patients on high-dose dexamethasone treatment. DisclosuresNo relevant conflicts of interest to declare.

Meta-Analysis: Reduced Risk of Anxiety with Psychostimulant Treatment in Children with Attention-Deficit/Hyperactivity Disorder.

Anxiety is a commonly reported side-effect of psychostimulant treatment. Our goal was to quantify the risk of anxiety as a side effect of psychostimulant treatment for attention-deficit/hyperactivity disorder (ADHD). We conducted a PubMed search to identify all double-blind, randomized, placebo-controlled trials examining the efficacy of psychostimulant medications in the treatment of children with ADHD. We used a fixed-effects meta-analysis to examine the risk ratio of anxiety reported as a side effect in children treated with psychostimulants compared with those treated with placebo. We used stratified subgroup analysis and meta-regression to examine the effects of stimulant type, dosage, duration of use, and trial design on the measured risk of anxiety. We identified 23 studies involving 2959 children with ADHD for inclusion in our meta-analysis. The risk of anxiety associated with psychostimulant treatment was significantly lower than that experienced with placebo (relative risk [RR] = 0.86 [95% CI: 0.77, 0.95], z = -2.90, p < 0.05). Higher doses of psychostimulants were associated with a reduced measured risk of anxiety of psychostimulants when compared with placebo (β = -0.0039 [95% CI: -0.00718, -0.00064], z = -2.34, p = 0.019). Meta-analysis suggests that treatment with psychostimulants significantly reduced the risk of anxiety when compared with placebo. This finding does not rule out the possibility that some children experience increased anxiety when treated with psychostimulants, but suggests that those risks are outweighed by the number of children who experience improvement in anxiety symptoms (possibly as a secondary effect of improved control of ADHD symptoms). Clinicians should consider rechallenging children with ADHD who report new-onset or worsening anxiety with psychostimulants, as these symptoms are much more likely to be coincidental rather than caused by psychostimulants.

Music therapy for the reduction of chemotherapy-induced side effects in children with cancer: Two randomized controlled studies

Music therapy for the reduction of chemotherapy-induced side effects in children with cancer: Two randomized controlled studies

CD19-Targeted Nanodelivery of Doxorubicin Enhances Therapeutic Efficacy in B-Cell Acute Lymphoblastic Leukemia.

Nanomedicine has advanced to clinical trials for adult cancer therapy. However, the field is still in its infancy for treatment of childhood malignancies such as acute lymphoblastic leukemia (ALL). Nanotherapy offers multiple advantages over conventional therapy. It facilitates targeted delivery and enables controlled release of drugs to reduce treatment-related side effects. Here, we demonstrate that doxorubicin (DOX) encapsulated in polymeric nanoparticles (NPs) modified with targeting ligands against CD19 (CD19-DOX-NPs) can be delivered in a CD19-specific manner to leukemic cells. The CD19-DOX-NPs were internalized via receptor-mediated endocytosis and imparted cytotoxicity in a CD19-dependent manner in CD19-positive ALL cells. Leukemic mice treated with CD19-DOX-NPs survived significantly longer and manifested a higher degree of agility, indicating reduced apparent systemic toxicity during treatment compared to mice treated with free DOX. We suggest that targeted delivery of drugs used in childhood cancer treatment should improve therapeutic efficacy and reduce treatment-related side effects in children.

PP07.6 – 2810: A rare cause of status epilepticus in infant; Alpha lipoic acid intoxication

Objective Alpha lipoic acid (ALA), also known as thiotic acid, is a cofactor found in a number of multienzyme complexes. Lipoic acid is a powerful antioxidant and is widely used as supplementary treatment of diabetic neuropathy. There is no reported dose of safety in children. Methods A 14-month-old previously healthy girl was referred to our hospital with the diagnosis of drug intoxication. She was admitted to the emergency department with lethargy and involuntary movements for several hours after ingesting unknown number of pills of 600 mg ALA belonging to a diabetic parent at home. On admission she was lethargic, bilateral extensor toe sign, and having myoclonic seizures involving all extremities. She had no fever and laboratory examinations were normal except mild methabolic ascidosis (pH: 7.24). The seizures were unresponsive to bolus midazolam injection, fenitoin infusion at 20 mg/kg dose and levetiracetam infusion at 20 mg/kg dose. She was taken to the pediatric intensive care unit with the diagnosis of status epilepticus. Results After failure of the treatment with midazolam infusion (up to 1 mg/kg/hour) she was intubated and thiopental sodium infusion was started. Her myoclonic seizures was controlled with the thiopental sodium infusion (3 mg/kg/hour). After 48 hour intubation and mechanical ventilation the thiopental sodium infusion was gradually reduced and stopped. After withdrawing the thiopental sodium infusion she was seizure free, levetiracetam continued as anticonvulsant drug and she was discharged at the 8. day. Conclusion Alpha lipoic acid and derivatives cause side effects in children like refractory convulsions. As diabetes and the frequency of diabetic neuropathy increase, possibility of ALA usage and intoxication in children living in the same house also rises. When faced with refractory convulsions in children who have had no disease before, intoxication by medicaments with ALA should be taken into consideration.

