Phenotyping and follow up of forty-seven Iranian patients with common variable immunodeficiency.

BACKGROUND: Common variable immune deficiency (CVID) is a heterogeneous syndrome with a wide variety of signs and symptoms. This study describes the phenotyping and survival of the CVID patients in the allergy and clinical immunology department of Rasol-E-Akram Hospital of Iran University of Medical Sciences in Tehran. METHOD: We retrospectively reviewed hospital files of CVID patients in our department until January 2014. All patients were diagnosed with standard diagnostic criteria of CVID, treated and visited monthly, during the follow-up period. We divided the patients into four phenotypes; infection only, cytopenia, polyclonal lymphocytic infiltration and unexplained enteropathy. The immunologic, demographic and clinical findings in different phenotypes were analysed. RESULTS: The study included 47 CVID patients with mean age at onset of symptoms and diagnosis of 11.2 and 20.2 years, respectively. Phenotyping of our patients was: only infection (62%), cytopenia (26%) and PLI (19%) and 94% of cases had only one phenotype. We did not find a significant relation between the clinical phenotypes and immunologic or demographic data. Rate of parental consanguinity in our cases was 47%. Parental consanguinity was related to lower age at onset, lower age at diagnosis and higher baseline IgG levels. Patients with malignancy and autoimmunity had significantly higher age at onset. Our patients were followed-up for 6.9 years and the mortality rate during this time was 6%. CONCLUSIONS: Parental consanguinity and age at onset of CVID symptoms may have important roles in CVID manifestations.

The effects of vitamin D supplementation on airway functions in mild to moderate persistent asthma.

BACKGROUND: Vitamin D is hypothesized to have some roles in innate and adaptive immunity, inflammation reduction, and remodeling; therefore, it is supposed to affect the asthma phenotype, severity, and response to inhaled corticosteroid (ICS). OBJECTIVE: To explore the synergistic effects of vitamin D supplementation in addition to asthma controllers (ICS or ICS plus long-acting ß-agonist) on airway functions. METHODS: A randomized clinical trial was conducted in 130 individuals aged 10 to 50 years who lived in Tehran during a 24-week period. Data on age, sex, body mass index, stage of asthma, serum total IgE, history of allergic rhinitis, atopic dermatitis, food allergy, and urticaria were collected. Spirometric parameters (forced expiratory volume in 1 second [FEV1] and ratio of FEV1 to forced vital capacity) and serum vitamin D measurement were obtained before and 8 and 24 weeks after the intervention. Patients were divided in 2 groups randomly. Both groups received asthma controllers (budesonide or budesonide plus formoterol) according to their stage, but the intervention group received vitamin D supplementation (100,000-U bolus intramuscularly plus 50,000 U orally weekly) in addition to asthma controllers. RESULTS: FEV1 improved significantly in both groups after 8 weeks, but no significant difference was found between the 2 groups at baseline (P = .20) or after 8 weeks (P = .99); however, a significant improvement was seen in the intervention group in the last 16 weeks, and FEV1 was significantly better in the intervention group than the other group after 24 weeks (P < .001). CONCLUSION: Vitamin D supplementation associated with asthma controllers could significantly improve FEV1 in mild to moderate persistent asthma after 24 weeks. TRIAL REGISTRATION: irct.ir Identifier: IRCT201302079608N1.

Effect of COVID-19 on transportation air pollution by moderation and mediation analysis in Queens, New York.

