Epidemiology, Sociodemographic Factors and Comorbidity for Allergic Rhinitis, Asthma, and Rhinosinusitis Among 15 to 65-year-Old Iranian Patients.

Background: It is well established that upper and lower airways are often clumped together when diagnosing and treating a disease. This study was designed to determine the prevalence of upper and lower airway diseases and to assess the effect of sociodemographic factors on the prevalence and the comorbidity of these disorders. Methods: This cross-sectional population-based study included patients with ages ranging between 15 to 65 years, who were referred to allergy outpatient clinics in various provinces of Iran from April to September 2020. A modified global Allergy and Asthma European Network (GA2LEN) screening questionnaire was filled out by local allergists of the 12 selected provinces in Iran. Information about the patients and sociodemographic factors was also recorded. Statistical analysis was done by univariate statistical analyses and multiple logistic regressions in SPSS software Version 26. Results: Out of 4988 recruited patients, 1078 (21.6%) had the symptoms of allergic rhinitis (AR) and 285 (5.7%) met the criteria of asthma. The prevalence of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) was 21.6 % and 22%, respectively. The highest prevalence of AR and ARS was in Tehran with the arateof of 33.9% each. Asthma was more prevalent in Khuzestan (14.2%) and CRS in Baluchestan (57.5%). Our analysis showed that the patients with asthma were most likely to have other allergic diseases as well-CRS (OR = 4.8; 95% CI, 2.02- 5.82), AR (OR= 2.5, 95% CI, 2.10-3), ARS (OR = 1.8; 95% CI, 2.10-3), followed by eczema (OR = 1.4; 95% CI, 1.13-1.67).We found that those individuals with CRS were most likely to have painkiller hypersensitivity (OR= 2.1; 95% CI, 1.21-3.83). Furthermore, smoking has been found more than 1.5 folds in patients with ARS. After adjusting variables, there was no correlation between education, occupation, and ethnicity with the studied diseases. Conclusion: Rhinosinusitis is a common condition among Iranian patients. This study confirmed that inflammation of the upper and lower airways can occur simultaneously. Gender, education, occupation, and ethnicity were found to be irrelevant in the development of either AR, asthma, ARS, or CRS.

Comorbidity of asthma in patients with attention-deficit/hyperactivity disorder (ADHD) aged 4-12 years in Iran: a cross-sectional study.

Attention-deficit/hyperactivity disorder (ADHD) is defined as a stable pattern of attention deficits or impulsive hyperactivity that can interfere with the functioning, growth, and development of individuals. It is believed that both the type of asthma and the medications used to treat it exacerbate the symptoms of ADHD. Methods and Materials: The present study was a cross-sectional analytical study conducted to investigate the incidence of asthma in ADHD patients aged 4-12 years who were referred to Urmia University of Medical Sciences clinics and hospitals. In this study, ADHD patients were diagnosed through a psychiatric interview and based on a paediatric asthma questionnaire (approved by asthma and allergy organizations and scientific institutions), and individuals with suspected asthma were selected. All 101 ADHD patients referred to these clinics during the specified period were examined. Five patients were excluded from the study because of lack of cooperation or incomplete information. Then, the selected subjects were divided into two age groups of less than 5 years and between 5 and 12 years. The final diagnosis of asthma was made by clinical findings and demographic questionnaire in subjects younger than 5 years, while it was made by spirometry in subjects between 5 and 12 years. Data analysis was conducted using SPSS software. Results: The mean age of the 96 samples included in the study was 7.67 years with a standard deviation of 7.214. Sixteen of them (16.7%) were under 5 years of age and eighty of them (83.3%) were between 5 and 12 years of age. Asthma was diagnosed in 7 children under 5 years of age (7.3%) and in 14 children (14.6%) between 5 and 12 years of age. A total of 21 (21.9%) were diagnosed as having asthma after screening. On the basis of these results, the frequency of asthma according to classified age was significant (P=0.020). The frequency of asthma based on sex and birth rank was also examined, and none of these factors showed a significant association with asthma. Medications taken by the ADHD patients were also examined in this study. The most commonly used medications in both groups of patients with asthma and no asthmatic patients were a combination of risperidone and atomoxetine or risperidone alone. The prevalence of asthma in the target population was also assessed in terms of parental smoking. Conclusions: According to the results of this study, the incidence of asthma in ADHD patients aged 4-12 years is high, and this case is more frequent in subjects younger than 5 years than in subjects aged 5-12 years. It should be noted that according to the results of the present study, there was no significant association between birth rank, parental smoking, ADHD medication, and the frequency of asthma.

