Platelet Count and IgE Level in Chronic Idiopathic Urticaria: A Case-control Study.

BACKGROUND AND AIM: Chronic Urticaria is an allergic disorder that affects about 0.5 to 5% of the population in different communities. The disease's chronic course and long-term onset impose high economic and psychological costs on communities, adversely affecting individual and social life. Platelets play a role in various pathophysiological processes, including inflammation and immunology. Growing evidence suggests that platelets are actively involved in the pathogenesis of various inflammatory disorders, including inflammatory skin diseases. This study investigated the relationship between platelet and immunoglobulin-E markers and chronic idiopathic urticaria. MATERIALS AND METHODS: In the present case-control study, for the study population, patients with chronic idiopathic urticaria were referred to the Asthma and Allergy Clinic, and their caregivers were selected as the case and control groups, respectively. In this study, the mean platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and Total IgE values were simultaneously measured in the case and control groups. After taking 5CCs of venous blood, a blood sample was sent to the laboratory for platelet and IgE marker measurements. RESULTS: 100 patients and 100 healthy persons were evaluated in this study. The mean age in the case group was 34.95, and in the control group was 35.78 years. The results showed that the mean values of PLT, MPV, PDW, and Total IgE in the case group were 12.86, 9.83, 252190, and 147.05, respectively. The mean values of PLT, MPV, PDW, and Total IgE in the control group were 16.93, 7.53, 231410, and 15.29, respectively, which was statistically significant (P = 0.001). Moreover, total IgE in the Autologous Serum Skin Test (ASST) positive group was higher than ASST negative group and was statistically significant (P = 0.001). CONCLUSION: The study results indicate the possible role of platelets in urticaria and inflammation. MPV in patients with chronic urticaria was higher than in the control group. The present study showed no significant relationship between the severity of urticaria and platelet markers, but there was a significant relationship between the severity of urticaria and ASST. Moreover, the severity of urticaria was higher in the positive skin test group.

The Prevalence of Asthma among Iranian Children and Adolescent: A Systematic Review and Meta-Analysis.

BACKGROUND: Asthma is an important reason for hospitalization in children aged under five years. Information about the current status of asthma in Iranian children can help the Iranian health sector plan carefully and prevent asthma incidence by educating the families. The present systematic review and meta-analysis is aimed at estimating asthma prevalence in Iranian children and adolescents. METHOD: Data were found using keywords such as prevalence, epidemiology, asthma, adolescent, children, pediatrics, Iran in Web of Science, Scopus, PubMed, Cochrane, and Embase databases. Three national databases, including Magiran, Barakat Pharmed Co (Iran medex), and Scientific Information Databank (SID) were searched until 1 October 2020. Cross-sectional and original studies were included in the study, and then, quality assessment was done using the National Institutes of Health's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A pooled estimated prevalence of asthma was calculated using Der Simonian-Laird random model. Egger's test was used to evaluate publication bias. The data were analyzed using the STATA software version 16. RESULTS: 30 studies were selected and investigated. The prevalence of asthma in children and adolescents was 6% and 8%, and the prevalence in boys and girls was 9% and 8%, respectively. Among the asthma symptoms, wheezing had the most prevalence (17% in children and 19% in adolescents) and sleep disturbance had the lowest prevalence (6% in children and 6% in adolescents). CONCLUSION: The prevalence of asthma in Iranian children and adolescents is lower than in the world. Existing strategies should be pursued followed. Also, guidelines for asthma control and prevention should be considered in the future.

Diarrhea as a Presenting Symptom of Coronavirus Disease 2019 in Children.

Gastroenteritis is common among children and is usually caused by bacterial, viral, or parasitic gastrointestinal infections. The occurrence of gastroenteritis as the only symptom of coronavirus disease 2019 (COVID-19) is an uncommon condition. We present a 16-month-old girl that has recently been admitted to our hospital with vomiting, diarrhea, and lethargy, who was ultimately diagnosed with COVID-19. This case shows that the clinical manifestations of COVID-19 can be misleading in children.

Hepatic Failure following Metronidazole in Children with Cockayne Syndrome.

