Iranian Journal of Pediatric Hematology and Oncology最新文献

{"title":"Effects of 5-aza-2ˈ-deoxycytidine and Valproic Acid on Epigenetic-modifying DNMT1 Gene Expression, Apoptosis Induction and Cell Viability in Hepatocellular Carcinoma WCH-17 cell line","authors":"M. Sanaei, F. Kavoosi","doi":"10.18502/IJPHO.V9I2.607","DOIUrl":"https://doi.org/10.18502/IJPHO.V9I2.607","url":null,"abstract":"Background: DNA molecule of the eukaryotic cells is found in the form of a nucleoprotein complex named chromatin. Two epigenetic modifications are critical for transcriptional control of genes, including acetylation and DNA methylation. Hypermethylation of tumor suppressor genes is catalyzed by various DNA methyltransferase enzymes (DNMTs), including DNMT1, DNMT2, and DNMT3. The most well characterized DNA demetilating and histone deacetylase inhibitor drugs are 5-aza-2ˈ-deoxycytidine (5-Aza-CdR) and valproic acid (VPA), respectively. The purpose of the current study was to analyze the effects of 5-Aza-CdR and VPA on cell growth, apoptosis, and DNMT1 gene expression in the WCH-17 hepatocellular carcinoma (HCC) cell line. \u0000Materials and Methods: In this descriptive analytical study, MTT assay, flow cytometry assay, and Quantitative Real-Time RT-PCRwere done to evaluate proliferative and apoptotic effects and also gene expression. \u0000Results: Both compounds inhibited the cell growth and induced apoptosis significantly in a dose and time depended fashion. Additionally, 5-Aza-CdR down-regulated DNMT1 gene expression. The relative expression of DNMT1 was 0.40 and 0.20 (P < 0.001) at different times, respectively. The percentage of VPA- treated apoptotic cells were reduced by about 28 and 34 % (P˂0.001) and that of 5-Aza-CdR-treated were reduced by about 34 and 44 % (P˂0.001) after treatment time periods. \u0000Conclusion: In the current study, it was observed that 5-Aza-CdR and VPA could significantly inhibit the growth of WCH-17 cell and played a significant role in apoptosis. It was also found that 5-Aza-CdR could decrease DNMT1 gene expression.","PeriodicalId":44212,"journal":{"name":"Iranian Journal of Pediatric Hematology and Oncology","volume":"20 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74918382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glioblastoma Multiforme in a nine-year-old girl: a case report","authors":"H. Esfahani, A. Dehghan, Ghazal Sami, N. Eskandari","doi":"10.18502/IJPHO.V9I2.612","DOIUrl":"https://doi.org/10.18502/IJPHO.V9I2.612","url":null,"abstract":"Brain tumors are the most common solid tumors in childhood. Glioblastoma multiform (GBM) is the second most common primary brain tumor in adults. It usually affects the cerebral hemispheres of adults at the 6th or 7th decade of life. In comparison to adult population, GBM is rare in pediatrics and accounts for approximately 3% of all pediatric brain tumors. Pediatric glioblastoma was defined as patient age younger than 21 years at the time of craniotomy. The prognosis seems to be better in childhood. This report documented a GBM was located in the frontal lobe of a 9 year old girl who was diagnosed in Hamedan University of Medical Sciences in 2016. Magnetic resonance imaging (MRI) showed a huge well enhancing mass in left frontal lobe (47 ×35 mm ). This mass was surrounded by vasogenic edema and was extended to medial aspect of right frontal lobe through corpus callosum. The patient underwent a left frontal craniotomy, and gross total tumor removal was per¬formed. Pathology findings revealed neoplastic transformation of glial cells associated with vascular necrosis and neovascularization.","PeriodicalId":44212,"journal":{"name":"Iranian Journal of Pediatric Hematology and Oncology","volume":"144 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76238607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Frequency of Packed Red Blood Cells Transfusion in Preterm Infants Admitted to NICU of Shahid Sadoughi Hospital During 2016","authors":"M. Lookzadeh, F. Adhami, M. N. Shadkam, S. R. Mirjalili, E. Sheikhpour","doi":"10.18502/IJPHO.V9I2.609","DOIUrl":"https://doi.org/10.18502/IJPHO.V9I2.609","url":null,"abstract":"Background: Red blood cells transfusion is a useful practice for preterm infants. Large amount of blood is usually wasted in the infants. Considering that few studies have been carried out on infants, the aim of current study was to investigate the frequency of packed red blood cells transfusion in preterm infants admitted to NICU of Shahid Sadoughi Hospital