Iranian Red Crescent Medical Journal
Volume:21 Issue: 6, Jun 2019

Egg allergy for the Measles-Mumps-Rubella (MMR) vaccine is still the cause of concern for many healthcare workers and families due to reactions such as anaphylaxis. This study aimed to reassess the risk of MMR vaccination in infants with egg allergy referred by healthcare workers. This cross-sectional observational study was performed in a university-affiliated hospital in Istanbul, Turkey, between March 2017 and September 2018. The study patients were one-year-old infants who were candidates for MMR vaccination, and referred to our outpatient allergy clinic by healthcare workers due to egg allergy. The children were diagnosed with egg allergy by a pediatric allergist and then received the MMR vaccine. Among 50 children aged one year, 19 (38%) were female, and 31 (62%) were male. The diagnosis was atopic dermatitis in 29 (58%) patients, urticaria in 18 (36%) patients, angioedema in 2 (4%) patients, and anaphylaxis in one (2%) patient. Fourteen (28%) patients had both egg and cow’s milk allergy. Four (8%) patients had egg, cow’s milk, and wheat allergy. The total IgE level was 119.80 ± 213.43 IU/mL. Specific IgE levels for egg white were positive in 37 patients. Specific IgE levels for egg white were 15.26 ± 29.64 kU/L. Skin prick test results were positive for egg allergens in 35 patients with a mean diameter of 3.12 ± 2.18 mm for egg yolk and 3.27 ± 2.62 mm for egg white. None of the patients with egg allergy developed anaphylactic reaction and only one patient had urticaria within 5 min after vaccination. There was no correlation between specific IgE levels for egg white and diagnosis of the patients. MMR vaccine administration to children with egg allergy is safe. Life-threatening reactions to the MMR vaccine in patients with egg-allergy are very rare. It seems in cases of hypersensitivity reactions such as acute anaphylaxis events, the MMR vaccine needs to be administered in a hospital under the supervision of a pediatric allergist.

Several cytokines contribute to cutaneous leishmaniasis outcomes. IL-23 is a key cytokine in inflammation and a central cytokine in controlling Th17. IL-8, also known as a neutrophil chemotactic factor in the lesion site of cutaneous leishmaniasis, indicates disease promotion. This study aimed to evaluate the relationship of Leishmania major with IL-8 and IL-23 expression. This case-control study was performed on 25 healthy individuals and 25 cutaneous leishmaniasis patients who lived in Southwestern Iran, in 2017. Peripheral blood mononuclear cells (PBMCs) were first isolated. Total RNA was extracted and reverse-transcribed into cDNA. The expression levels of IL-8 and IL-23 were measured by the real-time PCR. The data were statistically analyzed using SPSS version 16. Our findings indicated that the expression of IL-8 was significantly higher in the leishmaniasis group than in the control group with the median (IQR) of 0.39 (0.92) and 0.03 (0.11), respectively (P = 0.02). The expression of IL-23 was higher in the leishmaniasis group than in the control group with the median (IQR) of 0.13 (0.43) and 0.11 (0.61), respectively (P = 0.48). The increased IL-8 expression accompanied the location sites in face and hand and the increased number of skin lesions. The expression of IL-8 in patients with cutaneous leishmaniasis is an index of increased activity of local neutrophils that can contribute to leishmaniasis survival or inflammation increase. However, IL-23 appears to be less important in the inflammatory reaction than IL-8.

Leishmaniasis is a parasitic disease caused by Leishmania protozoa. Iran is an endemic region for leishmaniasis and thus, many natural medicaments, such as Juniperus excelsa, are traditionally being used for the treatment of its cutaneous form. The current study aimed at assessing the anti-leishmanial activities of this medicament’s leaf and fruit extracts and respective leaf fractions against Leishmania major as the causative agent of zoonotic cutaneous leishmaniasis in both in vitro and in vivo models. This experimental study was carried out at Shiraz University of Medical Sciences, Shiraz, Iran, during the year 2013. For the generation of axenic amastigotes, promastigotes were mass cultivated and incubated at 33 to 34°C and pH 3.5. The anti-amastigote activity was evaluated using the colorimetric assay. For in vivo study, promastigotes were inoculated in 40 female BALB/c mice tails. Lesions were created after four weeks. Animals were randomly distributed to four groups as test, placebo, Glucantime, and control. Mice were treated for 30 days. Lesion diameters were measured and recorded weekly. All extracts and fractions possessed potent activities; leaves showed the highest with IC50 (SD) (50% inhibitory concentration) 0.97 ± 3.53 mg/mL, and among fractions, ethyl acetate with IC50 1.95 ± 5.30 had greater anti-leishmanial activity. In animal models compared with the beginning, the diameter of Cutaneous Leishmaniasis (CL) lesion had a significant difference in the test group (P < 0.05 vs. control group) at the end of the protocol. However, no significant differences were seen in placebo and Glucantime groups versus the control group. Comprehensive and long term therapy assessment with J. excelsa is needed to introduce it as a natural anti-leishmanial medicine.