Cockayne syndrome is an uncommon autosomal recessive disease characterized by microcephaly, abnormal growth, and pathologic premature aging. The purpose of this report is to evaluate liver failure in children with Cockayne syndrome following metronidazole administration. The first case was a 2-year-old boy with Cockayne syndrome. He had been treated with metronidazole for gastroenteritis. 48 hours after treatment initiation, he was hospitalized due to jaundice, intractable vomiting, and agitation. Unfortunately, he died of acute liver failure. The second case was a 5-year-old boy with Cockayne syndrome as well, who had been treated with amoxicillin and metronidazole for a dental infection. He developed jaundice, drowsiness, lethargy, and anorexia after treatment. At hospital, the child received supportive treatment, and his general condition gradually improved. The liver enzyme levels decreased. He was finally discharged in good general condition. The mortality after metronidazole consumption in patients with Cockayne syndrome due to liver failure is very high. The awareness of the dangers of using metronidazole in these patients is valuable.

The Prevalence of Allergic Rhinitis among Iranian Children: A Systematic Review and Meta-Analysis.

BACKGROUND: The prevalence of allergic rhinitis in the world is 10-15%, and it is currently the most common chronic disease among children. There is no comprehensive statistics about the prevalence of allergic rhinitis among Iranian children, therefore, this systematic review and metaanalysis was conducted to evaluate the prevalence of allergic rhinitis among the Iranian children. METHODS: The present study was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The data was collected using key words including allergic rhinitis, prevalence, epidemiology, child OR children, pediatrics and Iran, in international databases including PubMed, Scopus, Web of Science, Cochrane, Embase, and three national databases including Magiran, Iran Medex, and Scientific Information Databank (SID) till December 2018. The STROBE checklist was used for quality assessment. The data were analyzed using STATA software version 12.1. RESULTS: The prevalence of allergic rhinitis in children and adolescents were 18% (99.7% CI: 10-28% with publication bias of 0.174) and 25% (99.8% CI: 17-33 with publication bias of 0.617) respectively. The prevalence of allergic rhinitis in males was estimated to be 27% (99.4% CI: 17-36) with publication bias of 0.538 and in females was 23% (99.4% CI: 14-31) with publication bias of 0.926. CONCLUSION: The prevalence of allergic rhinitis is approximately high among Iranian children and adolescents; thus, educational strategies should be considered to decrease the prevalence of this disease in Iran.

Serum level of stem cell factor and its soluble receptor in aspirin-exacerbated respiratory disease.

Aim: Stem cell factor (SCF) may be associated with inflammatory processes leading to aspirin-induced asthma. This study evaluated the relationship between serum level of SCF and its soluble receptor with aspirin-induced asthma. Methods & materials: Twenty-five patients and 25 healthy controls were enrolled in this study. The concentration of SCF and mast/stem cell growth factor receptor (C-kit) was determined in serum samples. Spirometry and rhinometry were performed to determine the severity of the disease. p < 0.05 were considered significant. Results: The serum levels of SCF and C-kit receptor were significantly higher in the case group. The serum SCF and C-kit level had a significant positive correlation with the severity of asthma, disease duration and nasal obstruction. Conclusion: Our findings suggest that SCF and C-kit receptors have a direct effect on the severity of aspirin-induced asthma.

The relationship between B7 homologous 1 with interleukin-4, interleukin-17 and interferon gamma in patients with allergic rhinitis.

Background: The etiology of allergic rhinitis includes an increase in cytokine levels, including IL- 4, IL-13, IL-17, and reduction in B7 homologous 1 (B7-H1) or programmed cell death-1 ligand-1 (PD-L1), a new member of the CD28: B7 stimulant molecule family. The aim of this study was to determine the relationship between cytokines and PD-L1. Methods: In this experimental study, 80 patients with allergic rhinitis were enrolled according to inclusion and exclusion criteria. The severity and stage of the disease were determined by a specialist physician. A 5 cc venous blood sample was collected from the patients. IL-4, IL-17, INFγ and PD-L1 were measured using ELISA technique. Results: There was a significant correlation between SPD-L1 and INFγ, IL-4 and IL-17 in allergic rhinitis patients (P < 0.05). Statistical analysis based on the severity of the disease (Mild, Moderate and Severe) showed a significant positive correlation between the SPD-L1 and INFγ in all three levels (P < 0.001). There was also a significant negative correlation between SPD-L1 and two cytokines IL-4 and IL-17 (P < 0.001). Conclusion: PD-L1 may have a protective role against allergic rhinitis, although the precise mechanism requires further detailed studies.