in Yazd during 2016 \u0000Materials and Methods: This retrospective descriptive-analytical study was conducted on infants admitted to Neonatal intensive care unit (NICU) of Shahid Sadoughi Hospital, Yazd, Iran during 2016. Variables including fetal age, sex, birth weight, delivery method, Apgar score, infant status, premature birth complications and transfusion information were extracted from medical records of patients. \u0000Results: Current study was conducted on 335 premature infants. Among them, 85 cases were received packed red blood cells transfusion (25.4%). Of the infants receiving packed red blood cells, 59 cases (69.4%) were alive and 26 (30.6%) dead. Distribution of preterm complications in infants including respiratory distress syndrome, sepsis, respiratory failure and Pneumothorax was observed in 66 (77.6%), 19(22.4%), 52(61.2%) and 14 patients (16.5%), respectively. There was significant difference between mean age and mean Apgar score in terms of transfusion (p<0.01). The mean volume of consumed blood was 34.20 ± 27.44 ml. The mean volume of wasted blood was 488.39±355.88 ml. Minimum and Maximum volume of wasted blood was 220 and 1873 ml. \u0000Conclusion: According to results of current study, the mean age and mean Apgar score in patients undergoing transfusion was lower than those did not have transfusion. Moreover, total volume of wasted blood was 14.2 times more than consumed blood. Therefore, optimal usage of blood products and the use of smaller blood bags are proposed in order to improve the health of infants in intensive care units and lessen complications of blood transfusion in newborns.","PeriodicalId":44212,"journal":{"name":"Iranian Journal of Pediatric Hematology and Oncology","volume":"3 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87335715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Severity and Duration of Thrombocytopenia following Exchange Transfusion in neonatal hyperbilirubinemia","authors":"H. Boskabadi, M. Mir","doi":"10.18502/IJPHO.V9I2.608","DOIUrl":"https://doi.org/10.18502/IJPHO.V9I2.608","url":null,"abstract":"Background: Infant jaundice is one the most common causes of hospitalization in infant in the first month of birth, which is defined an abnormal increase in blood bilirubin levels. Exchange transfusion is the recommended treatment for neonatal jaundice who do not respond to phototherapy and experience dangerous complication of jaundice and signs of kernicterus. However, this treatment may lead to complications such as thrombocytopenia. This study aimed to investigate the severity and duration of thrombocytopenia following the exchange transfusion in neonatal jaundice. \u0000Material and Methods: This cross section study was performed on 217 infants. Infants with a gestational age of 35 to 42 weeks and bilirubin levels of above 17 mg/dl, who were undergoing treated with exchange transfusion, entered in this study. This study was conducted from 2012 to 2018 in the Ghaem Hospital (Mashhad, Iran). The samples were selected by convenience sampling. The platelet count was measured before exchange transfusion, right after exchange transfusion, 6 hours after exchange transfusion, and platelet count continued until platelet level was normal.  At the time of discharge, platelet levels were re-measured. \u0000Results: Among the samples, 104(53.8%) were males and 89 (46.2%) females. Of the infants who were transfused, 15 % had thrombocytopenia. After the exchange transfusion, 80 % of infants had thrombocytopenia. The mean platelet count before the exchange transfusion was 299,180 per mm3 of blood, and it was 105.140 per mm3 of blood after the exchange transfusion. With respect to severity of this complication, 86 % of the thrombocytopenia after exchange transfusion was mild to moderate. \u0000Conclusion: In this study, nearly one-sixth of the infants who needed exchange transfusions had thrombocytopenia that most of them had platelet of more than 100000.  