The outbreak of the COVID-19 virus in 2020 has left many changes in the quality of life and environment, including air quality in different parts of the world. As a result of lockdown conditions, the level of air pollution has been changed considerably due to topographic, geographical, and cultural conditions as well as traffic restrictions. Thus, this study aimed to investigate the effect COVID-19 outbreak on improving air quality as a result of changes in traffic volume and traffic patterns in Queens, New York, using the moderation and mediation analysis model structure. In this model, COVID-19 outbreak periods were defined as a moderating variable, traffic volume (number of daily vehicles) as an independent variable and mediator, and air pollution concentration parameters (NOx, PM2.5, and O3) individually as dependent variables. Three-time periods were selected, each representing the duration and severity of traffic restrictions and prohibitions, and these three periods corresponded to 1 February-4 March, 5 March-21 March, and 22 March-15 May. They represented the normal, aware, and lockdown periods, respectively. The result of the study showed that in 2020 compared to the last five consecutive years, PM2.5 and NOx pollutants decreased by 39.2% and 35.8% as a result of the traffic ban due to the COVID-19, but an increase of 15.1% in O3 pollutant was observed in the mentioned period. Although traffic restrictions reduced total traffic volume compared to the same period last year, there has been no significant reduction in the air quality index (AQI). The reduction in NOx concentration leads to more O3 ground levels, and this caused the AQI not to decrease significantly. Finally, the moderation and mediation model results showed that the COVID-19 almost has no significant effect on the correlation between daily traffic and the concentration of NOx, PM2.5, and O3 pollutants as moderator. However, the COVID-19 has a significant correlation with O3 and PM2.5 concentration, and the traffic volume mediation effect is negligible. Therefore, the statistical analysis and models show that the COVID-19 pandemic is an effective traffic volume and air quality parameter.

A sustainable Decision Support System for soil bioremediation of toluene incorporating UN sustainable development goals.

Decision Support System (DSS) is a novel approach for smart, sustainable controlling of environmental phenomena and purification processes. Toluene is one of the most widely used petroleum products, which adversely impacts on human health. In this study, Fusarium Solani fungi are utilized as the engine of the toluene bioremediation procedure for the monitoring part of DSS. Experiments are optimized by Central Composite Design (CCD) - Response Surface Methodology (RSM), and the behavior of the mentioned fungi is estimated by M5 Pruned model tree (M5P), Gaussian Processes (GP), and Sequential Minimal Optimization (SMOreg) algorithms as the prediction section of DSS. Finally, the control stage of DSS is provided by integrated Petri Net modeling and Failure Modes and Effects Analysis (FMEA). The findings showed that Aeration Intensity (AI) and Fungi load/Biological Waste (F/BW) are the most influential mechanical and biological factors, with P-value of 0.0001 and 0.0003, respectively. Likewise, the optimal values of main mechanical parameters include AI, and the space between pipes (S) are equal to 13.76 m3/h and 15.99 cm, respectively. Also, the optimum conditions of biological features containing F/BW and pH are 0.001 mg/g and 7.56. In accordance with the kinetic study, bioremediation of toluene by Fusarium Solani is done based on a first-order reaction with a 0.034 s-1 kinetic coefficient. Finally, the machine learning practices showed that the GP (R2 = 0.98) and M5P (R2 = 0.94) have the most precision for predicting Removal Percentage (RP) for mechanical and biological factors, respectively. At the end of the present research, it is found that by controlling seven possible risk factors in bioremediation operation through the FMEA- Petri Net technique, efficiency of the process can be adjusted to optimum value.

Otitis Media with Effusion in Children and the Impact of Risk Factors on Serum Cytokine Levels.

INTRODUCTION: To evaluate the role of allergic-type and infectious-type cytokines in children with chronic otitis media with effusion (OME). MATERIALS AND METHODS: We investigated serum levels of interleukins (IL)-4, IL-5, and IL-13, along with interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α), by enzyme-linked immunosorbent assay (ELISA) in 35 children with OME and 28 healthy controls. RESULTS: Children with OME had significantly higher levels of IL-5 in comparison with the control group, ranging from 1 pg/ml in cases to 0.04 pg/ml in controls (P=0.009). However, after adjusting for confounding variables, there was no significant difference in serum levels of IL-13, IL-4, IFN-γ, or TNF-α between the two groups (P=0.287, P=0.627, P=0.793, and P=0.217, respectively). CONCLUSIONS: The findings of this study suggest that in comparison with the control group, serum IL-5 levels were elevated in OME cases.

