Improving asthma control and quality of life via a smartphone self-management app: A randomized controlled trial.

BACKGROUND: Mobile phone applications (apps) show promise for enhancing asthma self-management, but their effectiveness varies. This study examined the effect of a smartphone asthma app on asthma control and quality of life. METHODS: Using block randomization, 60 patients with asthma were allocated to an intervention group (n = 30) or control group (n = 30) for this single-blind randomized controlled trial. At baseline, both groups completed the Asthma Control Test (ACT) and Asthma Quality of Life Questionnaire-Marks (AQLQ-M). The intervention group used a smartphone-based asthma self-management app plus their regular treatment, while the control group received only usual care. Follow-up ACT and AQLQ-M assessments occurred at 3 and 6 months. SPSS version 26 was used for analysis, including descriptive statistics, non-parametric tests (Wilcoxon and Mann-Whitney U), and analysis of variance with repeated measurements. RESULTS: Both groups showed improved asthma control and quality of life at 3 and 6 months compared to baseline. However, after 6 months the intervention group had significantly greater improvement than controls (p < 0.05). Repeated measures ANOVA revealed divergent changes in ACT and AQLQ-M scores over time, with the intervention group demonstrating greater enhancement of asthma control and quality of life (p < 0.001). CONCLUSION: This study demonstrated that use of a smartphone-based asthma self-management app improved asthma control and quality of life after 6 months compared to usual care alone. These findings indicate that guideline-based asthma apps can positively impact outcomes.

Clinical and immunological characteristics of 69 leukocyte adhesion deficiency-I patients.

BACKGROUND: In order to support the comprehensive classification of Leukocyte Adhesion Deficiency-I (LAD-I) severity by simultaneous screening of CD11a/CD18, this study assessed clinical, laboratory, and genetic findings along with outcomes of 69 LAD-I patients during the last 15 years. METHODS: Sixty-nine patients (40 females and 29 males) with a clinical phenotype suspected of LAD-I were referred to Immunology, Asthma, and Allergy research institute, Tehran, Iran between 2007 and 2022 for further advanced immunological screening and genetic evaluations as well as treatment, were enrolled in this study. RESULTS: The diagnosis median age of the patients was 6 months. Delayed umbilical cord separation was found in 25 patients (36.2%). The median diagnostic delay time was 4 months (min-max: 0-82 months). Forty-six patients (66.7%) were categorized as severe (CD18 and/or CD11a: below 2%); while 23 children (33.3%) were in moderate category (CD18 and/or CD11a: 2%-30%). During the follow-ups, 55.1% of children were alive with a mortality rate of 44.9%. Skin ulcers (75.4%), omphalitis (65.2%), and gingivitis (37.7%) were the most frequent complaints. Genetic analysis of the patients revealed 14 previously reported and three novel pathogenic mutations in the ITGB2 gene. The overall survival of patients with and without hematopoietic stem cell transplantation was 79.3% and 55.6%, respectively. CONCLUSION: Physicians' awareness of LAD-I considering delayed separation of umbilical cord marked neutrophilic leukocytosis, and variability in CD11 and CD18 expression levels, and genetic analysis leads to early diagnosis and defining disease severity. Moreover, the prenatal diagnosis would benefit families with a history of LAD-I.

Correlation of sensitization to food allergens in Iranian patients with migraine and tension headaches.

OBJECTIVES: Headache is one of the most common neurological disorders around the world. Previous studies have proposed associations of food allergies with headaches. Therefore, this study evaluated the frequency of sensitization to food allergens in patients with migraine and tension headaches and their correlations with these disorders. METHODS: The study subjects consisted of 20 patients with migraine headache and 20 subjects with tension headache. Headache disorders were confirmed by a specialist. Food allergen sensitization was diagnosed by skin prick test (SPT) or radioallergosorbent test (RAST), clinical history, and physical examination. RESULTS: There was no significant difference in age and gender between patients with migraine and tension headaches. Other results showed sensitization to food allergens, such as egg, wheat, fish, banana, orange, and soybean, in patients with migraine headache was similar to those in subjects with tension headache. However, patients with migraine headache significantly differed from individuals with tension headache in allergic responses to tree nut (P=0.047), peanut (P=0.028), and cow's milk (P=0.044). CONCLUSION: The results of this study showed that sensitization to food allergens may relate to migraine headache which their diagnosis can help to better control and manage the disease.

Rare clinical presentations of hyper-IgE syndrome in a patient with dental abnormalities: A case report.