The chemokine CCL28 is elevated in the serum of patients with celiac disease and decreased after treatment.

Accumulating evidence show that many inflammatory cytokines are involved in pathophysiology of celiac disease (CD). CCL28 known as mucosa associate epithelial chemokine (MEC) is produced by mucosa and chemoattracts IgA-producing B cells into the mucosa. However, its levels in patients with CD have not yet been elucidated. CCL28 levels and anti-tTTG (IgA) were detected in the serum of 28 new cases of CD, 32 cases of treated patents and 32 normal individuals by Elisa. Moreover, the effect of gluten on intestinal cells, Caco-2, was examined by RT-PCR. Our data show that (i) the levels of CCL28 is significantly higher in patients with CD than normal individuals, (ii) CCL28 levels is reduced in patients with CD who had gluten-free diets. Accordingly, we observed that CCL28 expression is upregulated in a dose-dependent manner when the Caco-2 cells were cultured in the presence of gluten. In conclusion, gluten enhances CCL28 expression and that CCL28 could be a novel biomarker for diagnosis and following up the patients with CD. However, further investigation in a larger number of patients is required.

Inverse correlation of soluble programmed cell death-1 ligand-1 (sPD-L1) with eosinophil count and clinical severity in allergic rhinitis patients.

BACKGROUND: T-cell response outcome is determined by co-stimulatory/inhibitory signals. Programmed cell death-1 ligand-1 (PD-L1) is a member of these co-signaling molecules with known soluble form in human serum. Soluble PD-L1 (sPD-L1) is also recognized in patients with some types of malignancy or autoimmune disorders, though there are few studies on sPD-L1 roles in allergic diseases. The purpose of this survey was to evaluate the association between sPD-L1 levels with eosinophil count as well as disease severity in allergic rhinitis (AR) patients. METHODS: 90 patients with AR were selected. Disease severity was determined by a modified Allergic Rhinitis and its Impact on Asthma (ARIA) classification as mild, moderate and severe. Whole blood samples were collected. Then eosinophil count and serum sPD-L1 were detected by a hematologic analyzer and a commercial ELISA kit. RESULTS: 13 (14.44%), 31 (34.44%), and 46 (51.12%) of patients had mild, moderate and severe disease, respectively. The mean levels of sPD-L1 and eosinophil count were ascertained 18.38 ± 14.42 ng/ml and 422.43 ± 262.26 cell/µl. A significant inverse correlation was determined between sPD-L1 levels and eosinophil count (r = -0.364, P < 0.001). Moreover, we detected a significant negative association between sPD-L1 levels and disease severity (r = -0.384, P < 0.001). CONCLUSIONS: It is deduced that sPD-L1 can be used as a helpful marker to determine the severity of AR. Furthermore, this study indicated that sPD-L1 may have an inhibitory role in AR development, and its modulation may be considered as a useful accessory therapeutic approach for reduction of AR progression.

A model-based approach to stability analysis of autonomic-cardiac regulation.

This paper presents a model-based approach to analyze the stability of autonomic-cardiac regulation. In the proposed approach, a low-order lumped parameter model of autonomic-cardiac regulation is used to derive the system equilibria based on the measurements of heart rate and blood pressure, and then the stability margin associated with the equilibria is quantified via the Lyapunov's stability analysis method. A unique strength of the proposed approach is that it provides a quantitative measure of autonomic-cardiac stability via a computationally efficient analysis. Therefore, by integrating it with system identification techniques to derive autonomic-cardiac regulation model tuned to each individual, the proposed approach is able to assess subject-specific autonomic-cardiac stability. Indeed, our initial in-silico investigation showed that the proposed approach could estimate the system equilibria accurately, and the associated stability margin behaved consistently with widely accepted physiologic knowledge. The proposed approach may be useful in identifying physiological conditions that can lead to instability in autonomic-cardiac regulation, quantifying the margin of stability and distance to instability related to autonomic-cardiac regulation, and developing interventions to prevent autonomic-cardiac instability.

