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1.
J Investig Allergol Clin Immunol ; 34(4): 233-245, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-39077769

RESUMEN

BACKGROUND: Common variable immunodeficiency (CVID) is considered the most symptomatic type of inborn errors of immunity in humans. Along with infectious complications, which have numerous consequences, noninfectious complications are a major challenge among CVID patients. METHODS: All CVID patients registered in the national database were included in this retrospective cohort study. Patients were divided into 2 groups based on the presence of B-cell lymphopenia. Demographic characteristics, laboratory findings, noninfectious organ involvement, autoimmunity, and lymphoproliferative diseases were evaluated. RESULTS: Among 387 enrolled patients, 66.4% were diagnosed with noninfectious complications and 33.6% with isolated infectious presentations. Enteropathy, autoimmunity, and lymphoproliferative disorders were reported in 35.1%, 24.3%, and 21.4% of patients, respectively. Some complications, including autoimmunity and hepatosplenomegaly, were reported to be significantly more frequent among patients with B-cell lymphopenia. As for organ involvement, the dermatologic, endocrine, and musculoskeletal systems were predominantly affected in CVID patients with B-cell lymphopenia. Among autoimmune manifestations, the frequency of rheumatologic, hematologic, and gastrointestinal autoimmunity was reported to be higher than that of other types of autoimmunity not associated with B cell-lymphopenia. Furthermore, hematological cancers, particularly lymphoma, were the most common type of malignancy. The mortality rate was 24.5%, and respiratory failure and malignancies were the most common causes of death, with no significant differences between the 2 groups. CONCLUSIONS: Considering that some of the noninfectious complications might be associated with B-cell lymphopenia, regular patient monitoring and follow-up with proper medication (in addition to immunoglobulin replacement therapy) are highly recommended to prevent sequelae and increase patient quality of life.


Asunto(s)
Linfocitos B , Inmunodeficiencia Variable Común , Linfopenia , Humanos , Inmunodeficiencia Variable Común/complicaciones , Inmunodeficiencia Variable Común/inmunología , Femenino , Masculino , Adulto , Estudios Retrospectivos , Linfocitos B/inmunología , Persona de Mediana Edad , Linfopenia/inmunología , Adulto Joven , Autoinmunidad , Adolescente , Anciano , Niño
2.
Artículo en Inglés | MEDLINE | ID: mdl-38347809

RESUMEN

Summary: Background. Little is known about the relationship between allergic diseases and seizure disorders including epilepsy. It is hypothesized that inflammation from allergic diseases may predispose children to seizures. the aim of this study is to investigate frequency of seizure disorder in children with asthma and allergy. Methods. A cross-sectional survey study of parents of 1300 children and adolescents under 20 years of age referred to the Allergy and Asthma Clinic of Imam Ali Hospital (Karaj) who were asked to complete a screening questionnaire for seizures in their children. Parents who reported any history of seizures in their children were contacted to answer a second in-depth questionnaire to determine more detail of type, triggers, and treatment of seizures. Results. A total of 705 males (62%) and 433 females (38%) participated in this study, with a mean and standard age of 6.62±4.57 years. Among them, 70.6% had asthma, 15.2% had allergic rhinitis, 5.6% had atopic dermatitis, 3.5% had urticaria, 2.7% had food allergies, 1% had drug allergies, and 1.4% had other allergic diseases. Additionally, 88 patients (7.7%) had a history of doctor-diagnosed seizures, 57 patients (5%) had febrile convulsions, and 15 patients (1.31%) had idiopathic epilepsy. There was no significant relationship found between febrile convulsions, seizures, and epilepsy with the type of allergic diseases. However, a significant association was observed between the number of comorbid allergic diseases in patients with febrile convulsions (OR=1.4, 95% CI: 1.07-1.83, P=0.013).There was also an association between the epilepsy and comorbid allergic diseases number with an odds ratio OR=1.84, 95% CI=0.28-12, however the risk of epilepsy was increased by 0.84 percent but this increase was not significant. Regarding the relation between the number of allergic diseases in parents and idiopathic epilepsy in their children, a significant association was found only for mothers (OR=1.28, 95% CI: 1.04-2.23, P=0.024), but not for fathers (P>0.05). Conclusions. Febrile convulsion is associated with the .number of comorbid allergic diseases in children and the mother's number of allergic diseases is more related to idiopathic epilepsy in children than the father's.