Thrombocytopenia is associated with jaundice and can be exacerbated by phototherapy.","PeriodicalId":44212,"journal":{"name":"Iranian Journal of Pediatric Hematology and Oncology","volume":"317 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80124144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The surface markers and survival rate of platelets during storage at 4°C: The influence of sodium octanoate","authors":"Vahid Baghdadi, F. Yari, N. Rezaei, M. Rafiee","doi":"10.18502/IJPHO.V9I2.610","DOIUrl":"https://doi.org/10.18502/IJPHO.V9I2.610","url":null,"abstract":"Background: Storage of platelet concentrates (PCs) at room temperature (20-24°C) limits its storage time to 5 days due to the destructive effects of platelet storage lesion (PSL) and bacterial contamination. Although prolonged storage of platelets (PLTs) at 4°C reduces the likelihood of bacterial contamination and PSL levels, it is accompanied by an increase in the clearance rate and changes in the surface markers of PLTs. The goal of this study was to evaluate the effects of sodium octanoate (SO) as a stabilizer on PLTs during storage at 4°C. \u0000Materials and Methods: In this experimental study, PCs were divided into three portions and stored for 5 days at 3 different conditions, including 20-24°C, 4°C temperature, and 4°C in presence of SO. PLTs enumeration was performed using an automated hematology analyzer. To measure the metabolic activity and survival rate of PLTs, the water-soluble tetrazolium salt (WST-1) assay was performed. The activity of lactate dehydrogenase enzyme (LDH) was measured by a biochemical analyzer. Additionally, the levels of PLT glycoprotein Ibα (GPIbα) and CD62P (P-selectin) were measured on PLTs by flow cytometry technique. \u0000Results: PLTs count was higher in SO-treated (4°C) PLTs than two other studied samples. Additionally, the viability was higher in the SO-treated PLTs than that in other groups. LDH amount was lower in the SO-treated PLTs than that in other groups (P>0.05). GPIbα expression was significantly higher in SO-treated PLTs than that other groups (P<0.05). On the other hand, the expression of CD62P was lower at 4°C in PLTs in the presence of SO (P>0.05). \u0000Conclusions: SO could modulate the effects of cold temperatures on PLTs. Furthermore, we found that the survival of platelets was better maintained in the presence of SO at 4°C.","PeriodicalId":44212,"journal":{"name":"Iranian Journal of Pediatric Hematology and Oncology","volume":"16 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81814349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurocognitive Function of Children suffering from Acute Lymphoblastic Leukemia in Southern Iran","authors":"S. Zareifar, A. Shoushtari, Aida Abrari, S. Haghpanah","doi":"10.18502/IJPHO.V9I2.606","DOIUrl":"https://doi.org/10.18502/IJPHO.V9I2.606","url":null,"abstract":"Background: Children with acute lymphoblastic leukemia (ALL) are prone to neurotoxicity and consequently neurocognitive function impairment mainly due to undergoing different treatment modalities. In the current investigation, neurocognitive function of children with ALL was compared to that of healthy children. \u0000Materials and Methods: In this cross-sectional study, 155 ALL and 155 age- matched healthy children in Shiraz, Southern Iran, were included and evaluated using Continuous Performance Test (CPT).  \u0000Results: Mean age of the patients was 9.9± 2.4 years. The number of wrong responses and duration of response did not lead to significant difference between healthy and affected children. In the age group less than 12 years old, the frequency of no-response was higher in the case group compared to control group both in boys and girls (P = 0.012, P = 0.006 respectively). In addition, in male patients younger than 12 years old, the number of correct responses was significantly less than that of  controls (P = 0.010). Patients underwent concurrent radiotherapy and chemotherapy needed significantly more time for responding compared to patients in whom chemotherapy were discontinued and were in remission (P=0.001). \u0000Conclusion: Based on the results, ALL children younger than 12 years old showed some defects in cognitive function. Moreover, it was more prominent in young boys compared to young girls. Regardless of the type of treatment regimens, early detection of neurocognitive disorders should be warranted in this high-risk population with more focus on boys and younger children. Psychological support and appropriate interventions can help improve cognitive function, reduce the disruption of education, and enhance the social and family relationships.","PeriodicalId":44212,"journal":{"name":"Iranian Journal of Pediatric Hematology and Oncology","volume":"9 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85449240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The incidence of hyperglycemia during the induction phase of chemotherapy in patients with acute lymphoblastic leukemia","authors":"A. Tamaddoni, M. Alijanpour, Hassan