javad ghaffari

Chronic spontaneous urticaria (CSU) is a skin disease caused by mast cells that produce inflammatory mediators. Immune checkpoint receptors such as program death-1 (PD-1) and T-cell immunoglobulin and mucin domain 3 (TIM-3) are essential for the pathophysiology of many autoimmune and allergic diseases. The aim of this study was to investigate the expression of PD-1 and TIM-3 in CSU patients and their relationship to the anti-inflammatory cytokines (TGF-β and IL-10). In the current study, peripheral blood mononuclear cells (PBMCs) from CSU patients and healthy individuals were used and the Urticaria Activity Score 7 (UAS7) was used to assess disease severity. TaqMan-based RT-PCR was used to assess the expression of TIM-3 and PD-1 as well as the anti-inflammatory cytokines transforming growth factor-β (TGF-β) and IL-10. The protein concentrations of TGF-β and IL-10 were also measured by ELISA. The relationship between the expression of TIM-3 and PD-1 as well as TGF- β and IL-10 and the severity of the disease was investigated. The results showed that PD-1 mRNA expression was significantly increased in CSU patients (P<0.0001), while TGF- β and IL-10 levels were higher in CSU patients, but this difference was not significant (p=0.638, p= 0.798). The increase in protein level of IL-10 was significant (P<0.0001).  There was also a positive correlation between the expression of PD-1 and TGF- β molecules and disease activity (P=0.0043, P=0.0018). In conclusion, the study found that the immune system expresses inhibitory molecules and anti-inflammatory cytokines to control disease severity. The higher expression of PD-1 molecules and IL-10 is associated with disease severity, suggesting that the immune system is trying to control inflammation and reduce disease severity.

Humans in their nature and innately have the motivation to perform moral behavior. But why do people not have the motivation to behave morally in some situations? Or even have the motivation to behave immorally. They become careless and evil. The same problem exists in the moral teachings of religion. The main question of the article is, "Why do religious people or those who claim to be religious, knowing the moral requirements of religion, do not have the motivation to perform moral actions?". Or sometimes they act against the moral orders of religion. So what is the relationship between religious beliefs aimed at moral propositions and moral motivation? Since the concept of "motivation" and related theories are discussed in "psychology" and the concept of "moral motivation" is one of the important and key topics in "moral psychology". For this reason, this article with a descriptive and analytical method tries to explain the factors and obstacles of "moral motivation" from a new perspective called "psychology of religious ethics" by referring to some verses and narrations. The result is that internal factors such as "weakness of will", "Faith" and "irreligiousness" and overcoming "desires and instincts" and "lack of awareness" and carelessness are obstacles to moral motivation. Also, external factors such as family, education and training system of society, real and virtual social relations and government behavior are effective in moral motivation of people.

Upper respiratory tract infections (URTI) are the most common human illnesses, leading to high absenteeism from school and work. 

 Although the importance of viral respiratory infections is known, preventive strategies are not yet well understood, so this study aims to investigate the preventive strategies. 

Several studies have confirmed that probiotics can reduce the frequency, duration and severity of upper respiratory tract infections.

Probiotic consumption was also associated with a significant reduction in school absenteeism and antibiotic prescription, as well as a significant decrease in fever (OR=0.19), cough (OR=0.14) and rhinorrhea episodes (OR=0.18). However, few clinical trials have investigated the effects of probiotics or synbiotics on specific viruses.

Further research is needed to determine the role of probiotics and prebiotics, especially postbiotics, in the treatment and prevention of respiratory infections. This study aimed to review the effect of probiotics against various viruses.