3.
Artículo en Inglés | MEDLINE | ID: mdl-37103527

RESUMEN

BACKGROUND AND OBJECTIVE: Common variable immunodeficiency (CVID) is considered the most symptomatic type of inborn errors of immunity in humans. Along with infectious complications, which have numerous consequences, non-infectious complications are also a major challenge among CVID patients. METHODS: All registered CVID patients in the national database were included in this retrospective cohort study. Patients were divided into two groups based on the presence of B-cell lymphopenia. Demographic characteristics, laboratory findings, non-infectious organ involvements, autoimmunity, and lymphoproliferative diseases were evaluated. RESULTS: Among 387 enrolled patients, 66.4% were diagnosed with non-infectious complications; however, 33.6% had only infectious presentations. Enteropathy, autoimmunity, and lymphoproliferative disorders were reported in 35.1%, 24.3%, and 21.4% of patients, respectively. Some complications, including autoimmunity and hepatosplenomegaly, were reported to be significantly higher among patients with B-cell lymphopenia. Among organ involvement, dermatologic, endocrine and musculoskeletal systems were predominantly affected in CVID patients with B-cell lymphopenia. Among autoimmune manifestations, the frequency of rheumatologic, hematologic, and gastrointestinal autoimmunity was reported to be higher compared to other types of autoimmunity independent from the B cell-lymphopenia. Furthermore, hematological cancers, particularly lymphoma, were slightly introduced as the most common type of malignancy. Meanwhile, the mortality rate was 24.5%, and respiratory failure and malignancies were reported as the most common cause of death in our patients without significant differences between the two groups. CONCLUSION: Considering that some of the non-infectious complications might be associated with B-cell lymphopenia, therefore, regular patient monitoring and follow-up along with proper medications (besides immunoglobulins replacement therapy) are highly recommended to prevent further sequels and increase the patients' quality of life.

4.
Eur Ann Allergy Clin Immunol ; 55(1): 19-28, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-34918886

RESUMEN

Summary: Background. Inborn errors of immunity (IEIs) are a group of heterogeneous disorders with inherited faults in the immune system that increase susceptibility to infections, malignancies, lymphoproliferation, and autoimmune/autoinflammatory disorders. Methods. We retrospectively studied the demographic characteristics, clinical features, and immunological profiles of the 90 IEIs patients, who were diagnosed and classified according to the European Society for Immunodeficiencies (ESID) and International Union of Immunological Societies (IUIS) criteria from July 2010 to June 2021. The study was carried out in the Non-communicable Diseases Research Center, Imam Ali Hospital, Alborz, Iran. Results. Within a period of 11 years, 53 (58.9%) males and 37 (41.1%) females were diagnosed and followed up for 20 IEI disorders. The median (IQR) age of onset, age of clinical diagnosis and diagnostic delay was 0.7 (0.08-2.0), 3.18 (1.0-8.0) and 1.5 (0.17-5.0) years, respectively. Twelve patients (36.4%) had a positive family history of IEI, and the majority of patients (84.5%) had recurrent infections. Pneumonia (51.7%) was the most common clinical manifestation among IEI patients, followed by skin complications (46.2%). The most frequently diagnosed IEI was immunoglobulin A deficiency (IgAD) (14.4%) and severe combined immunodeficiency (SCID) (11.1%). Predominantly antibody deficiencies group (36.7%) was the most common category, followed by combined immunodeficiencies with associated or syndromic features group (27.8%). Conclusions. IEIs have different patterns within populations with high consanguinity. There is a need to search for underlying genetic and epigenetic factors in most common IEIs in Alborz.


Asunto(s)
Síndromes de Inmunodeficiencia , Enfermedades de Inmunodeficiencia Primaria , Masculino , Femenino , Humanos , Estudios Retrospectivos , Irán/epidemiología , Diagnóstico Tardío , Síndromes de Inmunodeficiencia/diagnóstico , Síndromes de Inmunodeficiencia/epidemiología , Síndromes de Inmunodeficiencia/genética
5.
Eur J Clin Microbiol Infect Dis ; 37(2): 255-263, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29103153

RESUMEN

The humoral immune responses against 46 different staphylococcal antigens in 27 bacteremia patients infected by clonally related methicillin-resistant Staphylococcus aureus (MRSA) strains of a single sequence type (ST) 239 were investigated. A group of non-infected patients (n = 31) hospitalized for different reasons served as controls. All strains were confirmed as ST 239 by S. aureus and mecA-specific PCR, spa, and multi-locus sequence typing (MLST). In each bacteremia patient, a unique pattern of S. aureus antigen-specific immune responses after infection was observed. Antibody levels among bacteremia patients were significantly higher than controls for HlgB (P = 0.001), LukD (P = 0.009), LukF (P = 0.0001), SEA (P = 0.0001), SEB (P = 0.011), SEC (P = 0.010), SEQ (P = 0.049), IsaA (P = 0.043), IsdA (P = 0.038), IsdH (P = 0.01), SdrD (P = 0.001), SdrE (P = 0.046), EsxA (P = 0.0001), and SA0104 (P = 0.0001). On the other hand, the antibody levels were significantly higher among controls for SSL3 (P = 0.009), SSL9 (P = 0.002), and SSL10 (P = 0.007) when the IgG level on the day of infection was compared with that measured on the day of admission. Diversity was observed in the immune response against the antigens. However, a set of antigens (IsaA, IsdA, IsdH, SdrD, and HlgB) triggered a similar type of immune response in different individuals. We suggest that these antigens could be considered when developing a multi-component (passive) vaccine. SEA and/or its specific antibodies seem to play a critical role during ST239 MRSA bacteremia and SEA-targeted therapy may be a strategy to be considered.


