Hemophagocytic lymphohistiocytosis following dengue hemorrhagic fever in Hb H/Hb Constant Spring patient

Infection‐associated hemophagocytic syndrome (IAHS), a secondary form of hemophagocytic lymphohistiocytosis (HLH), has been found following several types of infections and can be fatal. We report herein a case of IAHS following dengue infection in a 14‐year‐old patient with underlying α‐thalassemia syndrome (non‐deletional Hb H/Hb Constant Spring disease). He developed prolonged fever, thrombocytopenia, and progressive splenomegaly. Further investigations indicated hyperferritinemia, and increased reactive histiocytes with hemophagocytic activity in the bone marrow. He responded promptly to dexamethasone and i.v. immune globulin. Physicians should be aware of this condition, especially in countries where both dengue hemorrhagic fever and thalassemia are prevalent. The fatal outcome of IAHS can be prevented with prompt appropriate treatment.     

Outcomes of pediatric retinoblastoma treated with ICEV regimen: A single-center study

Retinoblastoma is the most common intraocular malignancy in children. The aim of this study was to investigate the efficacy and toxicity of combination ifosfamide, carboplatin, etoposide, and vincristine (ICEV) in advanced-stage pediatric retinoblastoma [International Classification of Retinoblastoma (ICRB) group D or E], and in ICRB group C in the second eye in simultaneously treated bilateral retinoblastoma. The medical records of retinoblastoma patients treated with concurrent ICEV regimen and focal therapy were retrospectively reviewed. The ICEV treatment protocol was, as follows: ifosfamide 1800?mg/m² on Days 1–3; MESNA 600?mg/m² on Days 1–3; carboplatin 560?mg/m² on Day 1; etoposide 150?mg/m² on Days 1–3; and vincristine 1.5?mg/m² on Day 1. Of 16 retinoblastoma patients, 13 had bilateral disease. Seven first eyes in bilateral disease that were enucleated prior to ICEV therapy were excluded. Twenty-two eyes were finally included (six group C, six group D, and ten group E). Median follow-up was 3.4 years, and the median number of ICEV courses was 7. Fifteen globes could be salvaged, 12 responded to ICEV (six group C, five group D, and one group E), and three unresponsive eyes could be salvaged with external beam radiation therapy (EBRT). Enucleation-free and relapse-free survival was 68.2 and 54.5%, respectively. The results of this study suggest ICEV as an alternative therapeutic approach for globe salvage in pediatric retinoblastoma, especially in ICRB groups C and D with manageable acute toxicity. Further study in larger cohort is needed to confirm the effectiveness of treatment.     

Microhardness of sub-restoration dentine in primary molars after carious tissue removal to soft and firm dentine

ObjectivesTo compare the microhardness of sub-restoration dentine after selective carious tissue removal and placing glass ionomer restorative cement.MethodsForty-three primary molars with carious lesions extended to the inner third of dentine in subjects aged 8–12 years were included. The teeth were randomly assigned to the following carious tissue removal conditions: Group 1 - removal to the soft dentine, Group 2 - removal to the firm dentine, and Group 3 - removal to the hard dentine. Following restoration with glass ionomer restorative cement for three to six months, 30 tooth samples underwent microhardness testing performed on sub-restoration dentine and sound dentine. The Wilcoxon signed-rank test was used to compare the microhardness values of sound dentine and sub-restoration dentine within the group. The Kruskal–Wallis test was used to analyse the microhardness of the sub-restoration dentine across the three groups.ResultsAll 30 teeth available for analysis were asymptomatic, with no signs of pulpitis. The average microhardness values of sub-restoration dentine and sound dentine ranged from 16 to 23 KHN and 20 to 27 KHN, respectively. In each group, the microhardness value of the sub-restoration dentine was significantly lower than that of the sound dentine (p < 0.01). There were no significant differences in the microhardness values of sub-restoration dentine relative to that sound dentine among three groups (p = 0.86).ConclusionThe microhardness values of sub-restoration dentine with selective carious tissue removal were comparable to those with complete carious tissue removal after glass ionomer restorative cement placement.