In this research, the phenomenon of stress relaxation in unreinforced and reinforced sandy soil with geotextile layer has been studied using a large-scale direct shear test. To investigate the effect of shear speed and soil density on the amount of resistance loss due to stress relaxation, two shear speeds of 0.5 and 5 mm/min and two relative densities of 35% and 60%, respectively, loose and medium density, have been used. All samples have been tested in direct shear test under vertical stress of 100 kPa. The results show that the amount of resistance loss due to stress relaxation depends on the shear stress level, soil density, presence of a geotextile layer in the soil and shear speed. In such a way that by increasing the level of shear stress and shear speed and by decreasing the density of sand and also with the presence of a geotextile layer in soil, the amount of resistance loss due to stress relaxation increases.

Allergic disorders are increasing prevalence from decades. Often of allergic diseases such as chronic urticaria in some aspects of quality of life of patients affected. Outdoor and indoor allergens can cause   aggravation of symptoms in allergic patients.H1-antihistamines have been available for decades and those are over-the-counter drugs. The first generation H1-antihistamines have anticholinergic and sedative effects. Basically, their use (H1 blockers) for the routine management of allergic diseases is not recommended.  Second generation H1-antihistamines (bilastine, cetirizine, desloratadine, ebastine, fexofenadine, levocetirizine, loratadine, and rupatadine) have minimally or non-sedating and free of anticholinergic effects. About 10–15% of pregnant women used antihistamine within pregnancy.

Ataxia-telangiectasia is a multi-organ disease. It is due to a mutation of the Exon No. 5 ataxia telangiectasia mutated gene (c.381delA: p.v128fls). Complications including recurrent infections, progressive cerebellar ataxia, and varying degrees of humoral and cellular immunodeficiency arise. 

We report a 7-year-old girl patient with A-T who developed acute rheumatic fever. 

Rheumatoid disorders and or infectious diseases such as acute rheumatic fever could be observed in A-T patient.

Urticaria is a common itchy skin condition characterized by swelling and erythema. A variety of treatments is available today. The purpose of this study was to evaluate the clinical effects of probiotic use in patients with chronic resistant urticaria.

This four-way blind randomized clinical trial was conducted between June 2019 and June 2020. Study population consisted of patients with chronic urticaria who did not respond well to first line treatment with antihistamines. For the intervention group, antihistamine (cetirizine) and probiotics (femilact capsule) and for the control group, antihistamine (cetirizine) and placebo were administered twice a day for 8 weeks. The “Urticarial Activity for 7 Days” (UAS7) questionnaire was used to assess urticaria activity and the Dermatology Life Quality Index (DLQI) questionnaire was used to assess the quality of life of patients.

Patients’ age range was 7 to 30 years with a mean and standard deviation of 23.6±9.2 years. 31 (81.57%) cases were females and 7 (18.42%) cases were males. Twenty patients were in the intervention group and eighteen patients were in the control group. The mean scores of UAS7 questionnaire were reduced in both groups, but it was more significant in the intervention group (9.6±6.4) compared to the control group (12.7±8.1) at the end of week eight of treatment (P=0.036). Also, there was no significant difference in the quality of life between the two groups after 8 weeks (P=0.805).

This study showed that probiotic consumption along with antihistamines significantly improved the activity of urticaria but not the quality of life of patients.

Coronavirus disease 2019 (COVID‐19, the 7th coronavirus) was a pandemic infectious disease with significant morbidity and mortality in the world. The respiratory system is often involved in COVID-19 infection. Underlying disorders such as uncontrolled asthma are a risk factor for COVID-19 infection. For protecting against COVID-19, we need vaccination-associated social care such as facial masks, distance, and sanitizers.

Chronic Urticaria (CU) is a skin disorder characterized by wheal and flare with a duration of more than 6 weeks affecting 1%-2% of the population (more common in women). Thirty to 35% of cases of CU have angioedema [1]. The etiology of chronic spontaneous urticarial is not usually clear, 40%-50% are idiopathic and 30%-40% are autoimmune [2, 3]. Quality of life in CU is usually disturbed which has a direct relation with severity [4].

Preterm delivery is one of the main causes of newborn mortality, signifying the inequality of conditions in receiving the necessary prenatal care. 