Trends of major cardiovascular risk factors are less investigated in Middle-Eastern countries. This study aimed to assess the trend of major cardiovascular risk factors among Iranian individuals. This Longitudinal population-based study was performed by multistage random sampling on 6504 participants aged at least 35 years for 12 years initiating in 2001 until 2013 in three phases. Cardiovascular risk factors including systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference (WC), waist to hip ratio (WHR), body mass index (BMI), fasting blood sugar (FBS) and lipid indices were measured for each subject in 2001, 2007 and 2013 and were analyzed using repeated measure analysis of variance using Bonferroni correction. Mean value of SBP, DBP, BMI and FBS increased significantly in both genders during follow-up (SBP: 119.3 ± 18.7 to 128.4 ± 17.5 mmHg, P value < 0.001, DBP: 76.7 ± 11.8 to 82.8 ± 12.5 mmHg, P value < 0.001, BMI: 27.4 ± 4.4 to 28 ± 4.6 kg/m2, P value < 0.001, FBS: 86.7 ± 29.6 to 106.5 ± 38 mg/dL, P value < 0.001). Lipid profiles including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and TG/ high-density lipoprotein cholesterol (HDL-C) showed favorable downward patterns in population (TC: 219.5 ± 51.3 to 200.1 ± 40.9 mg/dL, P value < 0.001, TG: 200.2 ± 110.3 to 155.1 ± 85 mg/dL, P value < 0.001, LDL-C: 132.6 ± 42.4 to 111.7 ± 27.8 mg/dL, P value < 0.001, TG/HDL-C: 4.5 ± 2.8 to 3.9 ± 2.8, P value < 0.001) with an exception of HDL-C showing less desirable results. In spite of controversial results in terms of WC and WHR changes relative to gender, total population changes of those variables were not significant. Although favorable patterns were observed in most lipid indices, other risk factors showed an inverse or insignificant trend. Several health-promoting strategies are required in order to improve lifestyle in a way that those raising cardiovascular risk factor trends would decline.

Vascular calcifications caused by atherosclerosis are frequently observed, especially in aortic and carotid arteries, with large and elastic characteristics. Early detection of calcification in these arteries can play an important role in reducing the clinical pathologies where atherosclerosis may cause, such as stroke and long-time disability. The aim of the present study was to determine the prevalence of calcified carotid artery plaques (CCAPs) on digital panoramic radiographs (DPR) and its association with gender, age, as well as 3 risk factors of cerebrovascular attack including hypertension, cardiovascular diseases, and diabetes mellitus. In this retrospective study, a total of 500 DPRs of subjects 45 years old and older (248 females and 252 males) were evaluated. All the subjects had been referred to the Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey, during 2014 - 2017 for a routine dental examination. Socio-demographic variables, as well as medical anamnesis, were obtained from the participants and medical records. The radiographs were grouped according to gender, age groups (45 - 60 years old and 61 years old and older), and associated risk factors (diabetes mellitus, hypertension, and cardiovascular diseases). Of 500 DPRs, 243 (48.6%) were noted to have CCAPs. The 243 individuals who had CCAPs consisted of 119 males (49.0% of all males) and 124 females (51.0% of all females). Of the subjects aged 45 - 60 years old, 87 individuals (17.4%) showed carotid artery calcifications on their DPRs while 156 subjects (31.2%) aged 61 years old and older showed carotid calcification. There were significant differences between age groups, hypertension, cardiovascular diseases, and the prevalence of CCAP, which increased (P < 0.01). As the associated risk factor increased, the prevalence of bilateral CCAP also increased (P < 0.01). The existence of bilateral calcified carotid artery plaques on digital panoramic radiographs has a higher prevalence in the subjects who had at least two associated risk factors and older; however, their detection is important to orient the diagnosis and prevention of diseases in asymptomatic high-risk patients.