MMR and DTP vaccination side effects in children under 18 months in Bojnurd

MMR and DTP vaccination side effects in children under 18 months in Bojnurd

Salbutamol and around

Short-acting beta agonists (SABAs) such as salbutamol are well known as the first-line therapy for the treatment of acute exacerbations, exercise-induced asthma and childhood intermittent asthma. As needed, SABAs with no controller should be considered only if symptoms are rare and there is no awakening due to asthma. Salbutamol, through its effects of relaxing airway smooth muscle and increasing airflow, provides rapid relief of acute asthma symptoms. Treatment's effects begin in about 10-15 minutes and peak effect is usually within 30 minutes. Patient experience prompt benefit with reduction in coughing, wheezing, chest tightness and shortness of breath. The treatment dose includes 4-10 puffs by pMDI+spacer every 20 minutes for 1 hour [1]. The rapid relief provided by salbutamol may invite misuse and overuse, particularly in adolescents. SABAs should not be prescribed on a regular schedule as it may lead to a beta receptor downregulation. Moreover, frequent use of salbutamol is an indication of poor asthma control and an increased use of controller therapy should be considered. An heterogenous response to beta agonist therapy has been described and individual response is related to many factors, including: the relative contribution of bronchoconstriction versus airway inflammation and edema in producing the airway obstruction, different triggering mechanisms, the duration of symptoms, the patient's age and the route of medication delivery. Salbutamol is normally delivered through the inhaled route while intravenous salbutamol is used when children are unresponsive to inhaled treatment [A]. Less common are the oral and subcutaneous routes. Inhaled SABAs, administered through a MDI with attached spacer device along with infant- or child-sized mask or by nebulization, have the advantages of smaller doses and fewer side effects [3]. Inhaled SABAs allow selectivity for beta-2 receptors on bronchial smooth muscle to achieve bronchodilation without significant tachycardia associated with activation of beta-1 receptors on cardiac muscle. The incidence of adverse effects is dependent upon age of patient, dose, and route of administration. Examples of possible mild or moderate side effects in children and adolescents, not very common at recommended doses, include: palpitations, tachycardia, excitement, hyperactivity, insomnia, nervousness, shakiness and unpleasant taste (inhalation site) [4].

H1R Antagonists for Brain Inflammation and Anxiety: Targeted Treatment for Autism Spectrum Disorders

H1R Antagonists for Brain Inflammation and Anxiety: Targeted Treatment for Autism Spectrum Disorders Autism Spectrum Disorders, which covers Autism, Asperger’s, and Disintegrative and Pervasive Developmental disorders, have risen in the awareness of researchers due to the dramatic increase in diagnosed cases over the last decade. Currently, one child in eighty is diagnosed while Autism Spectrum Disorder with the absolute cause remaining unknown. Since the number of cases of ASD is increasing, many physicians and clinicians are looking for a solution for some of the symptoms. For many patients that are diagnosed with ASD, exhibit symptoms include behavioral disabilities, insomnia, locomotor activity disability, anxiety, and communication issues. However, the current standard of care has been aimed at behavioral and medical treatments for these symptoms. Treatments can include medications ranging from antidepressants and serotoninreuptake inhibitors to antipsychotics. However, many of these treatments can incite various side effects in children and adolescents. We show that current research correlates brain inflammation with many of these symptoms. Therefore, we present a theory that indicates that a patient may lessen or eliminate a variety of the aforementioned symptoms by directly reducing neuroinflammation through the use of the well-known antihistamine hydroxyzine. Furthermore, we present a general mechanism of action for use and delivery of hydroxyzine, which may be a much better choice over other multiple medications.