The present systematic review was conducted to investigate the relationship between preterm delivery and socio-structural determinants of health with an emphasis on occupation, education, and income in Iranian society based on the World Health Organization model.

In this systematic review, all observational articles published from 2000 to November 2021 were examined by searching the international and Persian databases of Scopus, PubMed, Google Scholar, Web of Science, Embase, ProQuest, Cochrane, IranDoc, and SID. Keywords were extracted through the MESH. The articles were searched using English and Persian keywords of occupation, education, income, social and economic status, and preterm delivery and appropriate operators, such as AND, OR, as well as a combination of the search strategy of each database, and all related articles were collected.

In the initial search, 1456 articles were found, and a total number of 17 articles were finally included in the study, of which 12 articles were on occupation, ten articles on education, four studies on income, two studies on socio-economic status, seven studies on occupation, and eight studies on education. All studies on income and socio-economic status had shown a statistically significant relationship between these structural determinants and preterm delivery. 

Preterm delivery is a prevalent problem with critical complications in Iran and there is a significant relationship between structural determinants and preterm delivery. Appropriate interventions, such as life skills training, self-care, and prenatal care can help mitigate pregnancy outcomes.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new coronavirus disease that is highly contagious and affects all age groups of children. The incubation period of Coronavirus disease (COVID-19) ranges from 2 to 14 days. Diagnosis of COVID-19 is made by conducting nasal and pharyngeal swabs and analyzing sputum, stool, and blood samples for COVID-19 nucleic acid using reverse-transcription polymerase chain reaction (RT-PCR). A nasal swab is more sensitive and specific than a pharyngeal swab. Lung CT imaging is a confirmation and complimentary method which is more sensitive than RT-PCR analysis. The mortality rate of COVID-19 infection is very low in children. Treatment of COVID-19 is supportive care and home isolation for 2 weeks (1). The disease has now spread to most countries. Clinical manifestations of COVID-19 vary from asymptomatic to a severe form in children (2).

Coronavirus disease 2019 (COVID‐19, the seventh coronavirus) is a new infectious disease that spread worldwide and rapidly became a pandemic. COVID‐19 is rare in children and often asymptomatic. The respiratory system is mainly involved in COVID-19 infection. 

This study aimed to review respiratory manifestations in children with COVID-19.

We searched for studies published from January 2020 to January 2021 in PubMed, Google Scholar, and Scopus in English. The search words were “2019-nCoV,” “novel coronavirus,” “COVID-19,” “SARS-CoV-2,” “severe acute respiratory syndrome coronavirus 2,” “children,” “child,” “infant,” “teenager,” “adolescent,” “pediatric,” and “neonate.”

Cough was a common symptom in our study (18.8%-100%, mean=64%). Pneumonia prevalence in children with COVID-19 is 11%-67% (mean=46%). Mild respiratory symptoms (14% - 60%) and severe respiratory distress syndromes (14%) were reported in some studies. Upper respiratory tract infection (URTI) was reported in 4 studies ranging from 11.1% to 34.4% (mean=24.1%). Ground-glass opacities (GGO) was reported in 12.2% to 81% of cases (mean=49.01%). Isolated consolidations were reported in 17% and 58% of patients in two studies. Enhanced lung texture was reported in 1.3% to 50% (mean=20.07%) of patients. Bilateral patchy shadowing was seen in 12.3% to 68% (mean=46.58%) of patients.

Cough is the most common manifestation of respiratory system involvement in children with COVID-19. GGO and bilateral patchy involvement are the most common finding on lung CT scans in children with COVID-19.

Allergic disorders such as asthma, urticaria, eczema, and allergic rhinitis are common worldwide, and allergens are the most common etiology and exacerbating factors. So, This study aimed to find the allergens in these patients with skin prick tests.

All the allergic cases referred to an allergic clinic in the north of Iran were visited by an allergist and clinical immunologist. Based on patient history, physical examination, and diagnosis, we select food allergens and aeroallergens. A standard skin prick test was performed on all patients, and all data was then analyzed SPSS 20.