Heat shock proteins are extracellular inflammatory intermediaries and intracellular cytoprotective molecules. Despite many studies on intracellular HSP70, the clinical association between inflammatory biomarkers and extracellular HSP70 antibody (anti-HSP70) levels is not well-studied. The aim of this study was to investigate whether raised serum anti-HSP70 in hemodialysis (HD) patients are related to levels of serum inflammatory markers and uric acid, as the key players, in the pathogenesis of the disease. This cross-sectional study was carried out from January 2018 to July 2018, on patients referred by the nephrologists from the central outpatient dialysis center of a governmental university-affiliated hospital, in Ahvaz, Iran. Ninety HD patients enrolled based on the inclusion and exclusion criteria. Blood samples were collected directly from the arteriovenous fistula before a routine HD session. The circulating levels of anti-HSP70, highly sensitive C-reactive protein (hs-CRP), Interleukin-6 (IL-6), and endotoxin were measured by Enzyme-linked immunosorbent assay (ELISA). The univariate regression analysis revealed a significant association between serum anti-HSP70 level and diabetes mellitus, hypertension, hemodialysis vintage, uric acid, hs-CRP, and IL-6 (P < 0.05). In a multiple regression model, after adjusting for confounders, the association between circulating anti-HSP70 and uric acid (B = 16.92, P = 0.001), hs-CRP (B = 11.77, P = 0.002), IL-6 (B = 2.87, P = 0.002), endotoxin (B = 0.14, P = 0.005), and hemodialysis vintage (B = 43.76, P = 0.002) was significant. Our findings suggest that the development of the excessive systemic inflammatory response and uric acid contribute to a higher serum anti-HSP70 leading to cardiovascular disease.

Depression is a severe mental disorder. Current antidepressants are effective in only one-half to one-third of the patients. Besides, these medications might bring about adverse effects. Therefore, the need for newer anti-depressant medications or complementary compounds is utterly felt. We tested the hypothesis that geraniol (GE) attenuates anxiety and depression via the amelioration of oxidative stress and apoptosis in mice. In an experimental study, thirty-six BALB/c mice were randomly divided into three control, chronic restraint stress (CRS), and GE groups. CRS and GE groups underwent CRS for two weeks. Accordingly, the CRS group received normal saline (2 mL/kg, i.p.) whereas the GE group received GE (50 mg/kg, i.p.). The behavioral outcomes were assessed using the open-field test (OFT), elevated plus maze (EPM), and tail suspension test (TST). Moreover, superoxide dismutase (SOD) activity, glutathione peroxidase (GSH-px) activity, total antioxidant capacity (TAC), and reactive oxidative species (ROS) levels in the brain were assessed using the spectrophotometric method. The brain’s BAX, Bcl-2, and caspase-3 levels were measured using Western blotting. CRS increased anxiety in stressed mice compared to the control group as indicated by OFT and EPM (P < 0.01 for both comparisons). Furthermore, CRS increased the immobility time in TST compared to control animals (P < 0.001). Biochemically, CRS decreased SOD activity (P < 0.01), GSH-px activity (P < 0.01), TAC level (P < 0.001), and ROS level (P < 0.001). It also increased the BAX/Bcl-2 ratio (P < 0.001) and caspase-3 level (P < 0.001) compared to the control group. GE reversed all the behavioral and biochemical changes in stressed mice compared to the CRS group. GE renders potent anxiolytic and antidepressant effects possibly through the modulation of oxidative stress and apoptosis in the mouse brain.

Like any other countries, respiratory distress syndrome is a major cause of infantile mortality in China, especially in low birth weight infants. The study aimed to determine the incidence of respiratory distress syndrome and identify some predictors of mortality in Chinese infants with confirmed respiratory distress syndrome (Level of Evidence: III). We retrospectively analyzed the demographic characteristics, perinatal risk factors, and clinical manifestations of 600 infants with Downes’ score of ≥ 4 admitted to the Affiliated BaYi Children’s Hospital, China, and the Second Affiliated Hospital of Nanchang University, China, from 1 January 2013 to 1 December 2018. Infants were divided into two cohorts, non-survivors (who died, n = 109) and survivors (who survived, n = 491). Factors predicting infant mortality were determined using univariate and multivariate logistic regression analysis at a 95% confidence level. Infants of the non-survivor cohort were more likely to have severer respiratory distress (P = 0.003), to be of low birth weight (< 1,000 g, P = 0.028), to undergo cesarean delivery (P = 0.005), and to be born preterm (P = 0.0001) than those of the survivor cohort. Downes’ score of > 6, extreme low birth weight (< 1,000 g, P = 0.001), preterm delivery (gestational age < 37 weeks, P = 0.003), and cesarean delivery (P = 0.002) were found to be the independent risk factors of infant death. Preterm delivery, extremely low birth weight, and cesarean section were the risk factors of infant death from respiratory distress syndrome.