Antifungal therapy for onychomycosis in children

Onychomycosis is a chronic infection of the nail unit, and its prevalence increases with age. Treatment options for children are similar to those for adults and include both oral and topical therapies. Oral agents, such as terbinafine, itraconazole, and fluconazole have been reported to have good efficacy and a low rate of side effects in children. Topical therapies, such as amorolfine and ciclopirox, can also be used as monotherapy or combined with oral agents to treat onychomycosis. Due to their thinner, faster-growing nails, children are more likely to respond to topical monotherapy than adults. There is currently insufficient data comparing emerging medical devices, such as laser therapy, with standard therapeutic options to recommend their use in children.

Efficacy of ketamine in improving pain after tonsillectomy in children: meta-analysis.

Background and objectivesThe goal of this meta-analysis study was to perform a systematic review of the literature on the effects of ketamine on postoperative pain following tonsillectomy and adverse effects in children.Subjects and MethodsTwo authors independently searched three databases (MEDLINE, SCOPUS, Cochrane) from their inception of article collection to February 2014. Studies that compared preoperative ketamine administration (ketamine groups) with no treatment (control group) or opioid administration (opioid group) where the outcomes of interest were postoperative pain intensity, rescue analgesic consumption, or adverse effects (sedation, nausea and vomiting, bad dream, worsening sleep pattern, and hallucination) 0–24 hours after leaving the operation room were included in the analysis.ResultsThe pain score reported by the physician during first 4 hours and need for analgesics during 24 hours postoperatively was significantly decreased in the ketamine group versus control group and was similar with the opioid group. In addition, there was no significant difference between ketamine and control groups for adverse effects during 24 hours postoperatively. In the subgroup analyses (systemic and local administration) regarding pain related measurements, peritonsillar infiltration of ketamine was more effective in reducing the postoperative pain severity and need for analgesics.ConclusionPreoperative administration of ketamine systemically or locally could provide pain relief without side-effects in children undergoing tonsillectomy. However, considering the insufficient evaluation of efficacy of ketamine according to the administration methods and high heterogeneity in some parameters, further clinical trials with robust research methodology should be conducted to confirm the results of this study.

Ceftriaxone Associated Biliary Sludge in Children - A Study in Bangabandhu Sheikh Mujib Medical University

Background: Ceftriaxone is known to induce reversible precipitations, called billiary sludge or pseudolithiasis in the gall bladder.Objective: The aim of this study was to investigate the frequency of biliary sludge and factors that contribute to this side effect in children. Methodology: This study was conducted on 50 consecutive children who were admitted at paediatric department of Bangabandhu Sheikh Mujib Medical University (BSMMU) for different illness and who received ceftriaxone in different dosage and duration. Ultraso-nography of hepatobiliary system was done before and at the end of therapy. Children who developed biliary sludge, a third ultrasonography was done after one month. Results: Biliary sludge was found in 4 (08%) of 50 children which resolved within 30 days of cessation of therapy. The mean dose and duration of ceftriaxone in these four children were 92.5±9.6 mg/kg/day and 8.0±2.0 days respectively while it was 78.5±5.2 mg/kg/day and 6.1±1.2 days respectively rest 46 children who did not develop biliary sludge (p&lt;0.05). The mean age of children in sludge formation group was 8.3±2.1 years while it was 5.6±1.6 years in the normal group (p&lt;0.05). Conclusion: Biliary sludge was found in older children who got higher doses of ceftriaxone for a longer period and it was reversible in all the studied children. DOI: http://dx.doi.org/10.3329/bjch.v37i3.18617 Bangladesh J Child Health 2013; Vol.37(3): 142-145

The Role of Evidence Based Nursing in Prevention of Gastrointestinal Side Effects of Chemotherapy in Children with Cancer