Two thousand one hundred and twenty-eight cases entered the study with a mean age of 27.65 ± 15.52 years old. 1235 (58.04%) females and 893 males (41.96%) participated in this study. Prevalence of allergic rhinitis, asthma, urticaria, and eczema were 717 (33.7%), 611 (28.8%), 550 (25.8%), and 250 (11.7%), respectively. The most common aeroallergens were Dermatophagoides farinae (75.9%), Dermatophagoides pteronyssinus (65.4%), feather (56.1%), and Candida (51.1%), respectively, in all patients. The most common food allergens were egg white (31.1%), cacao (29.7%), and egg yolk (28.9%), respectively, in all cases.

Both aeroallergens and food allergens were the most common in all allergens by skin prick test. Therefore, it is important to find the relationship between sensitization and allergy.

The strength behavior of soil is affected by strength parameters including soil cohesion and its internal friction angle. These parameters are influenced by factors such as soil density, soil type, loading rate, moisture content, confining pressure and Etc. In this paper, the effect of loading rate on shear strength behavior of clay-sand mixtures is investigated using triaxial test. In this research, 8 types of "clay:sand" composite materials with weight ratios of 100:0, 80:20, 60:40, 40:60, 30:70, 20:80, 10:90 and 0:100 were used. To investigate the effect of loading rate, samples were subjected to non-uniform loading rates of 0.1, 1 and 5 mm/min with defined load pattern. In this study, three confining pressures of 100, 300 and 500 kPa were used. The results of this study show that, depending on the amount of confining pressure, the sudden change in loading rate has different effects on the strength of samples with different percentage of clay-sand combination. Deviator stress variations as well as the slope of the stress-strain curve depend on the amount of sand at the moment of sudden change in loading rate. In other words, changes in deviator stress and slope of the stress-strain curve are directly related to the amount of sand from one limit to the next. This limit of sand is 40% for low confining pressure (100 kPa) and 20% for higher confining pressure (300 and 500 kPa)

Acute generalized exanthematous pustulosis (AGEP) is a cutaneous reaction that can be appeared after the use of certain medications, such as cephalexin, with non-follicular sterile pustules, erythematous, urticaria, fever over 38  and leukocytosis. Cephalexin belongs to the family of beta-lactam antibiotics, which are widely used around the world to treat infections. However, cephalexin skin sensitivities have been reported worldwide once in a while. Herein, in this case, we aimed to report a patient presented with AGEP due to cephalexin usage.

Case Report:

A 12-year-old boy presented with warmth, skin lesions that gradually appeared on the other limbs, trunk, face, and neck after taking cephalexin powder arbitrarily on his left leg.  Due to his symptoms, acetaminophen, fexofenadine hydrochloride, loxoprofen sodium and ointment including difluprednate and hydrocortisone were prescribed. Over time, the patientchr('39')s fever subsided, and 8 days later, the symptoms of AGEP, including urticaria, erythematous, and pustules in the neck and trunk disappeared.

Cephalexin is one of the antibiotics that is considered by doctors and patients when there is a possibility of infection. AGEP is a rare but severe reaction that can develop into skin rashes of any age and sex following the use of cephalexin, paying attention to this issue forces the patient to be careful when using this antibiotic.

 Drug allergy is a subtype of Adverse Drug Reactions (ADR) mediated by the immunologic system. Extreme drug allergy is poorly known in children that contribute to the hospitalization in our region.

 This research aimed to study major drug hypersensitivity reactions in the north of Iran among hospitalized children.

 This corss-sectional study conducted at the Bou Ali Sina hospital, north of Iran, analyzing the medical history of 140 children with drug allergies from 2014 to 2018. Inclusion criteria were based on the DRESS scoring system, and those who scored more than four were enrolled. Patients with incomplete medical charts were excluded. The sampling methodology was based on the consecutive census.