Asunto(s)
Anticuerpos Antibacterianos/sangre , Antígenos Bacterianos/inmunología , Bacteriemia/inmunología , Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/inmunología , Infecciones Estafilocócicas/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antibacterianos/inmunología , Bacteriemia/microbiología , Proteínas Bacterianas/genética , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/microbiología , Femenino , Hospitales , Humanos , Inmunidad Humoral/inmunología , Masculino , Staphylococcus aureus Resistente a Meticilina/genética , Staphylococcus aureus Resistente a Meticilina/patogenicidad , Persona de Mediana Edad , Epidemiología Molecular , Tipificación de Secuencias Multilocus , Proteínas de Unión a las Penicilinas/genética , Infecciones Estafilocócicas/microbiología , Factores de Virulencia/inmunología , Adulto Joven
6.
Allergol Immunopathol (Madr) ; 46(2): 127-135, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-28735808

RESUMEN

BACKGROUND: Common variable immunodeficiency (CVID) is one of the most prevalent symptomatic primary immunodeficiencies (PIDs), which manifests a wide clinical variability such as autoimmunity, as well as T cell and B cell abnormalities. METHODS: A total of 72 patients with CVID were enrolled in this study. Patients were evaluated for clinical manifestations and classified according to the presence or absence of autoimmune disease. We measured regulatory T cells (Tregs) and B-cell subsets using flow cytometry, as well as specific antibody response (SAR) to pneumococcal vaccine, autoantibodies and anti-IgA in patients. RESULTS: Twenty-nine patients (40.3%) have shown at least one autoimmune manifestation. Autoimmune cytopenias and autoimmune gastrointestinal diseases were the most common. A significant association was detected between autoimmunity and presence of hepatomegaly and splenomegaly. Among CVID patients, 38.5% and 79.3% presented a defect in Tregs and switched memory B-cells, respectively, whereas 69.0% presented CD21low B cell expansion. Among patients with a defect in Treg, switched memory and CD21low B cell, the frequency of autoimmunity was 80.0%, 52.2% and 55.0%, respectively. A negative correlation was observed between the frequency of Tregs and CD21low B cell population. 82.2% of patients had a defective SAR which was associated with the lack of autoantibodies. CONCLUSIONS: Autoimmunity may be the first clinical manifestation of CVID, thus routine screening of immunoglobulins is suggested for patients with autoimmunity. Lack of SAR in CVID is associated with the lack of specific autoantibodies in patients with autoimmunity. It is suggested that physicians use alternative diagnostic procedures.


Asunto(s)
Enfermedades Autoinmunes/inmunología , Linfocitos B Reguladores/inmunología , Inmunodeficiencia Variable Común/inmunología , Enfermedades Gastrointestinales/inmunología , Linfocitos T Reguladores/inmunología , Adolescente , Adulto , Anticuerpos Antibacterianos/sangre , Autoanticuerpos/sangre , Enfermedades Autoinmunes/epidemiología , Autoinmunidad , Separación Celular , Inmunodeficiencia Variable Común/epidemiología , Femenino , Citometría de Flujo , Enfermedades Gastrointestinales/epidemiología , Humanos , Irán/epidemiología , Masculino , Vacunas Neumococicas/inmunología , Adulto Joven
7.
Eur Ann Allergy Clin Immunol ; 50(2): 72-80, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29384110