Introduction: Today, due to the broad spectrum of pediatric cancers are treated by the chemotherapy drugs, but these drugs have side effects and gastrointestinal toxicity is the most prevalent. One of the main roles of nurses is to better health through patient education and care for him. Evidence-based nursing is a process during which the nurse can use the available research evidence, their clinical expertise and the patient has to take appropriate decisions. This study reviews the role of evidence-based nursing in the prevention of gastrointestinal side effects of chemotherapy in children with cancer was conducted. Materials and Methods: Seeking information was performing through databases PubMed, SID, Since Direct, magiran, Ovid and etc. Within the years 2014-2002, the key issues in terms of evidence-based nursing, gastrointestinal side effect, chemotherapy was performed and 20 were studied English equivalents. Results: The most common gastrointestinal side effects in children undergoing chemotherapy are oral ulcers, vomiting, diarrhea, and dysphagia. Different strategies for prevention studies suggest that these effects need to perform their roles in teaching and nursing care. Nurses can use the results of studies such as music, ginger, semi sitting positions during chemotherapy, use of ice and etc. To prevent vomiting, the use of Persica for oral wound healing, hygiene perform especially hand washing for preventing diarrhea. The most important roles of nursing are recommended, Education on prevention of chemotherapy complications, adverse effects of proper nutrition and etc. Conclusion: Nurses can play an effective role in the education and care to relieve symptoms and prevent progression of gastrointestinal side effects of chemotherapy. Key words: Evidence-based nursing, Gastrointestinal side effects, Chemotherapy, Cancer

Psychopharmacological Interventions in Autism Spectrum Disorder

After participating in this educational activity, the physician should be better able to1. Prescribe the appropriate psychotropic medication to treat symptoms of ASD.2. Identify the side effects of the psychotropic medications used to treat ASD.Autism spectrum disorders (ASDs) are characterized by core deficits in social communication and language, and restrictive and repetitive behaviors that cause significant functional impairment and distress for affected individuals and their caregivers. The increasing prevalence of ASD, most recently estimated as 1 in 88 children, presents an ever-increasing burden on families, schools, medical systems, and society at large. Individuals with ASD commonly present for treatment of associated emotional and behavioral disturbances that include anxiety, symptoms of ADHD, compulsions and other repetitive behaviors, mood lability, irritability, aggression, and sleep disturbance. Psychotropic medications are widely utilized in alleviating these symptoms, though rigorous clinical trials in ASD are lacking for most areas of impairment. Strong evidence from randomized, placebo-controlled trials supports the use of atypical antipsychotics, particularly risperidone and aripiprazole, for managing severe irritability and aggression in ASD. Serotonin reuptake inhibitors are commonly used to treat anxiety and compulsions, though reports of efficacy in the literature are mixed, and behavioral side effects in children are common. Minimal evidence supports the utility of anticonvulsants and traditional mood stabilizers in managing mood lability and aggression. Stimulant and nonstimulant ADHD medications can be effective for reducing hyperactivity, inattention, and impulsivity, though to a lesser degree than in ADHD populations without ASD and with greater risk of adverse effects. Psychopharmacological interventions in development for core symptoms of autism include those that target the glutamatergic and GABAergic neurotransmitter systems and the neuropeptide oxytocin. Further research is needed to establish evidence-based interventions in ASD populations.

Association of -24CT, 1249GA, and 3972CT ABCC2 Gene Polymorphisms with Methotrexate Serum Levels and Toxic Side Effects in Children with Acute Lymphoblastic Leukemia

Acute lymphoblastic leukemia patients after being treated with methotrexate, have differences in methotrexate serum levels and toxic side effects. One of the main determinants of these toxic side effects is the host pharmacogenetics. The aim of this study was to evaluate the association of -24CT, 1249GA, and 3972CT ABCC2 gene polymorphisms with serum levels, and toxic side effects of methotrexate in childhood acute lymphoblastic leukemia. Applying polymerase chain reaction and restriction fragment length polymorphism techniques, the prevalence of -24CT, 1249GA, and 3972CT ABCC2 gene polymorphisms was evaluated in 65 acute lymphoblastic leukemia patients. The relationship between polymorphisms and methotrexate serum levels and toxicities was studied. A reverse significant relationship was detected between 3972T allele carriers and hepatotoxicity (P = 0.01, OR = 0.25, 95% CI = 0.09–0.72). Also, 1249A allele carriers had increased rate of gastrointestinal toxicity (P = 0.05, OR = 3.47, 95% CI = 1.04–11.57). No significant relationship was detected between -24CT polymorphism and methotrexate toxic side effects. There was no significant relationship between these three polymorphisms and methotrexate serum levels. Genotyping for 3972CT and 1249GA ABCC2 gene variants maybe useful in acute lymphoblastic leukemia to optimize methotrexate therapy and reducing the associated toxicity.