Asthma and anaphylaxis are two atypical presentations of hyper-IgE syndrome (HIES). Early diagnosis and management of HIES can improve quality of life of patients through minimizing orthodontic problems and other complications related to this disorder.

Adverse reactions in a large cohort of patients with inborn errors of immunity receiving intravenous immunoglobulin.

BACKGROUND: Intravenous immunoglobulins (IVIg) are the major treatment in inborn errors of immunity (IEI) disorders; However, IVIg infusions show some adverse effects. We aimed to assess the adverse reactions of IVIg infusions. METHODS: Data of IVIg infusions in IEI patients were collected from 2011 to 2021. Totally, 363 IEI patients received IVIg regularly in Iran entered the study. The adverse reactions are classified regarding their severity and chronicity. RESULTS: 22,667 IVIg infusions were performed in the study. 157 patients (43.2%) and 1349 (5.9%) infusions were associated with at least one type of adverse reaction. The highest rates of adverse reactions were seen in severe combined immunodeficiency. Myalgia, chills, headache, fever, and hypotension were the most frequent adverse effects of IVIg. CONCLUSION: The reactions affect almost half of the patients mainly in the first infusions which necessitate the close observation of IEI patients receiving IVIg.

Clinical complications and their management in a child with ataxia-telangiectasia (A-T): A case report study.

Ataxia-telangiectasia (A-T) is known as an uncommon autosomal recessive disorder associated with recurrent infections and other clinical complications. The management of its complications can improve life quality of patients.

Atypical Ataxia Presentation in Variant Ataxia Telangiectasia: Iranian Case-Series and Review of the Literature.

Ataxia-telangiectasia (AT) is a rare autosomal recessive neurodegenerative multisystem disorder. A minority of AT patients can present late-onset atypical presentations due to unknown mechanisms. The demographic, clinical, immunological and genetic data were collected by direct interview and examining the Iranian AT patients with late-onset manifestations. We also conducted a systematic literature review for reported atypical AT patients. We identified three Iranian AT patients (3/249, 1.2% of total registry) with later age at ataxia onset and slower neurologic progression despite elevated alpha-fetoprotein levels, history of respiratory infections, and immunological features of the syndrome. Of note, all patients developed autoimmunity in which a decrease of naïve T cells and regulatory T cells were observed. The literature searches also summarized data from 73 variant AT patients with atypical presentation indicating biallelic mild mutations mainly lead to an atypical phenotype with an increased risk of cancer. Variant AT patients present with milder phenotype or atypical form of classical symptoms causing under- or mis- diagnosis. Although missense mutations are more frequent, an atypical presentation can be associated with deleterious mutations due to unknown modifying factors.

The use of mobile phone functionalities by patients with asthma and their desire to use for self-care purposes.

BACKGROUND: Mobile health (mHealth) has good potential for promoting self-care in patients suffering from chronic diseases. The patients' positive attitude toward this technology is a key factor for the successful implementation. The present study was conducted to investigate the asthma patients' use of mobile phone functionalities and their desire to receive self-care services through this technology. METHODS: This survey study was conducted in Iran in 2018. The study population consisted of 146 patients suffering from asthma. The data collection tool was a questionnaire containing items on the demographic characteristics of patients, current use of mobile phone functionalities, and desire to use them for receiving self-care services. Data were analyzed using descriptive and analytical statistics. RESULTS: Out of the 160 questionnaires distributed, 146 (91.25%) were completed. The majority of the participants had smartphones (84.9%). Less than half of the participants occasionally used mobile phone functionalities including mobile phone calls (42.5%) and mobile Internet (40.4%) to receive asthma-related information. A significant number of the participants had never used smartphone applications (72.6%) and E-mail (66.4%) to receive asthma-related information. The participants had their greatest use of Internet search, followed by social media, to receive information about asthma symptoms, allergenic and irritating substances, medicinal therapy, and how to use therapy aids. The participants were most willing to use social media for receiving asthma information, communicating with other patients, receiving reminders about doctor's appointment, and receiving warnings about the lack of asthma control. CONCLUSION: In Iran as a developing country, asthma patients use Internet search mostly to receive instructional information and are willing to use social media rather than other mobile phone functionalities to receive self-care services. These patients believe that mobile phones are appropriate for receiving instructional information and reminders.

Enhancing Asthma Patients' Self-Management through Smartphone-Based Application: Design, Usability Evaluation, and Educational Intervention.