Effect of supplementary zinc on body mass index, pulmonary function and hospitalization in children with cystic fibrosis.

Zinc deficiency, which is common in patients with cystic fibrosis (CF), can lead to several complications that may increase the number of hospital admissions in this group of patients. As supplementary zinc can prevent such complications, this study was performed to evaluate the effect of supplementary zinc on body mass index (BMI), forced expiratory volume in one second (FEV1) and number of hospitalizations in CF patients. In this study, 30 children with CF, who were referred to the Digestive Diseases Clinic of the Children's Medical Center in Tehran, were enrolled. Supplementary zinc of 2 mg/kg per day was administered to all patients. Serum level of zinc, alkaline phosphatase, and albumin as well as BMI, FEV1, and number of hospitalizations were compared before and after zinc administration. Height (p<0.001), weight (p<0.001) and BMI (p=0.001) were significantly increased after zinc, while the number of hospitalizations was significantly decreased (p=0.023). In contrast to patients with normal pulmonary function tests who received supplement therapy, BMI was not increased in those with abnormal pulmonary function after supplementary zinc. Supplementary zinc can increase BMI in CF patients, mostly in those with normal pulmonary function. While supplementary zinc may decrease the number of hospitalizations, other factors can also influence the hospitalization number.

Noninvasive subject-specific monitoring of autonomic-cardiac regulation.

This paper presents a feasibility study of a model-based approach to noninvasive and subject-specific monitoring of autonomic-cardiac regulation. The proposed approach is built upon individualizing a physiologically-based model by applying a parameter estimation method to routine clinical observations, thereby assuring physical transparency, computational efficiency, and clinical adaptability. To develop an efficient parameter estimation procedure, a parametric sensitivity analysis was performed on the autonomic-cardiac regulation model to identify high-sensitivity model parameters whose changes exert significant impacts on the system outputs. Then, a parameter estimation problem formulated as a nonlinear optimization was solved to estimate high-sensitivity model parameters associated with autonomic-cardiac regulation, whereas the remaining parameters were fixed at their nominal values. The proposed approach can potentially monitor temporal changes in autonomic-cardiac regulation by identifying time-varying changes in the autonomic-cardiac model parameters, including sympathetic and parasympathetic nerve activities on the heart (modulating heart rate), and sympathetic nerve activity on the arterial tree (modulating total peripheral resistance). The proof-of-concept for the proposed approach was tested using a number of experimental data from the MIMIC database and the orthostatic hypotension tests. Our finding shows that the proposed approach is able to provide low-variance estimates of the autonomic-cardiac model parameters, which are consistent with their anticipated behaviors inferred from the physiologic knowledge. An extensive comparison study must be conducted in the future to establish the clinical validity of the proposed approach.

Breastfeeding and Helicobacter pylori Infection in Early Childhood: a Continuing Dilemma.

OBJECTIVE: Helicobacter pylori (H. pylori) is the most common chronic bacterial infection in humans. Chronic colonization increases the risk of duodenal ulcer and gastric cancer. The risk factors for acquiring the infection have been extensively studied. However, there are conflicting results on the role of breastfeeding in the prevention of H. pylori infection. We conducted a study to evaluate the effects of breastfeeding on the H. Pylori infection in Kurdish children in Sanandaj, IR Iran. METHODS: A historical cohort study was carried out from January 2011 through December 2012. Totally 221 children who were going to attain 2 years old during the study period were randomly enrolled. They were divided into two groups, i.e. breastfed and non-breastfed. We used H. pylori stool antigen test to detect infection in the selected group of children after age of 2 years and cessation of breastfeeding. Each group was subdivided into two subgroups, infected and non-infected. The associations of breastfeeding with H. pylori infection was assessed using statistical software. FINDINGS: We found no difference in the odds of infection between breastfed and non-breastfed groups (OR=0.809, 95% CI [0.453-1.444]). An association between age and the prevalence of infection was found (P=0.008). There was an increase in the odds of infection as the family size grew (OR=1.93, 95% CI [1.04-3.6]) as well as increasing housing density (OR=2.12, 95% CI [1.10-4.10]). CONCLUSION: The data suggests that breastfeeding in infancy does not protect against H. pylori infection for long duration among studied children in Iran. The protective effects of breastfeeding, if any, are at most transient.