Are Asthma Specialists and Non-Specialists Familiar With Inhaled Corticosteroid (ICS) Dosing Recommendations and Side Effects In Children With Asthma?

ICS are routinely recommended and used to treat asthma in children and dosing recommendations and side effects are well-documented in FDA-approved package labels and NHLBI asthma guidelines. A case of suspected asthma in a 6 year-old child and didactic lectures were presented to attendees of the 2012 Nemacolin Asthma Conference (NAC, n=46, 62% asthma specialists) and the 2013 Pittsburgh Asthma Summit (PAS, n=101, 4% asthma specialists). Responses to the same questions were gathered using anonymous audience response devices. Most respondents were not confident in their ability to detect growth and adrenal suppression (71% NAC, 94% PAS). Although fluticasone was identified as the ICS most-commonly used to treat asthma in children (60% NAC, 39% PAS), most were unfamiliar with the FDA-approved dose for children (66% NAC, 78% PAS) and the NHLBI guideline-recommended medium-dose range for children (93% NAC, 73% PAS). Wide variation in making the diagnosis of asthma in a child was also evident. There was evidence that education about growth and adrenal suppression was effective for both audiences. These findings illustrate the lack of familiarity of both asthma specialists and non-specialists with FDA and NHLBI guideline dosing recommendations and side effects of the ICS they use the most and highlight the need for education and dissemination of these sources of valuable information.

Stress indicators during general anesthesia with opioid analgesics in children.

To determine which of the applied opioid analgesics brings the most powerful blockade of the stress response with the fewest side effects in children. This was a prospective, observational clinical study. The study included 150 boys, aged 2-5 years, ASA I, who underwent herniectomy or orchidopexy in day case surgery. The introduction and maintenance of anesthesia was intravenous (propofol, rocuronium, and opioids); airway was maintained by laryngeal mask and ventilation by mixture of oxygen/air. Subjects were divided into 3 groups depending on the applied opioid analgesics (fentanyl, alfentanil, remifentanil). The fentanyl group had the highest blood glucose values (AS = 5.14; SD = 0.47) and the highest increase in cortisone level at the moment of incision and at awakening (AS = 536.09; SD = 198.56). The lowest increase in cortisone was recorded in the remifentanil group. A significant decrease in leptin was registered at awakening in the fentanyl group and at the moment of incision in the remifentanil group (P= 0.939). Remifentanil is the opioid analgesic with the highest suppressing effect on the stress response to surgical intervention in children.

Meta-analysis of randomized controlled trials on the efficacy of probiotics in Helicobacter pylori eradication therapy in children

The efficacy of probiotics supplementation in children undergoing Helicobacter pylori (H. pylori) eradication therapy remains controversial. This study aimed to meta-analyze whether probiotics supplementation in triple therapy could improve H. pylori eradication rates and reduce therapy-related side effects in children. Electronic databases PubMed and Embase were searched to identify all randomized controlled trials in pediatric patients comparing probiotics supplementation with placebo or no extra intervention in H. pylori eradication therapy. Two authors independently extracted the data. Results were expressed as odds ratios (ORs) and accompanying 95 % confidence intervals (CIs). Stata version 12.0 was used to perform all statistical analyses. Seven studies consisting of 508 pediatric patients were included in our study. The pooled ORs (studies n = 7) of eradication rates by intention-to-treat and per-protocol analysis in the probiotics group versus the control group were 1.96 (95 % CI 1.28-3.02) and 2.25 (95 % CI 1.41-3.57), respectively. The pooled OR (studies n = 5) of incidence of total side effects was 0.32 (95 % CI 0.13-0.79), with significant heterogeneity observed (I (2) = 71.9 %). Probiotics supplementation in triple therapy for H. pylori infection may have beneficial effects on eradication and therapy-related side effects, particularly diarrhea, in children.

