Introduction: Visceral leishmaniosis, kala-azar, or black fever is a fatal disease caused by protozoan parasites of the genus Leishmania. Serological testing is more frequently used in endemic areas. The recombinant kinesin antigen (rK39) is a useful antigen in enzyme-linked immunosorbent assay (ELISA), also available in strip format as a rapid test, but the best way for the diagnosis of visceral leishmaniosis is histopathologic demonstration of the parasite by aspiration or biopsy of affected organs (usually, bone marrow or spleen aspirations). Case Presentation: Here, wepresent the case of a 5-year-old girl with fever, weight loss, weakness and massive hepatosplenomegaly. In lab data, pancytopenia was observed. ELISA rapid test was negative for leishmaniosis. Bone marrow aspiration showed amastigotes within macrophages and outside cells. Conclusions: The aim of this report was to emphasize that bone marrow aspiration is an accurate method for the diagnosis of visceral leishmaniosis.

Background: Ketofol is usually using as a sedative drug during painful procedures now. That Provides sedation, analgesia and rapid recovery. The aim of this study was to compare the efficacy, respiratory and hemodynamic profiles, and side effects of two various combination of ketamine and propofol in patients undergoing bone marrow aspiration (BMA) and lumbar puncture (LP).Materials and Methods: This randomized, double blinded study was designed to compare the quality of analgesia and side effects of intravenous ketofol in sixty boys and girls. In this study Patients received a slow bolus injection of a solution containing combination of equal amount of propofol and ketamine (1: 1) (Group I) or two parts of propofol plus one part of ketamine (2: 1) (Group II). Subsequent slow bolus injects to a predetermined sedation level using Ramsay Sedation Scale. Vital signs, oxygen saturation (SpO2) and incidence of any side effects were recorded.Results: Ketofol was used in 49 surgical procedures in children with a median age of 5 years (1 to 10 years old). In this study there was an increase postoperative nausea, psychomimetic side effects, and increase recovery time with the largest ketamine dosage (Group I). (P-value<0.001) Conclusion: The adjunctive use of smaller dose of ketamine in ketofol combination minimizes the psychomimetic side effects and shortens the recovery time. A large number of patients are required to evaluate and validate these findings.

Background & objective: Introduction: First detection of any solid tumour as metastatic deposits in bone marrow directs clinicians to start searching for the primary tumour. Detection of bone marrow metastasis determines the stage of the malignancy, prognosis, mode of treatment, chemotherapeutic response and follow-up in case of relapse. The aim of the current study was to analyse the clinico-haematological presentation and morphological pattern of infiltration of solid tumours detected first as metastatic deposits on bone marrow examination. Methods: Three-year retrospective analysis of MGG-stained bone marrow aspiration smears and touch imprints of the bone marrow biopsy and Hematoxylin and Eosin (H&E) stained histopathological sections of biopsies was performed at the Department of Pathology at a tertiary care institute (January 2014 to December 2016). The morphological pattern of metastatic deposits and haematological profiles of the patients were analysed. Exclusion criterion was the presence of hematolymphoid malignancies. Results: In 22 cases, bone marrow was the first site of detection of metastasis. The age of the patients ranged from 3 years and 10 months to 82 years, with equal gender predilection. Overall, 16 cases had cytopenias, 9 cases each had leucocytosis and leukoerythroblastic presentation. The metastasis was from Ewing’ s sarcoma, prostate carcinoma, gastric adenocarcinoma invasive duct carcinoma breast, gallbladder carcinoma, lacrimal duct carcinoma and invasive papillary urothelial carcinoma. Conclusions: Bone marrow examination is a cheap and reliable investigation to detect metastasis in an unsuspecting case. Bilateral trephine biopsies are recommended to increase the efficacy of detecting bone marrow metastasis.