Mahmoudi, Beniamin Miladi, Ali Bijani, E. Assadollahi, Faeze Aghajanpour","doi":"10.18502/IJPHO.V9I2.605","DOIUrl":"https://doi.org/10.18502/IJPHO.V9I2.605","url":null,"abstract":"Background: Hyperglycemia is one of the most complications of corticosteroid and asparaginase during induction phase of chemotherapy in children suffering from acute lymphoblastic leukemia (ALL). \u0000This study was carried out to evaluate the incidence of hyperglycemia and associated risk factors during chemotherapy induction phase at Amirkola Children's Hospital. \u0000Materials and Methods: In this cross-sectional (retrospective) study, 150 children (mean age: 79.16±42.68 months) with ALL were evaluated (2000- 2011). Hyperglycemia was described as random blood glucose level more than 200mg/dl in patients less than 2 years old. In patients older than 2 years, fasting blood glucose level more than 110-125 mg/dl was considered as impaired glucose level and fasting blood glucose level more than 126 mg/dl was defined as diabetes mellitus. The data were analyzed using SPSS (version 18) and running chi square test, pearson Ccorrelation, and logistic regression. P-values less than0.05 was considered statistically significant. \u0000Results: Out of 150 children with ALL, 21 (14%) of them had hyperglycemia, but none of them had diabetic ketoacidosis. Hyperglycemia was significantly associated with gender (P=0.014) and age. (P=0.000) which was more likely in patients older than 10 years. The incidence of hyperglycemia was also related to BMI (P=0.000). Relapse rate for ALL was 14.7%, which was not significantly associated with hyperglycemia. \u0000Conclusion: Hyperglycemia was common and transient during induction phase of chemotherapy and it was correlated with age, sex, and weight.","PeriodicalId":44212,"journal":{"name":"Iranian Journal of Pediatric Hematology and Oncology","volume":"8 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91333809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimized Method for Reticulocyte Counting: Simple, Accurate, and Comparable to Flow Cytometry","authors":"Alireza Moradabadi, M. Khaleghi, Maryam Shahdoost, A. Farsinejad","doi":"10.18502/IJPHO.V9I1.292","DOIUrl":"https://doi.org/10.18502/IJPHO.V9I1.292","url":null,"abstract":"Background: Reticulocytes are immature red blood cells with RNA, spending the final stages of their maturation in the peripheral blood. The number of reticulocytes in the peripheral blood is the salient evidence of the effectiveness of bone marrow to produce red blood cells. Currently, reticulocyte count is done manually or automatically in clinical laboratories. Difficulties and limitations of these approaches, including imprecision, poor reproducibility and laboriousness are clear. This study used modification in manually staining method to achieve better counting. \u0000Materials and Methods: The reticulocyte counts of 30 samples were obtained from patients referred to Afzalipour hospital in Kerman, Iran. The patients aged between 0-3 years old (median age= 1.4 years). Samples were investigated for reticulocyte count by three different methods, including conventional, modified, and flow cytometry methods. Modified staining method is used in the optimized method which helps operator to countg reticulocyte better than conventional method. \u0000Results: Analysis of the results showed a reasonable agreement. Sphericity assumption was checked by Kolmogorov-Smirnov and Mouchley analyses. Repeated measurement analysis was performed using Greenhouse-Geisser correction (F=16.6, df=1.105) according to pairwise comparisons with Bonferroni adjustment. Mean differences for flow cytometry, optimized and common methods were 3.88, 3.59, and 2.46 were significant at the 0.05 level, respectively. \u0000Conclusion: The proposed optimized method was simple method, highly reliable, and comparable to flow cytometry. Due to the ease of implementation, this method did not need specialized training or the use of complex devices so it is affordable. \u0000Key words: Blood Stains, Flow Cytometry, Reticulocyte, Reticulocyte Count, Staining and Labeling","PeriodicalId":44212,"journal":{"name":"Iranian Journal of Pediatric Hematology and Oncology","volume":"76 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86730766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency and Risk Factors of Red Blood Cell Alloimmunization in Thalassemia Major Patients in Markazi province","authors":"A. Eghbali, Roghaieh Rahimi afzal, S. Mehrabi, S. Sanatkar, Morteza