Multidisciplinary therapy including proton beam radiotherapy for a Ewing sarcoma family tumor of maxillary sinus in a 4‐year‐old girl

Although complete resection offers the best chance for controlling head and neck Ewing sarcoma family tumors (ESFTs), it is occasionally unfeasible because of possible functional and cosmetic side effects. Planning multidisciplinary treatment for head and neck ESFT is challenging. A 4-year-old girl had left-sided excessive tearing, nasal obstruction, and exophthalmos for 4 months. A CT scan showed a mass filling the left maxillary sinus and extending to the left orbital wall. After a diagnosis of ESFT was established with biopsy, the patient was treated with vincristine, doxorubicin, cyclophosphamide/ifosfamide etoposide (VDC/IE) regimen over 50 weeks; partial maxillectomy was performed at week 15 and was followed by proton radiotherapy. The patient has remained tumor-free for 16 months, with preservation of facial form and function. Partial resection combined with proton radiotherapy may enable maximal tumor control and minimal functional and cosmetic side effects in children with head and neck ESFT.

Comparison of granisetron plus dexamethasone versus an antiemetic cocktail containing midazolam and diphenhydramine for chemotherapy induced nausea and vomiting in children

Background:Chemotherapy induced nausea and vomiting (CINV) is one of the most disturbing side-effects in children receiving highly emetogenic chemotherapy. We aimed to assess whether the addition of an antiemetic cocktail containing midazolam and diphenhydramine to granisetron plus dexamethasone combination could ameliorate CINV in this study.Patients and Methods:A total of 23 children aged between 1 and 16 years to receive cisplatin containing chemotherapy in our clinic were included in this study from April 2007 to April 2008. 76 cycles in 23 patients were randomly assigned to receive either antiemetic regimen 1 or antiemetic regimen 2. Antiemetic regimen 1 containing granisetron 0, 04 mg/kg plus dexamethasone 0, 2 mg/kg were given in 45 chemotherapy cycles. In 31 cycles, an antiemetic cocktail containing midazolam 0, 04 mg/kg, diphenhyramine 2, 5 mg/-kg in addition to granisetron plus dexamethasone was given. Number of vomiting, severity of nausea, the use of rescue therapy and adverse events were assessed between day 1 and day 5.Results:Complete response for the acute phase was observed 38/45 (84, 4%) cycles in regimen 1 as compared with 28/31 (90, 3%) in regimen 2, antiemetic cocktail regimen (P > 0.05). Complete response for delayed emesis after 24 h of the beginning of chemotherapy was observed in 29/45 (64, 4 %) in regimen 1 and 16/31 (51, 6%) in regimen 2. Antiemetic cocktail was not superior to the granisetron plus dexamethasone combination in controlling emesis in acute and delayed phase. Furthermore, patients receiving antiemetic regimen 2 were noted significantly more side effects.Conclusion:Our data showed that antiemetic cocktail containing midazolam and diphenhydramine was not better in controlling acute and delayed emesis. A slightly more toxicity with additional drugs was also observed.

Rapamycin has a beneficial effect on controlling epilepsy in children with tuberous sclerosis complex: results of 7 children from a cohort of 86

Tuberous sclerosis complex (TSC) is a genetic disorder characterized by the formation of hamartomas in various organ systems. We would like share our experience from 86 patients and the results of rapamycin treatment in seven children with TSC. Eighty-six children with TSC were enrolled into this retrospective study. The clinical features of seven children treated with oral rapamycin were presented in detail. The most common complaint of administration was convulsion in 77 children (89.5%). Hypopigmented skin lesions, adenoma sebaceum, resistant epilepsy, intracardiac mass, renal angiomyolipomas, and West syndrome were detected (n = 83, 96.5%; n = 47, 54.7%; n = 36, 41.9%; n = 27, 31.4%; n = 18, 20.9%; and n = 13, 15.1%, respectively). Subependymal nodules were the most frequent finding in cranial imaging followed by cortical tubers and subependymal giant cell astrocytomas (n = 75, 87.2%; n = 71, 82.6%; and n = 8, 9.3%, respectively). Of the seven patients treated with rapamycin, the lesions of six children with facial adenoma sebaceum showed regression in various degrees. The frequency of convulsions decreased in five patients with resistant epilepsy within the first 6 months of the treatment, and complete control of convulsion for all patients was achieved in the second 6 months. This is the first study that showed that rapamycin is an effective agent for controlling epilepsy without any significant side effect in children with TSC. Rapamycin seems to be effective after 6 months of therapy, and we recommend tapering the dosage after successful management of epilepsy.