Background: Invasive procedures such as bone marrow aspiration in children with oncologic malignancies are painful and may produce anxiety for both patients and their parents. Various pharrnacologic treatments have been used to sedate children undergoing bone marrow aspiration. This prospective randomized study was designed to compare the effectiveness of these combinations, as well as their associated hemodynamic and respiratory side-effects and recovery in pediatric patients undergoing bone marrow aspiration.Methods: Fifty children with oncologic malignancies whose ages ranged between 2- 12 years were emolled in this study. Patients were randomly assigned either to the Propofol- Alfentanyl group or the Midazolam- Ketamine group for analgesia and sedation during bone marrow aspiration in the operating room. Time to induce sedation, sedation score and recovery time were recorded.Results: There were no statistical differences between groups in weight, age, sex and duration of procedures. Procedures were completed with satisfactory sedation levels in all patients in the study groups according to the modified Ramsay score. Induction and recovery times in the Propofol- Alfentanyl group were significantly shorter than in the Midazolam- Ketamine group (p<0.001).fter Midazolam- Ketamine sedation, a statistically significant increase in systolic blood pressure and heart rate were seen, however the opposite was observed after Propofol- Alfentanyl sedation. Other side effects, such as nausea and vomiting, agitation myoclonus and aspiration, were not seen in our patients.Conclusion: Both Propofol- Alfentanyl and Midazalam-Ketamine combinations can be used safely and effectively for sedation and analgesia during bone marrow aspiration in the pediatric patient group.

Aim and Background: Patients with hematological malignancies are at higher risk for mycobacterial and many other opportunistic infections due to immunosuppression that resulted from dysfunctional blood cells and chemotherapy-induced depletion in cells of immune system. This study was performed to evaluate the frequency and contributing factors for mycobacterial infections in patients with hematological malignancies according to the both culture and PCR methods on bone marrow aspiration.Materials and Methods: In this cross-sectional descriptive study, 96 patients with hematological malignancies attending to tertiary health care centers in 2009 and 2010 were enrolled. The bone marrow aspiration was cultured and also evaluated by PCR method.Results: The mean age of the patients was 39.49 years and 64.6 percent were male. Acute myeloblastic leukemia (23.3%), acute lymphoblastic leukemia (19.2%), and multiple myeloma (17.8%) were the most common malignancies. The cultures of bone marrow aspiration were negative for mycobacterium species in all patients but nucleic acid of this bacterium was detected by PCR method in three cases (3.1%) including two patients with acute lymphoblastic leukemia and one patient with multiple myeloma. Aspergillus, streptomyces, and brucella species.were found in culture of two, one, and two patients, respectively. The age, sex, type of malignancy, and bone marrow transplantation had no effect on PCR results (P>0.05).Conclusions: The frequency of mycobacterial infections in patients with acute lymphoblastic leukemia and multiple myeloma may be higher than other hematological malignancies. However for decreasing the morbidity and mortality in these patients monitoring of bone marrow aspiration for mycobacterial and other opportunistic infections is suggested.

Introduction: Splenomegaly is one of the common and important clinical findings in some of the diseases, careful history, physical examination and necessary laboratory tests can lead to underlying causes of splenomegaly but in some cases further investigations including marrow aspiration is necessary. This study was done in this respect. Materials & Methods: During one year from July 1999 children who were admitted in Tabriz pediatric medical center with splenomegaly were studied prospectively. In this study 71 patients had clinical and sonographic splenomegaly with or without hepatomegaly. Possible laboratory tests and imaging studies were done for diagnosis of these patients but in cases of failure, marrow aspiration was done. Results: 19 patients were diagnosed by laboratory assessment. In rest of cases marrow aspiration was performed, which led to final diagnosis in 38 patients but if was not helpful in remaining cases. The results indicated that when either high ESR, cytopenia or both were present marrow aspiration was necessary to establish the diagnosis. In this study leukmeia was the most common cause of splenomegaly while visceral leishmaniasis was 2nd in frequenty. Discussion: This study shows that dications for bone marrow aspiration in splenomegaly includes decrease in at least two element of blood cells which has sensitivity of 91.8% and specificity of 73.3% (p<0.001) and high ESR with bicytopenia has sensitivity of 95.6% and specificity of 44.8% (p<0.001).