RESUMEN

Summary: Recurrent infections seem to be a common complaint in children who are referred to general practitioners and pediatricians offices. Detection of primary immunodeficiencies (PID) etiology is very important for achieving appropriate diagnosis and treatment of these patients. The absence of appropriate treatment could lead to subsequent complications, in a hospital inpatient and/or outpatient settings. This study was performed in a group of children with recurrent infections to identify patients with underlying PID. A cross-sectional study was designed to evaluate the final clinical diagnosis obtained in 100 pediatric patients with a history of recurrent infections referred to Children s Medical Center, Tehran, Iran, during one year (2011-2012). History taking and physical examination, complementary laboratory tests including immunological investigations were done to confirm the main causes of disease according to our previously published stepwise approach to recurrent infections. Among all studied patients, 21% (11 males and 10 females) were diagnosed to have PID. Parental consanguinity (p = 0.001) and soft tissue infections (p = 0.004) were significantly higher in PID group, comparing to other causes of recurrent infections. Gender and location of infections were also linked to the type of PID including antibody deficiency, combined immunodeficiency and phagocytosis disorders. The real rate of PID as a cause of recurrent infection appears to be much higher than what is generally considered in a se-lected group of pediatric patients; so, following the suggested stepwise guideline can im-prove timely diagnosis and appropriate treatment of these patients.


Asunto(s)
Síndromes de Inmunodeficiencia/diagnóstico , Infecciones/epidemiología , Infecciones/inmunología , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Infecciones/tratamiento farmacológico , Irán/epidemiología , Masculino , Recurrencia
8.
Scand J Immunol ; 85(1): 13-29, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27862144

RESUMEN

Primary immunodeficiency diseases (PIDs) consist of a genetically heterogeneous group of immune disorders that affect distinct elements of the immune system. PID patients are more prone to infections and non-infectious complications, particularly autoimmunity. The concomitance of immunodeficiency and autoimmunity appears to be paradoxical and leads to difficulty in the management of autoimmune complications in PID patients. Therefore, management of autoimmunity in patients with PID requires special considerations because dysregulations and dysfunctions of the immune system along with persistent inflammation impair the process of diagnosis and treatment.


Asunto(s)
Autoinmunidad , Síndromes de Inmunodeficiencia/inmunología , Síndromes de Inmunodeficiencia/terapia , Inmunoterapia/métodos , Animales , Autoantígenos/inmunología , Autoinmunidad/genética , Diagnóstico Diferencial , Humanos , Tolerancia Inmunológica , Síndromes de Inmunodeficiencia/diagnóstico , Mutación/genética
9.
Allergol Immunopathol (Madr) ; 45(4): 333-338, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28159384

RESUMEN

BACKGROUND: A clear picture of interaction of Th1/Th2 cytokines in pathogenesis of chronic spontaneous urticaria (CSU), remains elusive. Impaired IFN-γ production and decreased levels of IL-2 have been reported. The aim of this study was to evaluate the association of Th1 cytokines; IL-2, IL-12 and IFN-γ polymorphisms with CSU. METHODS: 90 patients with CSU and 140 age-sex matched subjects were included in this study. DNA samples were evaluated through PCR-SSP assay in order to detect single nucleotide polymorphisms of IL-12 (A/C -1188) or (rs3212227), IFN-γ (A/T UTR5644) or (rs2069717) and IL-2 (G/T -330 and G/T +166) or (rs2069762 and rs2069763). RESULTS: G allele at -330 at promoter region of IL-2 gene was overrepresented in CSU. Heterozygotes (GT) at this locus and heterozygotes at +166 of IL-2 gene (GT) were more prevalent in CSU group. Additionally, the haplotype GT for loci -330 and +166 of IL-2 gene was powerfully associated with CSU (OR (95%CI)=57.29 (8.43-112.7)). CONCLUSIONS: SNP at position -330 and +166 of IL-2 gene are differently expressed in CSU. The haplotype GT of IL-2 at -330 and +166 might confer vulnerability to a number of immunological disorders in Iranian region.


Asunto(s)
Interferón gamma/genética , Interleucina-12/genética , Interleucina-2/genética , Urticaria/genética , Estudios de Casos y Controles , Enfermedad Crónica , Femenino , Frecuencia de los Genes , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Irán , Masculino , Polimorfismo de Nucleótido Simple
10.
Am J Transplant ; 16(2): 518-26, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26595767

RESUMEN

Few current studies compare the outcomes of islet transplantation alone (ITA) and pancreas transplantation alone (PTA) for type 1 diabetes (T1D). We examined these two beta cell replacement therapies in nonuremic patients with T1D with respect to safety, graft function and cost. Sequential patients received PTA (n = 15) or ITA (n = 10) at our institution. Assessments of graft function included duration of insulin independence; glycemic control, as measured by hemoglobin A1c; and elimination of severe hypoglycemia. Cost analysis included all normalized costs associated with transplantation and inpatient management. ITA patients received one (n = 6) or two (n = 4) islet transplants. Mean duration of insulin independence in this group was 35 mo; 90% were independent at 1 year, and 70% were independent at 3 years. Mean duration of insulin independence in PTA was 55 mo; 93% were insulin independent at 1 year, and 64% were independent at 3 years. Glycemic control was comparable in all patients with functioning grafts, as were overall costs ($138 872 for ITA, $134 748 for PTA). We conclude that with advances in islet isolation and posttransplant management, ITA can produce outcomes similar to PTA and represents a clinically viable option to achieve long-term insulin independence in selected patients with T1D.