Mousavi Hasanzadeh","doi":"10.18502/IJPHO.V9I1.293","DOIUrl":"https://doi.org/10.18502/IJPHO.V9I1.293","url":null,"abstract":"Background: Thalassemia is one of the most common genetic disorders throughout the world. Blood transfusion plays an important role in the treatment of thalassemia but it leads to numerous complications such as iron overload and alloimmunization. This study evaluated the frequency and risk factors associated with alloimmunization in thalassemia major patients living in Markazi province, Iran. \u0000Materials and Methods: In this descriptive study, 48 thalassemia major patients who underwent blood transfusion at Amirkabir hospital were included. Patients' demographic data were recorded using a questionnaire. In order to perform alloimmunization screening and autoantibody assessment, patients were referred to Tehran Blood Transfusion Organization Laboratory. \u0000Results: The current study was performed on 48 patients with thalassemia major,. The mean age of patients was 12.5 ± 8.3 years. Among patients 26 (54.16%) were male and 22 (45.83%) were female, 13 patients (27.08%) had alloantibodies. Among 48 patients, 19 (39.58%) had undergone splenectomy. The patients' age of the first blood transfusion ranged from 1 month to 14 months      and the mean age of the first blood transfusion was 9.5 ± 7.08 months. The blood transfusion intervals in patients were from 21 days to 40 days and the blood volume received at each transfusion session was 10-15 cc/kg of the body weight. In the current study, the data analysis indicated no significant correlation between alloantibodies and RH phenotype (P=0.43), patients' gender (P=0.9), or blood groups (P=0.4); whereas, a significant correlation was found between alloantibodies and splenectomy (P=0.02) as an increase in the prevalence of alloantibodies was reported in splenectomised patients. \u0000Conclusion: No significant difference was found between the patients with and without alloantibodies in terms of the prevalence of Rh phenotype, gender, and blood groups. However, there was a significant difference between the patients with and without alloantibodies in terms of splenectomy. \u0000Key words: Allo-immunization, Risk factors, Thalassemia major  ","PeriodicalId":44212,"journal":{"name":"Iranian Journal of Pediatric Hematology and Oncology","volume":"35 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91171507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges of palliative care for children with cancer in Iran: a review","authors":"M. Rassouli, N. Salmani, Zahra Mandegari, A. Dadgari, B. F. Tafti, I. Bagheri","doi":"10.18502/IJPHO.V9I1.296","DOIUrl":"https://doi.org/10.18502/IJPHO.V9I1.296","url":null,"abstract":"Pediatric palliative care is a holistic caring approach for children and families that begins with diagnosis of a life-threatening illness and continues until death; it aimed to relieve pain and other symptoms in physical, mental, social and spiritual aspects. In spite of available evidence concerning optimal outcomes of the provision of palliative care, establishment of a palliative care system for children has hardly been feasible so far due to a number of challenges. Therefore, this review study aimed at identifying the challenges of the provision of pediatric palliative care along with the relevant solutions. The identified challenges were classified into two categories including structure-based challenges (i.e. lack of a clear structure in the health system and classification of services, shortage of specialized staff, insufficient home care services, absence of health care tariffs along with insurance coverage of palliative care services) and process-based challenges (i.e. absence of guidelines, lack of educational programs for family, family attitudes and beliefs, communication barriers, and lack of access to opioids). Thereafter, the solutions for each challenge are provided in accordance with the available literature separately. Given the significance of palliative care for children with cancer and in order to improve the quality of life of the children and the families, it appears necessary that policymakers and managers take account of the challenges as well as the feasibility and the implementation of provided solutions.","PeriodicalId":44212,"journal":{"name":"Iranian Journal of Pediatric Hematology and Oncology","volume":"15 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81648164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}