Ten-year-old boy with atypical COVID-19 symptom presentation: A case report.

Since reactive arthritis (ReA) and urticaria could be seen in this age group along with atypical COVID-19 symptom presentation, pediatrics should be familiar with urticarial rashes and ReA in COVID-19 to enable early diagnoses of infected individuals.

Pulmonary embolism in an adolescent girl with negative ACLA systemic lupus erythematosus (SLE): a case report.

Pulmonary involvement is a common manifestation in systemic lupus erythematosus (SLE), whereas pulmonary thromboembolism (PTE) is rarely seen in SLE. PTE related to anti-phospholipid antibody syndrome (APS) is also a rare disease. We have reported a 13-year-old female diagnosed with SLE Two years ago, who is being treated with hydroxychloroquine and prednisolone. She presented with shortness of breath, dry cough, and fever about two weeks prior to admission. She was initially admitted with the diagnosis of pneumonia, but no clinical improvement was seen she was given antibiotics. Hemoptysis was added to her symptoms, so spiral high resolution computed tomography (HRCT) of the lungs was requested, and it indicated patchy consolidations bilaterally. With suspicion of pulmonary thromboembolism (PTE), spiral computed tomography angiography of pulmonary vessels was done, revealing PTE. After initiation of anti-coagulants, her clinical condition and respiratory status improved significantly. We present a rare case of SLE where only lupus anti-coagulant test was abnormal while other tests, such as anti-cardiolipin antibody and anti-phospholipid antibody were normal. Therefore, we can conclude that clinical suspicion had the main role in diagnosis in our case, as it has in medicine.

Short Time Efficiency of Rhinophototherapy in Management of Patients with Allergic Rhinitis Resistant to Medical Therapy.

Allergic rhinitis is one of the most common health problems with a major effect on the quality of life. We intended to treat Allergic Rhinitis (AR) in patients who are either unresponsive to antihistamines or their job requires optimal alertness that may be disturbed by antihistamine's side effects and those who do not comply with the regular use. We tried short term phototherapy and evaluated its effect on AR. As phototherapy is effective in the treatment of atopic dermatitis (AD) and the same allergens can produce both AD and AR, phototherapy is proposed as a new tool in the AR treatment. In AD, phototherapy causes induction of apoptosis in infiltrating T cells and other immunomodulatory effects. We performed a randomized single-blind study to investigate the effect of low-dose phototherapy in AR patients. Among AR patients who did not respond to local and systemic therapy, we chose 62 allergic patients all above 25 years of age with moderate to severe AR whose disease was verified by allergy skin test or specific IgE to allergens; then, they were randomly divided into 31 patients as treatment group and 31 patients as control group. In treatment groups, we used a mixture of UVA, UVB and visible light. In the control group, we used visible light alone as placebo. Then we evaluated the level of response to treatment in two groups and compared them according to Total Nasal Symptom scores (TNSS) and Global Severity Scores (GSS) and Rhinoconjunctivitis Quality of Life Questionnaires (RQLQ) symptom scores. We found out that phototherapy in the treatment group in comparison with placebo was effective in treatment of AR (p-value <0.001). However, we recommend that for substantiation of the claim, further investigations are still required.

Brain Abscess and Keratoacanthoma Suggestive of Hyper IgE Syndrome.

Hyper immunoglobulin-E (IgE) syndrome is an autosomal immune deficiency disease. It is characterized by an increase in IgE and eosinophil count with both T-cell and B-cell malfunction. Here, we report an 8-year-old boy whose disease started with an unusual skin manifestation. When 6 months old he developed generalized red, nontender nodules and pathologic report of the skin lesion was unremarkable (inflammatory). Then he developed a painless, cold abscess. At the age of 4 years, he developed a seronegative polyarticular arthritis. Another skin biopsy was taken which was in favor of Keratoacanthoma. Laboratory workup for immune deficiency showed high eosinophil count and high level of immunoglobulin-E, due to some diagnostic criteria (NIH sores: 41 in 9-year-olds), he was suggestive of hyper IgE syndrome. At the age of 8, the patient developed an abscess in the left inguinal region. While in hospital, the patient developed generalized tonic colonic convulsion and fever. Brain computed tomography scan revealed an abscess in the right frontal lobe. Subsequently magnetic resonance imaging (MRI) of the brain indicated expansion of the existing abscess to contralateral frontal lobe (left side). After evacuating the abscesses and administrating intravenous antibiotic, the patient's condition improved dramatically and fever stopped.