Reactivation of BK virus (BKV), viremia is a major clinical complication in transplant recipients. There are many studies of BKV infection among tissue transplant recipients, especially renal-transplant recipients. Although the presence of BKV in patients’ urine occurs frequently, the detection of BKV in the blood of transplant recipients, especially after bone marrow transplantation (BMT), is less studied. The aim of this study was to detect BKV in 54 blood samples of BMT recipients in the first days after transplantation. This case-control study was performed in a university-affiliated hospital, Tehran, Iran, from October 2017 to October 2018. Blood samples were collected from 54 hematopoietic stem cell transplant recipients, and 54 healthy subjects without any tissue transplantation, and tested daily for BKV DNA using the quantitative real-time PCR technique. In this study, two patients (3.7%) developed BK viremia at a median of 10 days (range: 1 - 10 days) after BMT, while none of the control subjects was positive for BKV in blood samples. The analysis of data showed no significant difference between the case and control groups (CI: 0.986 - 1.094, P < 0.153). Our data suggest that BKV viremia involved in active infection may not occur in the first days after BMT. This finding can affect controlling and managing BMT patients.

Pelvic inflammatory disease (PID) is an infection of the upper genital tract often caused by ascending sexually transmitted infection. However, this condition is very rare in preadolescent and adolescent virgin females who are not sexually active. Pyosalpinx is a complication of PID and a cause of acute abdominal pain misdiagnosed due to similar abdominal emergencies. A 14-year-old virgin female patient was admitted to the Emergency Department of a secondary care general Hospital in Birjand City, South Khorasan Province, Iran, in 2017. She presented with abdominal pain, nausea, vomiting, and fever started two days earlier. She had no history of vaginal discharge. Ultrasound findings indicated enlargement of the right ovary and a hypo-echogenic mass surrounded by a fluid; adnexal torsion suspected. Another cystic lesion with a thick wall and 14 mm diameter was detected in the left ovary. The patient underwent appendectomy four years earlier. Laparatomy performed due to acute abdomen and pyosalpinx was real diagnosis. The PubMed, Scopus, Clinical Key, and Up To Date were searched for articles published in the English language up to 2017, using various combinations of the following keywords (MeSH terms were not used): pyosalpinx, virgin, intact, entire, virtuous, Vestal, pure, and maiden. Although rare, it is important to keep the pelvic infection in mind in the differential diagnosis of virgin female patients presenting with clinical symptoms of an acute abdomen, especially in the ones with the history of gastrointestinal and urinary tract infection or surgery.

Mediastinal hemangiomas are uncommon benign vascular tumors. They are histologically classified into capillary, cavernous, and venous types, according to the size of their vascular spaces. Phleboliths, multiple enhanced vessels, and peripheral puddling of contrast enhancement are the typical diagnostic features on computed tomography (CT). The cardiophrenic angle (CPA) area is a particular area of mediastinum and diseases in this region are rare but various. This paper describes a case of cavernous hemangioma located in the right CPA, lacking the typical CT imaging findings, that was definitively diagnosed after surgery. On March 20, 2017, a 38-year-old woman referred to Da-Ping hospital, which is a level III military hospital affiliated to the Army Medical University, Chongqing, China. She had a three-week history of intermittent cough, dull aching chest pain, and occasional palpitation. Her general physical examination and other routine lab tests and tumor markers were reported within the normal ranges. One day later, the chest plain CT showed a well-defined and non-invasive mass with soft-tissue density interspersed with a fatty ingredient in the right CPA with contrast agent. The tumor demonstrated non-enhancement neither in the arterial phase nor in the venous phase, and no apparent feeding vessels to the tumor were identified. It was initially suspected to be a benign ectopic thymoma. On March 27, 2017, the tumor was completely resected by video-assisted thoracoscopic surgery (VATS). Post-operative histological findings confirmed the diagnosis of cavernous hemangioma. The patient was in good condition at a five-month follow-up. Mediastinal cavernous hemangioma should be considered as an important differential diagnosis of mediastinal masses even though it is rare. Chest CT is useful in providing valuable information on the origin and invasiveness of the tumor, evaluating the relationship between tumors and intrathoracic vessels, and mapping the blood supply of tumors to select more suitable operative intervention.