Asunto(s)
Análisis Costo-Beneficio , Diabetes Mellitus Tipo 1/terapia , Trasplante de Islotes Pancreáticos/economía , Tiempo de Internación/estadística & datos numéricos , Trasplante de Páncreas/economía , Adulto , Diabetes Mellitus Tipo 1/economía , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Rechazo de Injerto , Supervivencia de Injerto , Humanos , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Seguridad
11.
Am J Transplant ; 16(6): 1827-33, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-26699829

RESUMEN

Kidney transplantation is the optimal treatment for children with end-stage renal disease. For children with undocumented immigration status, access to kidney transplantation is limited, and data on transplant outcomes in this population are scarce. The goal of the present retrospective single-center study was to compare outcomes after kidney transplantation in undocumented children with those of US citizen children. Undocumented residency status was identified in 48 (17%) of 289 children who received a kidney transplant between 1998 and 2010. In undocumented recipients, graft survival at 1 and 5 years posttransplantation was similar, and mean estimated glomerular filtration rate at 1 year was higher than that in recipients who were citizens. The risk of allograft failure was lower in undocumented recipients relative to that in citizens at 5 years posttransplantation, after adjustment for patient age, donor age, donor type, and HLA mismatch (p < 0.04). In contrast, nearly one in five undocumented recipients who reached 21 years of age lost their graft, primarily because they were unable to pay for immunosuppressive medications once their state-funded insurance had ended. These findings support the ongoing need for immigration policies for the undocumented that facilitate access to work-permits and employment-related insurance for this disadvantaged group.


Asunto(s)
Emigración e Inmigración/estadística & datos numéricos , Rechazo de Injerto/epidemiología , Supervivencia de Injerto , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Obtención de Tejidos y Órganos/métodos , Adolescente , Adulto , Niño , Preescolar , Emigración e Inmigración/legislación & jurisprudencia , Femenino , Tasa de Filtración Glomerular , Política de Salud , Humanos , Incidencia , Lactante , Masculino , Estudios Retrospectivos , Medición de Riesgo , Factores Socioeconómicos , Donantes de Tejidos , Receptores de Trasplantes , Trasplante Homólogo , Resultado del Tratamiento , Estados Unidos/epidemiología , Adulto Joven
12.
Allergol Immunopathol (Madr) ; 44(4): 341-5, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26796858

RESUMEN

BACKGROUND: Filaggrin (FLG), which is formed from profilaggrin protein during epidermal terminal differentiation, is a prerequisite to squame biogenesis and thus for perfect formation of the skin barrier. Yet, the relationship between genetic polymorphisms of FLG and chronic idiopathic urticaria (CIU) has not been investigated. METHODS: The study population consisted of 93 CIU patients and 93 healthy control subjects without a history of allergic, autoimmune or any other systemic disease. Five single nucleotide polymorphisms (SNPs) of FLG were investigated: rs2485518, rs3126065, rs2786680, rs3814300, and rs3814299. RESULTS: For all the investigated polymorphisms, 100% of both CIU patients and control subjects exhibited one given allele and consequently one given genotype as following: A/A genotype for two SNPs, rs3126065 and rs2786680, C/C genotype for two SNPs, rs2485518 and rs3814300, and G/G genotype for one SNP rs3814299 of FLG, and hence no association was found between either allele frequencies or genotype distributions of FLG SNPs and CIU in an Iranian population. CONCLUSIONS: The present study examined the possible relationship between SNPs of FLG and CIU for the first time, and demonstrated that none of five investigated SNPs (rs2485518, rs3126065, rs2786680, rs3814300, and rs3814299) are correlated with CIU in an Iranian population. Further investigations are required to address whether ethnicity/race impacts on relationship between SNPs of FLG and CIU.