Background The present review study provides specific evidence to assess the impact of distraction techniques and hypnosis on the pain of bone marrow aspiration in children. Materials and Methods This review study aimed to determine the effects of distraction techniques and hypnosis on the controlling pain of bone marrow aspiration in children. Internal databases (SID, Magiran, IranMedex and Irandoc), and international databases (Google-Scholar, Medline, PubMed, Elsevier, ProQuest, Springer and Web of Science), were searched by using the Mesh key words including "cancer", "bone marrow", "aspiration", "distraction", "hypnosis", "pain", "children" and "pediatric", with no time limit since the foundation of these databases until December 2016. Results In overall review of the articles, based on the issues expressed, the effect of most of various distraction interventions and hypnosis on the pain severity of children under the bone marrow aspiration procedure was significant and positive (P<0. 05). Of course, pain severity variations in all studies, were different. Conclusion According to the results of the mentioned studies, we find that in order to reduce the pain of venipuncture in children most effectively, it is better that these techniques be done according to age and the children's mental and physical conditions.

Dogs as a valuable large animal model display important roles for investigation of diagnosis and treatment of different disorders of human diseases such as pain relieving procedures. Analgesic efficacy of preoperative administration of piroxicam, ketamine and lidocaine combined with local anesthesia for management of intra and early post-operative pain in the three equal groups of dogs undergoing bone marrow aspiration was evaluated in twenty-four immature female stray dogs that had been referred for FNA technique. Some clinical, physiological and biochemical parameters of the animals were studied before and during the three hours after the BMA. In the ketamine group, hyperglycemia was found to be less than piroxicam and lidocaine groups. A maximum increase of heart rate and respiratory rate was recorded 0. 5 h after premedication in all the groups and these variations were significantly recorded in the piroxicam group. Immediately after FNA, clear increments of rectal temperature, especially in the piroxicam group, were also seen in all used drug groups. Evaluation of sedation and analgesia results of the present study indicated no analgesic effect of piroxicam in bone marrow FNA and minor sedative effect just immediately before aspiration. Ketamine with its analgesic nature provided more sedation and adequate pain relief due to FNA technique rather than other groups. Therefore, pain therapy can be improved using preoperative sub-anesthetic dose of ketamine combined with local anesthesia for bone marrow FNA in dogs.

Background: Bone marrow aspirations and biopsies are very painful diagnostic procedures in pediatric candidates and must be done under sedation or analgesia.Objectives: The current study aimed at investigating the effect of using Entonox gas during sedation and analgesia induction in pediatric candidates of bone marrow aspiration.Methods: It was a single-blind, randomized clinical trial. All pediatric candidates of first time bone marrow aspiration were included and allocated to either group 1 or 2, using a random number table. In group 1, a combination of midazolam, fentanyl, ketamine, and propofol was injected intravenously. In group 2, the mentioned combination was injected intravenously and Entonox gas was used for patients’ ventilation. The goal was to reach level 4 sedation based on the Ramsay sedation scale. If needed, extra propofol was injected intravenously every minute. Physician and the helping nurse satisfaction of the procedure were evaluated. Duration of the procedure, the administered dosage for each patient, occurrence of any complications, and the recovery time were recorded.Results: A total of 88 cases with the mean age of 6.8±3.6 years, and mean weight of 25.4±12.5 kg were included in the study (50% female). Baseline and demographic data of the groups showed no significant difference. Propofol consumption was significantly lower in group 2, for whom Entonox gas was prescribed, compared with group 1 (P-value<0.001). Decrease of recovery time in group 2 compared with group 1 was evident (P-value<0.001). Physician and nurse’s satisfaction was higher in group 2 compared to group 1, and the difference was statistically significant. Conclusions: It is likely that Entonox prescription during bone marrow aspiration in pediatric leads to decrease in consumption of propofol to provide proper sedation, shorter recovery time of the patients, and increased satisfaction in both the physician and nurse in charge of performing the procedure.