 In the current study, 62 patients were females (44.29%), and 78 were males (55.71%). Ninety-six cases (68.57%) were children under five, and 44 cases (31.43%) were over five years old. Most ADRs were seen in patients from urban areas (58.57%)  than in rural areas (41.43%). In 82.6% (116 children) of these patients, maculopapular rashes were seen. Phenobarbital and cefalexin had the highest levels of drug reactions, including 55.19% of patients (85 persons) and 11.69% of patients (18 persons), respectively. Pruritus, fever, and scaling were the most common symptoms observed in patients. The most commonly used treatment was antihistamines.

 The most causative medication inducing ADR was phenobarbital. The maculopapular rash was the most common skin manifestation, and there were no relationship between sex, age, medication type, and type of hypersensitivity reactions.

Asthma is a chronic inflammatory respiratory disorder. Nutritional conditions affect allergic diseases such as asthma. The aim of this study was to review the serum zinc level in children with asthma.

This is a review article found in databases such as Google, PubMed, SID, Irandoc, Scopus and up-to-date. Key words for search included zinc, asthma, children and pediatric. There was no time limitation for the search. These articles on zinc levels in asthmatic children were meta-analyzed.

Out of the 40 articles, 19 articles were excluded and 21 articles were included in this analysis. 15 articles evaluated serum zinc levels, 4 articles on hair zinc levels, one article evaluated nail zinc levels and another on zinc level in erythrocyte cells in children with asthma. Only 3 articles evaluated effects of zinc supplement treatment in children with asthma. Meta-analysis of studies showed that there was no significant difference between the standard mean differences of zinc level in asthmatic patients compared to the control group. We cannot analyze the association between zinc levels in hair and nail in children with asthma. All clinical trial studies show that zinc supplement improves clinical manifestations of asthma and patient’s pulmonary function test.

We found that the mean serum zinc level difference is not significant in children with asthma than healthy control group and it seems that there is no relation between mean serum zinc level and severity of asthma in children.

Urticaria is a pruritic cutaneous disease characterized by weal and flare.  Acute and chronic urticaria affects the quality of life. Some abnormalities are associate or comorbid with urticaria. The purpose of this study was to examine comorbid conditions in patients with urticaria.

We searched in many databases including Google Scholar, PubMed, Scopus, and Embase. Keywords were comorbid and urticarial. All full articles and the English language were included. We evaluated 500 articles that reported association or relation as comorbidity between urticarial and disorders in primary screening to be 250, 100, 80, and 70 articles in Google Scholar, PubMed, Scopus, and Embase, respectively.

Prevalence of psychiatric problem (according to SCID-1) was 60% in chronic idiopathic urticaria. Thyroid autoantibodies (anti-thyroglobulin and anti-peroxidase) were found to be positive about 5 to 15% of CU. Food allergy, allergic rhinitis, atopic dermatitis, and asthma were significantly higher in CSU. Eradication of H.pylori infection was a tendency to more rapid improvement of chronic urticaria.

Psychiatric disturbances, such as depression or anxiety and autoimmune thyroid disorders, were documented to be more common in chronic urticaria which should be considered as comorbidity.

Waste tires are widely used for geotechnical applications as backfill material that is either a substitute for natural soils or combined with them. This paper determines the shear strength parameters of tire chip-sand-geotextile mixtures using a triaxial test apparatus. For this purpose, tire chip–sand mixtures with mixing ratios of 0:100, 15:85, 25:75, 35:65, and 100:0 by volume were used as fill materials. Also, for the reinforcement of these mixtures, the layer of geotextile is used. In all tests, the strain rate has been kept the same. Three confining pressures have been applied in all experiments. The influences of the tire chip content, number of geotextile layers, and confining pressure at the strain levels of 3%, 6%, 9%, 12%, 15%, and 18% on the sample were studied and described. This paper focuses on the stress-strain behavior of different mixtures. The results show that the imposed strain level on the samples plays an essential role to increase the strength of the tire chip-sand mixtures compared with sand alone. It implies that the beneficial effect of tire chip content to enhance the strength of samples appears in high strain, especially for reinforced samples with geotextile, while in low strain, tire chip does not have a beneficial effect. Hence, it is necessary to consider the strength of tire chip-sand mixtures compared with sand alone at the imposed strain level.