Asunto(s)
Predisposición Genética a la Enfermedad , Proteínas de Filamentos Intermediarios/genética , Polimorfismo de Nucleótido Simple , Urticaria/genética , Estudios de Casos y Controles , Enfermedad Crónica , Proteínas Filagrina , Frecuencia de los Genes , Genotipo , Humanos , Irán
13.
Allergol Immunopathol (Madr) ; 42(6): 533-8, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24051251

RESUMEN

BACKGROUND: This study was performed to evaluate association of gene polymorphisms among proinflammatory cytokines and susceptibility to chronic idiopathic urticaria (CIU). METHODS: Ninety patients with prolonged urticaria more than 6 weeks were included as case group. Single nucleotide polymorphisms (SNPs) of IL-6 (G/C -174, G/A nt565) and TNF-α (G/A -308, G/A -238) were evaluated, using polymerase chain reaction (PCR); and the results were compared to the control group. RESULTS: G allele was significantly higher in the patients at locus of -238 of promoter of TNF-α gene (p<0.001). Frequency of following genotypes were significantly lower in patients with CIU, compared to controls: AG at -308 and GA at -238 of TNF-α gene (p<0.05 and p<0.001, respectively), CG at -174 and GG at +565 of IL-6 gene (p<0.05). Additionally, following genotypes were more common among patients with CIU: GG at -308 and -238 of TNF-α gene (p<0.05 and p<0.001, respectively), GG at -174 and GA at +565 of IL-6 gene (p<0.05). CONCLUSIONS: Pro-inflammatory cytokine gene polymorphisms can affect susceptibility to CIU. TNF-α promoter polymorphisms as well as IL-6 gene polymorphisms are associated with CIU.


Asunto(s)
Interleucina-6/genética , Factor de Necrosis Tumoral alfa/genética , Urticaria/inmunología , Enfermedad Crónica , Femenino , Frecuencia de los Genes , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Irán , Masculino , Polimorfismo de Nucleótido Simple , Regiones Promotoras Genéticas/genética , Urticaria/genética
14.
Am J Transplant ; 13(10): 2611-8, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24034208

RESUMEN

For solid organ transplant (SOT) donors, nucleic acid-amplification testing (NAT) may reduce human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission over antibody (Ab) testing given its shorter detection window period. We compared SOT donor NAT + Ab versus Ab alone using decision models to estimate incremental cost-effectiveness ratios (ICERs; cost per quality-adjusted life year [QALY] gained) from the societal perspective across a range of HIV/HCV prevalence values and NAT costs. The cost per QALY gained was calculated for two scenarios: (1) favorable: low cost ($150/donor)/high prevalence (HIV: 1.5%; HCV: 18.2%) and (2) unfavorable: high cost ($500/donor)/low prevalence (HIV: 0.1%; HCV: 1.5%). In the favorable scenario, adding NAT screening cost $161 013 per QALY gained for HIV was less costly) for HCV, and cost $86 653 per QALY gained for HIV/HCV combined. For the unfavorable scenario, the costs were $15 568 484, $221 006 and $10 077 599 per QALY gained, respectively. Universal HCV NAT + Ab for donors appears cost-effective to reduce infection transmission from SOT donors, while HIV NAT + Ab is not, except where HIV NAT is ≤$150/donor and prevalence is ≥1.5%. Our analyses provide important data to facilitate the decision to implement HIV and HCV NAT for deceased SOT donors and shape national policy regarding how to reduce infection transmission in SOT.


Asunto(s)
Donantes de Sangre , Análisis Costo-Beneficio , Infecciones por VIH/diagnóstico , Hepatitis C/diagnóstico , Tamizaje Masivo/economía , Modelos Económicos , Técnicas de Amplificación de Ácido Nucleico/economía , Trasplante de Órganos , ADN Viral/genética , Toma de Decisiones , VIH/genética , Infecciones por VIH/economía , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Hepacivirus/genética , Hepatitis C/economía , Hepatitis C/prevención & control , Hepatitis C/transmisión , Humanos , Pronóstico
15.
Surg Endosc ; 27(1): 81-5, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22752278

RESUMEN

BACKGROUND: Obesity, steroid-induced diabetes, hypercholesterolemia, and steatohepatitis can occur after liver transplantation and may respond to bariatric surgery. The safety and feasibility of bariatric surgery after liver transplantation is unknown. METHODS: Nine morbidly obese patients with prior liver transplants underwent sleeve gastrectomy in a pilot program. Sleeve gastrectomy was chosen over gastric banding to avoid foreign body implantation, and over gastric bypass to maintain endoscopic access to the biliary system and reduce surgical complexity. We reviewed patient demographics, operative details, 30-day complications, weight loss, postoperative hepatic and renal functions, and resolution of comorbidities. RESULTS: Sleeve gastrectomy was performed laparoscopically in eight patients and as an open procedure in one patient. The mean operative time was 165 min and mean postoperative length of stay was 5 days. Follow-up ranged from 3 to 36 months. In the first 30 days, there were three complications in three patients: mesh dehiscence after a synchronous incisional hernia repair, bile leak from the liver surface requiring laparoscopic drainage, and postoperative dysphagia that required reoperation. Calcineurin inhibitor levels and hepatic and renal functions remained stable. There were no episodes of graft rejection. At 3 months liver function tests remained stable. Excess weight loss averaged 55.5% at 6 months. CONCLUSION: Sleeve gastrectomy is technically feasible after liver transplantation and resulted in weight loss without adversely affecting graft function and immunosuppression. Early complications may be more frequent as a result of adhesions of the left upper quadrant. Late complications were rare.