Comparative Evaluation of Tacrolimus Versus Interferon Alpha-2b Eye Drops in the Treatment of Vernal Keratoconjunctivitis: A Randomized, Double-Masked Study.

PURPOSE: Vernal keratoconjunctivitis (VKC) is a bilateral, chronic, external ocular inflammatory disorder that mainly affects patients in their first or second decade. This study was designed to compare tacrolimus and interferon alpha-2b (IFN alpha-2b) eye drops in the treatment of VKC. METHODS: In this randomized, double-masked clinical trial, 40 consecutive patients with VKC were sent to a referral eye hospital in a tropical region southeast of Iran. Patients were randomly assigned to receive either 0.005% tacrolimus or IFN alpha-2b (1,000,000 units/cc). Chi-square and t tests were used for comparison of outcomes between both groups. RESULTS: Mean ± SD age was 11.1 ± 5.2 years. Thirty-one patients (77.5%) were male. The mean duration of disease was 3.4 ± 2.9 years. In this study, the signs and symptoms were significantly reduced in patients after treatment in both groups (P = 0.0001). In the tacrolimus group, all patients responded to treatment whereas only one subject in the IFN group failed to respond (P = 0.99). Side effects in both groups were mild and tolerable. CONCLUSIONS: This study indicated that both 0.005% tacrolimus and IFN alpha-2b are effective and appear to be safe in treatment of recalcitrant VKC.

Circulating level of CD4+ CD25+ FOXP3+ T cells in patients with chronic urticaria.

BACKGROUND: CD4+ CD25+ T-regulatory (Treg) cells play critical roles in maintaining peripheral tolerance and preventing autoimmunity. As characteristics of Treg cells have not been precisely investigated in chronic urticaria (CU) yet, this study was performed. OBJECTIVE: To determine the frequencies of circulating CD4+ CD25+ FOXP3+ T cells and serum levels of interleukin (IL)-10, transforming growth factor (TGF)-ß, and IL-17 in patients with chronic autoimmune urticaria and chronic idiopathic urticaria compared to healthy controls. METHODS: Peripheral blood mononuclear cells (PBMCs) were obtained from patients with CU and healthy controls. The frequency of CD4+ CD25+ T cells in PBMCs and expression levels of FOXP3 were detected by flow cytometry. The serum levels of IL-10, TGF-ß, and IL-17 were measured by enzyme-linked immunosorbent assay. RESULTS: A significant decrease in the percentage of circulating CD4+ CD25+ FOXP3+ T cells was detected in patients with CU, compared to control subjects. However, no significant difference was detected on the serum levels of IL-10, TGF-ß, and IL-17 between patients with CU and control subjects. CONCLUSIONS: This study demonstrated that the frequency of Treg cells in PBMCs was decreased in patients with CU. Further studies are needed to clarify the exact role of Treg cells in the pathogenesis of CU and factors regulating their function.

Evaluation of immunological parameters in purified protein derivative positive tuberculin workers.

OBJECTIVE(S): According to the occupationally risk of infection in staff workers who have direct contact with mycobacterium species, we investigated their immunological parameters and compared with healthy purified protein derivative (PPD) negative volunteers. Materials and Methods : We investigated 20 PPD positive volunteers working at Tuberculin Unit of Razi Vaccine and Serum Research Institute and PPD negative healthy controls with no exposure or history of active tuberculosis. The percentages of circulating lymphocyte subpopulations were detected by flowcytometry. IL-4 and IFN-γ production levels were measured by ELISA in supernatants of PPD-stimulated peripheral blood mononuclear cells (PBMCs) culture. Results : Tuberculin workers showed an increase in IFN-γ level and significant decrease of CD4+ T cells percentage and CD4/CD8 ratio compared to PPD negative normal individuals. However the IL-4 production and percentage of other lymphocyte population has been unchanged. DISCUSSION: These observations suggest that the immunological parameters of tuberculin workers with PPD positive reaction, who are occupationally exposed to mycobacterium antigens, could be changed. Future studies will be directed towards cytokine networking and regulatory lymphocytes, which will help us validate the significant data presented in this study.