Context: 

Asthma is a chronic inflammatory respiratory disorder, and nutritional conditions affect allergic diseases such as asthma. This study aims to find the relationship between maternal gestational vitamin D levels and asthma progression and wheezing in children later in life. 

Allergic disorders are common everywhere in the world. Asthma is the most chronic inflammatory respiratory disorder among children. It causes significant morbidity and mortality in children as well as adults. Vitamin D deficiency or insufficiency, is a global problem. Vitamin D has immunological effects, and it may prevent autoimmune diseases. Maternal plasma vitamin D during pregnancy has a different impact on children’s allergic disorders.

Evidence Acquisition:

 This is a review article. We searched databases, including Google Scholar, PubMed, SID, IranDoc, Scopus, until now. The keywords for the search included maternal vitamin D, asthma, wheezing, children, and pediatric. We searched in the mentioned databases until March 2020. Full-text articles in the English language were included in this study.

A few articles were found in our search. All of them were cohort studies. They evaluated maternal vitamin D and its outcomes in their children’s asthma and wheezing using questionnaire data and serum samples. After assessing the articles (more than 100), 15 papers were included in our review. Six and four articles showed that higher maternal vitamin D levels reduce children’s asthma and or wheezing, respectively. In contrast, 7 articles showed no association between maternal vitamin D and children’s asthma or wheezing. Vitamin D does not have any serious side effects. Because the articles were heterogenic, a meta-analysis could not be done.

Administering vitamin D supplements or food enriched vitamin D during pregnancy has different effects on the prevalence of wheezing and or asthma in children.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus with highly contagious that affects all ages such as children. Any age, including infancy, could be affected by the pandemic.

Exposure to house dust mites is an important cause of asthma among children. The main asthma-causing mites found in homes are Dermatophagoides farinae and Dermatophagoides. pteronyssinus. Der f1 or Der p1 are allergens of the mentioned mites. This study aimed to assess the levels of Der p1, and Der f1 in the homes of families that had a case of childhood asthma in a northern city of Iran and to determine the association between indoor house environment and the level of mites allergens present there.

Dust samples were collected from bedrooms of 91 homes of families that had cases of childhood asthma. Families filled a questionnaire about demographical characteristics and the indoor condition of their living environment. The levels of Der f1 and Der p1 were measured by enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed in SPSS 24 and a P value less than 0.05 was considered significant.

we found that Der p1 was more prevalent than Der f1 among samples. The mean concentration of Der p1 concentration was 271.35 ng/g (9 times greater than the concentration of Der f1). When the indoor environment status was evaluated, it was found that keeping pets and having old carpets are associated with Der f1 (P<0.05). However, no significant association was found between Der p1 and the indoor conditions of the home.

Our study showed that Der p1 level is higher than Der f1 level in the houses of children with asthma. We suggest removing carpets and pets from the house.

Asthma is one of the most common persistent inflammatory respiratory disorders. Comorbidities are relatively common in asthma. The aim of this review study was to find comorbid disorders in children with asthma.

For the purpose of this review, we searched databases including Scopus, Google scholar, PubMed, SID, Irandoc and up-to-date. Key words for the search included children asthma, comorbidity and pediatric asthma. There were no time limitations for the search. Full text articles in English language were included in this study.