Asunto(s)
Gastrectomía/métodos , Derivación Gástrica/métodos , Trasplante de Hígado , Obesidad Mórbida/cirugía , Anciano , Biomarcadores/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/sangre , Proyectos Piloto , Complicaciones Posoperatorias/etiología , Adherencias Tisulares/etiología , Pérdida de Peso
16.
Antimicrob Agents Chemother ; 56(3): 1595-8, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22203603

RESUMEN

Chitin and ß-glucan are major cell wall components of Aspergillus spp. We investigated the antifungal activity of chitin synthesis inhibitors nikkomycin Z, polyoxin D, flufenoxuron, lufenuron, and teflubenzuron, alone and combined with the ß-glucan synthesis inhibitor caspofungin. Only nikkomycin Z and caspofungin were found to act synergistically. The nikkomycin Z-induced chitin decrease corresponded with a ß-glucan increase, while with the caspofungin-induced ß-glucan decrease, an increase in chitin was found. This could explain the synergistic activity of this combination of drugs.


Asunto(s)
Aminoglicósidos/farmacología , Antifúngicos/farmacología , Aspergillus fumigatus/efectos de los fármacos , Pared Celular/efectos de los fármacos , Quitina/metabolismo , Equinocandinas/farmacología , beta-Glucanos/metabolismo , Aspergillus fumigatus/fisiología , Aspergillus fumigatus/ultraestructura , Benzamidas/farmacología , Caspofungina , Pared Celular/fisiología , Pared Celular/ultraestructura , Interacciones Farmacológicas , Hifa/efectos de los fármacos , Hifa/fisiología , Hifa/ultraestructura , Lipopéptidos , Pruebas de Sensibilidad Microbiana , Nucleósidos de Pirimidina/farmacología
17.
Eur J Clin Microbiol Infect Dis ; 31(12): 3317-21, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23010901

RESUMEN

Methicillin-resistant Staphylococcus aureus (MRSA) is well known for its epidemicity, with the emergence of new clones on a daily basis. Diversity in the clonal types of MRSA challenges the success of treatment, as different clones respond to different sets of antibiotics. However, the antibiotic susceptibility among the isolates within the same clones is largely unexplored. In a previous study on MRSA epidemiology in Malaysia, we identified six major clonal complexes (ST-239-CC8, ST-1-CC1, ST-188-CC1, ST-22-CC22, ST-7-CC7 and ST-1283-CC8). In the present study, we investigated the antibiotic susceptibility patterns of isolates of different clones. Three hundred and eighty-nine MRSA isolates were subjected to the disc diffusion test, oxacillin minimum inhibitory concentration (MIC) determination and assessment of the distribution of macrolide, lincosamide and streptogramin B (MLS(B)) resistance genes. Thirty-six different antibiotic profiles were observed: 30 (83.3 %) among ST-239, 2 (5.6 %) among ST-1283 and 1 (2.8 %) each for ST-1, ST-7, ST-22 and ST-188. All ST-239 (362, 9 %) isolates were multiple drug-resistant (MDR; resistant to more than three classes of antibiotics) and had oxacillin MICs >256 mg/l. Among the 385 clindamycin-resistant isolates, 375 (96.4 %) illustrated inducible resistance (D-zone-positive), while 10 (2.6 %) showed constitutive resistance. The vast majority of the macrolide-resistant isolates carried the ermA gene (95.1 %), followed by ermC (12.9 %). Diversity in the antibiotic susceptibilities of isolates within the clones emphasises the need for continuous surveillance of MDR strains to prescribe the correct antibiotic rather than empirical treatment. This will likely reduce the emergence of new endemic or epidemic resistant MRSA clones.