A novel approach to the design of an artificial bionic baroreflex.

This paper presents a computationally efficient method to design an artificial bionic baroreflex. This work is built upon a physiology-based mathematical model of autonomic-cardiac regulation describing the regulation of heart rate and blood pressure as well as a system identification technique to identify a subject-specific mathematical model for each subject. The control strategy to regulate blood pressure is developed based upon the in-vivo baroreflex mechanism. A unique strength of the proposed method is its capability to determine the modulating baroreflex functions on the sympathetic and parasympathetic nerve activities. This method can be used in the treatment of individuals with baroreflex failure through overriding the corresponding nerves to properly regulate blood pressure. In fact, nerve overriding causes heart rate and arterial stiffness to adjust such that blood pressure reaches a proper range to provide enough oxygenated-blood to the critical organs.

Autonomic-cardiorespiratory regulation: a physiology-based mathematical model.

This paper presents a novel physiology-based mathematical model of autonomic-cardiorespiratory regulation described by a set of three nonlinear, coupled differential equations. We improved our previously proposed autonomic-cardiac regulation model by considering neuromechanical and mechanical coupling of cardiovascular and respiration systems including lung stretch-receptor reflex and venous return variation. We also introduced a differential equation describing respiration rate regulation which mainly originates in the medullary respiratory center. The results of simulation experiments suggest that the venous return variation generates a higher perturbation on heart rate and blood pressure than lung stretch-receptor reflex. The proposed model is also powerful in determining and removing direct respiratory impacts on parasympathetic activation tone to accurately extract parasympathetic activity caused by emotional states and environmental conditions.

Cow's Milk Allergy among Children with Gastroesophageal Reflux Disease.

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) and cow's milk allergy (CMA) are two common conditions that occur in infancy. This study was performed to investigate the frequency of CMA in a group of patients with GERD. METHODS: Eighty-one children with signs and symptoms of GERD were enrolled in this study. All subjects received omeprazole for 4 weeks after the initial evaluation. Empirical elimination of cow's milk from the diet was started for the patients who did not respond to the omeprazole treatment. RESULTS: Seventy-two cases presented with gastrointestinal signs and symptoms, whereas the remaining nine cases presented with respiratory complaints. After the initial treatment with omeprazole, two thirds of the cases (54 patients, 66.7%) responded well, and all of their symptoms were resolved. Cow's milk was eliminated from the diets of the remaining 27 patients. All signs and symptoms of GERD were resolved in this group after a 4 week elimination of cow's milk from the diet. CONCLUSIONS: A diagnosis of CMA was considered in one third of the pediatric cases with signs and symptoms of GERD. This finding shows that CMA can mimic or aggravate all signs and symptoms of severe GERD during infancy.

A systematic approach to local stability analysis of cardiovascular baroreflex.

This paper presents a novel systematic approach to the stability analysis of the cardiovascular (CV) baroreflex. The proposed approach determines the equilibrium state and the system stability in its neighbourhood with computational efficiency, once the parameters of the CV baroreflex model are specified for an individual. We first propose a linearization-based analytical method for determining the equilibrium state of the CV baroreflex. We then present a Lyapunov-based systematic approach to analyze the system stability in the neighbourhood of the equilibrium state. The results of simulation experiments suggest that the performance of the proposed approach is encouraging: it was able to accurately determine the equilibrium state and quantify the stability of the CV baroreflex. The proposed approach is also powerful in exploring the relationship between the CV baroreflex stability and its parameter configurations.