Neuropsychiatric comorbidities were Attention-deficit/hyperactivity disorder (ADHD) (11.5%), oppositional defiant disorder (ODD) (10.7%), separation anxiety disorder (6.1%), social anxiety disorder (3.8%), specific phobias (2.3%), agoraphobia without panic (1.5%), (mild) manic episodes (1.1%), major depressive episodes (MDE) (0.8%), movement (tic) disorder (0.8%) and dysthymia (0.4%). The prevalence of sinusitis was 13% in children with asthma (17). Prevalence of asthma in chronic rhinosinusitis with polyposis (CRSwP) is 26-48%, but the prevalence of CRSwP in asthmatic patients is only 7%. Asthma was prevalent in 25-35% patients with allergic rhinitis, and rhinitis symptoms were present in 75-90% of asthmatic patients. Asthma and obstructive sleep apnea (OSA) commonly coexist. Snoring (49.5%), gastro-esophageal reflux disease (GERD) (46.3%), atopic dermatitis (27.3%), allergic sinusitis (20%) and food allergy (10.5%) were common in children with asthma.

Our review has revealed that allergic rhinitis, gastroesophageal reflux, obesity, food allergy, obstructive sleep apnea, allergic conjunctivitis, chronic rhinosinusitis and psychological abnormalities are common comorbidities in children with asthma.

Asthma is the most common disease in childhood that can impair lung function but can be prevented with asthma attacks to a large extent.Also the purpose of this study was to evaluate the effectiveness of periodic exercises and respiratory muscles on some anthropometric and spirometric indices and strength and endurance of respiratory muscles in children with asthma. This study was a quasi-experimental research. It was administered to male students with asthma aged 10-12 years. The study samples consisted of 32 asthmatic patients, non-randomly screened. Subjects were divided into 4 groups: control, periodic exercise, respiratory muscles and combination group and one healthy control group.. Periodic training program using the Ergometer for eight weeks, three sessions per week for 30 minutes between 50 and 80 W / min.Respiratory Muscle Exercises were performed using a tail-specific exercise machine for two sets of 10 repetitive 10-second repetitions and 15 seconds resting with a closed nose once a day, three days a week, at 30% S-Index intensity. Every two weeks, its intensity increased by five centimeters. Statistical analysis was performed using one-way ANOVA, covariance analysis, pair sample t test at p <0.05.. Anthropometric and spirometric indices and strength and endurance of respiratory muscles were measured before and after training.Results showed that weight, BMI and heart rate significantly decreased after eight weeks of intermittent exercise, respiratory muscles and hybrid compared to control (P <0.05).In FVC, FEV1 and FEV1 / FVC, there was a significant increase (P <0.05) after intervention in the groups compared to the pretest and the control group.Respiratory muscle strength in the periodic training, respiratory muscles and Combined group increased significantly (18.32%, 25.88% and 36.72%, respectively) compared to the pretest and control group.Respiratory muscle endurance also increased in the periodic training group, the respiratory muscles group and the combined group significantly 33.93%, 23.67% and 50.81%, respectively (P <0.05) compared to the pretest and control group. According to the findings of the study, it is suggested that combination of respiratory and periodic muscles exercises will improve spirometric parameters and strength and endurance of respiratory muscles.

Urticaria is a pruritic skin lesion characterized by rapid onset of blanchable central wheals and marginal flare. Urticaria diseases are categorized on the basis of their duration, etiology, and causes. In this review, a thorough search was conducted in electronic databases such as Scopus, Pubmed, and Google Scholar using the following keywords: urticaria, acute urticaria, chronic urticaria, etiology of urticaria, diagnosis of urticaria, and treatment of urticaria. Search was limited to the articles published in January 2006 to December 2019. Urticaria is a highly prevalent disease that is experienced by 10-20% of general population during their lifetime. Acute urticarial is more common and affects about 1-5% of the population. Patients with urticaria, especially chronic urticaria are prone to stress, excitement, or obsession and have low quality of life. The etiology of urticaria is still unknown in most cases and usually a complete history and physical examination helps in making diagnosis. Antihistamines are the first-line treatment of both acute and chronic urticaria. This study aimed to review the latest etiologies of urticaria and its diagnostic and therapeutic approaches.