Asunto(s)
Antibacterianos/farmacología , Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Infecciones Estafilocócicas/microbiología , Farmacorresistencia Bacteriana Múltiple , Genotipo , Humanos , Malasia/epidemiología , Staphylococcus aureus Resistente a Meticilina/genética , Pruebas de Sensibilidad Microbiana , Tipificación Molecular , Infecciones Estafilocócicas/epidemiología
18.
Eur J Clin Microbiol Infect Dis ; 31(1): 97-100, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21573817

RESUMEN

Staphylococcus aureus (S. aureus) colonizes the anterior nares in part of the population and the persistent carrier state is associated with increased infection risk. Knowledge concerning the determinants of S. aureus nasal carriage is limited. Previously, we found that glucocorticoid receptor polymorphisms influence carrier risk, suggesting involvement of glucocorticoids. Our aim was to study long-term cortisol levels in non-carriers, intermittent, and persistent carriers of S. aureus. We hypothesized that cortisol levels are higher in carriers, since cortisol-induced immune suppression would enhance S. aureus colonization. We determined nasal carrier state and long-term hair cortisol levels in 72 healthy subjects. Nasal swabs were collected twice with an interval of 2 weeks. Cortisol levels were determined in hair segments of 3 cm, which corresponds to a period of roughly 3 months. Of all 72 participants, 38 were non-carriers, 10 were intermittent carriers, and 24 were persistent carriers of S. aureus. Cortisol levels did not differ between these carrier groups (p=0.638). Long-term cortisol levels are not associated with S. aureus nasal carriage.


Asunto(s)
Cabello/química , Hidrocortisona/análisis , Mucosa Nasal/microbiología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/aislamiento & purificación , Adulto , Portador Sano/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cavidad Nasal/microbiología , Polimorfismo de Nucleótido Simple , Receptores de Glucocorticoides/genética , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/patogenicidad , Factores de Tiempo
19.
J Investig Allergol Clin Immunol ; 22(3): 208-14, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22697011

RESUMEN

BACKGROUND: Common variable immunodeficiency (CVID) is the most common form of symptomatic primary immunodeficiency disease. It is characterized by hypogammaglobulinemia, increased predisposition to infections, autoimmunity, and cancer. OBJECTIVES: This study was performed to evaluate the clinical and immunological features of a group of pediatric patients with CVID. METHODS: The study population comprised 69 individuals with CVID diagnosed during childhood. RESULTS: The patients were followed up for a mean (SD) period of 5.2 (4.3) years. The mean diagnostic delay was 4.4 (3.6) years, which was significantly lower in patients who were diagnosed recently. Children were classified according to 5 clinical phenotypes: infections only (n=39), polyclonal lymphocytic infiltration (n=17), autoimmunity (n=12), malignancy (n=7), and enteropathy (n=3). Postdiagnosis survival (10-year) was 71%. CONCLUSIONS: The high percentages of pediatric patients with CVID in Iran may be due to the considerable prevalence of parental consanguinity in the region and an underlying genetic background.


Asunto(s)
Agammaglobulinemia/inmunología , Inmunodeficiencia Variable Común/inmunología , Adolescente , Agammaglobulinemia/sangre , Agammaglobulinemia/genética , Agammaglobulinemia/mortalidad , Niño , Preescolar , Inmunodeficiencia Variable Común/sangre , Inmunodeficiencia Variable Común/genética , Inmunodeficiencia Variable Común/mortalidad , Diagnóstico Tardío , Femenino , Estudios de Seguimiento , Predisposición Genética a la Enfermedad , Humanos , Inmunoglobulinas/sangre , Irán/epidemiología , Masculino , Fenotipo
20.
Eur J Clin Microbiol Infect Dis ; 30(11): 1365-9, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-21479532

RESUMEN

The usefulness of mec-associated dru typing in the epidemiological analysis of methicillin-resistant Staphylococcus aureus (MRSA) isolated in Malaysia was investigated and compared with pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and spa and SCCmec typing. The isolates studied included all MRSA types in Malaysia. Multilocus sequence type ST188 and ST1 isolates were highly clonal by all typing methods. However, the dru typing of ST239 isolates produced the clearest discrimination between SCCmec IIIa and III isolates, yielding more subtypes than any other method. Evaluation of the discriminatory power for each method identified dru typing and PFGE as the most discriminatory, with Simpson's index of diversity (SID) values over 89%, including an isolate which was non-typeable by spa, but dru-typed as dt13j. The discriminatory ability of dru typing, especially with closely related MRSA ST239 strains (e.g., Brazilian and Hungarian), underscores its utility as a tool for the epidemiological investigation of MRSA.


Asunto(s)
Técnicas de Tipificación Bacteriana/métodos , Staphylococcus aureus Resistente a Meticilina/clasificación , Infecciones Estafilocócicas/microbiología , Antibacterianos/farmacología , Análisis por Conglomerados , Intervalos de Confianza , ADN Bacteriano/genética , Electroforesis en Gel de Campo Pulsado , Genotipo , Humanos , Malasia/epidemiología , Resistencia a la Meticilina/genética , Staphylococcus aureus Resistente a Meticilina/genética , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Epidemiología Molecular , Tipificación de Secuencias Multilocus , Secuencias Repetitivas de Ácidos Nucleicos/genética , Análisis de Secuencia de ADN , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/genética
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