OBJECTIVE: The aim of this study was to design and evaluate a smartphone-based application for improving self-management in patients with asthma and evaluate its effects on their knowledge. METHODS: In this applied research, based on the Clinical Practice Guideline and a systematic review, a questionnaire was designed to determine the application information content and functionality requirements by 15 pediatric and adult asthma and allergy specialist. Then the application was designed and developed using Adobe Air software on the Android operating system. Usability evaluation of the mobile application was performed using the standard questionnaire for user interaction satisfaction (QUIS), which completed by 30 patients with asthma, 8 information technology (IT) specialists, and 2 asthma and allergy specialists. Self-management knowledge of 30 asthma patients was measured using a researcher-made questionnaire before and after using the application. RESULTS: The number of specialists in the both Delphi rounds was 15 and the mean work experiences were 17.6 years. The most important elements for asthma self-management were avoiding exposure to allergen and triggers (96%), drug treatment (94.6%), and how to use the therapeutic tools (92.4%), and the most important functionalities were alerting the patients when they did not control asthma (92%), setting reminders for timely drug use (85.4%) and therapeutic tools (82.6%), recording prescription drugs (82.6%), and peak flow meter values (82%). Usability evaluation showed that 30 patients with asthma, 8 IT specialists, and 2 physicians evaluated the application at a "good" level. The mean score of the patients' knowledge before intervention was 2.43 ± 0.95 which after intervention was significantly increased to 4.3 ± 0.56 (p < 0.001). CONCLUSION: Considering the desirable outcomes of application evaluation and a positive impact of this educational intervention on asthma patients' knowledge, it is possible to use mobile-based self-management programs to help these patients to manage illness and gain knowledge and self-management skills.

Evaluation of QT Dispersion in Children with Breath Holding Spells.

OBJECTIVE: Breath holding spells (BHS) are common involuntary reflexes in infancy and early childhood. Differential diagnosis should embrace Long QT Syndrome (LQTS) and paroxysmal abnormalities of rhythm. The aim of this study was to compare QT dispersion (QTd) in children with breath holding spells and normal controls. MATERIALS & METHODS: QT dispersion and Corrected QT(QTc) dispersion were measured in 12 lead surface electrocardiograms in 56 patients with BHS and compared with healthy children of the same age referred to the clinic for regular checkup visits. RESULTS: The most common type of BHS was cyanotic (83.9%). Seven patients (12.5%) had pallid and two patients (3.5%) had mixed spells. There was a history of breath holding spells in 33.9% of the children. QT dispersion was 61.6± 22.5 and 47.1±18.8 ms in patient and control groups, respectively. QTc dispersion (QTcd) was 104 ± 29.6 and 71.9 ±18.2 ms, respectively. There was a significant difference between patient and control groups in terms of QTd and QTcd (P<0.001). CONCLUSION: QTd and QTcd were increased in children with BHS. Therefore, the evaluation of EKG for early diagnosis of rhythm abnormalities seems reasonable in these children.

Evaluation of the Correlation Between Childhood Asthma and Helicobacter pylori in Kashan.

BACKGROUND: Asthma is a chronic inflammatory air-way disease with increasing prevalence rate during the recent years. There are studies about the relationship between asthma and infectious diseases, including the association between asthma and Helicobacter pylori. According to the latest studies, there is an epidemiological correlation between asthma prevalence and prevalence of H. pylori. OBJECTIVES: The aim of this research was to study the correlation between H. pylori and asthma by biopsy in five to eighteen year-old children who had undergone endoscopy at Shahid Beheshti Hospital. PATIENTS AND METHODS: Three hundred children (5 to 18 years old) undergoing endoscopy owing to gastro-intestinal problems at Shahid Beheshti Hospital were observed for childhood asthma using the Gina 2010 questionnaire which included 24 questions with "yes" and "no" answers to identify asthmatic patients with five positive answers. Next, the patients were referred to an allergy and asthma specialist for clinical examinations, spirometry and post bronchodilator test (Post BD). RESULTS: Among 138 H. pylori positive patients, eight cases (5.8 %) were asthmatic while of the 162 H. pylori negative patients 28 (17.3%) were asthmatic. This difference was statistically significant (P Value = 0.002). The correlation between H. pylori and asthma was studied after controlling the confounding variables including, gender, age and family history. The results obtained for the above-mentioned variables were significant (P Values of 0.004, 0.005 and 0.002, and Odd-Ratio Mantel Haenszel (ORMH) of 3.38, 3.24 and 4.06, respectively). CONCLUSIONS: Our findings showed that there is an inverse correlation between H. pylori and asthma. Performing more studies with larger sample sizes is necessary to confirm these results.