Association between the copper/selenium ratio and the immune response to SARS-CoV-2 infection.

Aim: To assess the association serum levels of selenium (Se) and copper (Cu) with symptoms and IgG immune response to SARS-CoV-2. Patients & methods/materials: Blood samples and nasopharyngeal swabs were obtained from 126 COVID-19 patients with mild and severe symptoms. The serum levels of Cu and Se were measured by atomic-absorption spectrophotometry. Results & conclusion: Mean Se was higher in patients with mild symptoms and IgG nonresponders, whereas mean Cu was higher in patients with severe symptoms and IgG responders. The Cu/Se ratio was lower in patients with no IgG responses to infection and mild symptoms versus IgG responders with severe symptoms. These results suggest the Cu/Se ratio as a nutritional biomarker of severity and IgG immune response in COVID-19 patients.

The association between the strong immune response to infections and trace elements such as copper (Cu) and selenium (Se) is well documented. Se and Cu are changed under infectious conditions. Since SARS-CoV-2 causes inflammation in the body, this study was conducted to evaluate the association between serum levels of Se and Cu changes with the symptoms and immune response to SARS-CoV-2, and then assess the Cu/Se ratio. Blood samples and nasopharyngeal swabs were obtained from 126 SARS-CoV-2 participants with mild and severe clinical symptoms. The SARS-CoV-2 infection and immune response to the virus were confirmed in the laboratory. Next, the Se and Cu serum levels were measured. Finally, we analyzed our findings. The median Se levels were higher in patients with mild symptoms (115 µg/l) in comparison with the severe symptoms group (99 µg/l), and the mean Se levels were higher in immune nonresponders (110.33 ± 3.38 µg/l) in comparison with the immune responders' group (102.42 ± 1.83 µg/l). However, the median Cu was higher in participants with severe symptoms (124 µg/dl) compared with the mild symptoms group (103 µg/dl), and the mean Cu levels were higher in immune responders (112 ± 9.98 µg/dl) in comparison with the immune nonresponders' group (105.1 ± 9.4 µg/dl). The Cu/Se ratio was lower (ratio <1) in participants with no responses to infection and mild symptoms versus responders with severe symptoms. Our results suggest that the Cu/Se ratio may act as a nutritional biomarker of severity and immune response in SARS-CoV-2-infected patients.

Anesthesia technique and serum cytokine concentrations in the elective cesarean section.

BACKGROUND: Anesthesiologists should obtain the best technique for cesarean section (CS). This study designed to compare the effect of general anesthesia (GA) and spinal anesthesia (SA) on immune system function in elective CS. MATERIALS AND METHODS: This descriptive study was performed on forty candidates for elective CS. They were randomly divided into GA and SA groups. The serum concentrations of interleukin (IL)-4, IL-6, IL-10, and IL-17 and interferon-gamma (IFN-γ) were measured using ELISA method prior to anesthesia (T0), immediately after the uterine incision (T1), 2 h post CS (T2), and 24 h post CS (T3). Data were analyzed using descriptive statistics and Chi-square, independent t-test, and repeated measures. RESULTS: No significant differences were observed between the GA and SA groups regarding the serum levels of IL-4, IL-6, IL-10, IL-17, and IFN-γ. The serum levels of transforming growth factor beta (TGF-ß) in the SA group were significantly (P = 0.003) more than that of the GA group at T3. CONCLUSION: According to the angiogenesis properties of TGF-ß, it seems that SA probably affects the rate of recovery more than that of the GA.

General Anesthetics on Immune System Cytokines: A Narrative Review Article.

CONTEXT: According to the previous studies, general anesthesia influences the immune system. Evaluating such impacts on the immune system helps to improve the management of anesthesia. EVIDENCE ACQUISITION: The current review aimed to summarize the literature related to the effects of general anesthesia agents on the cytokines. Google Scholar, PubMed, and ISI/Web of Sciences databases were searched using the following keywords: cytokine, general anesthesia, immune response, intravenous anesthetics, volatile anesthetics, opioids, benzodiazepines, and controlled ventilation. RESULTS: Long-term administration of general anesthesia drugs, due to their effects on cytokines, can lead to disease progression in patients with immune deficiency. Due to the conflicting results of various studies and the increasing number of patients with immune deficiency, the choice of the appropriate general anesthesia agents facilitates achieving the more favorable function of the cytokines. CONCLUSIONS: It seems that the effect of general anesthesia on the immune system in healthy patients and short-term surgeries is not considerable and changes in the immune system are related to surgical trauma, particularly in major surgery.

Communication apprehension and level of anxiety in the medical students of Rafsanjan University of Medical Sciences.

BACKGROUND: Communication apprehension (CA) is the fear or anxiety about communicating. This study was designed to investigate the CA and its related factors in the medical students at Rafsanjan University of Medical Sciences (RUMS). MATERIALS AND METHODS: In this cross-sectional study, personal report of CA (PRCA-24) was administered to 340 medical and paramedical students to measure anxiety in four domains of large groups, small groups, public speaking, and dyadic interaction. Pearson's correlation and linear regression analysis were used to investigate the relationship between CA and the variables of birth order, number of siblings, and university entrance score. Data were analyzed using descriptive and inferential statistics (Chi-square and Kruskal-Wallis Test). RESULTS: CA in the dimension of public speaking was higher than the other dimensions. Evaluation of the economic stability and its relationship to CA indicated a significant difference among all the domains of the PRCA-24. There was a significant relationship between the scores of CA and the number of siblings (P = 0.001). Linear regression and Pearson's correlation tests indicated a significant correlation between the variables of birth order, number of siblings, and university entrance score. The correlation between the CA with dimensions of group discussion, interpersonal, speaking, and meeting was weak but significant (P < 0.01). CONCLUSION: Without communication, the materialization and development of the human community are not possible. This aspect is more evident and crucial in the healthcare industry. Based on the results of this study, the medical and paramedical students at RUMS have a medium-to-high level of CA. Therefore, it is of utmost importance to detect students with high CA to prevent further communication problems after graduation.

Effect of Different Anesthetic Techniques on Cytokine Gene Expression in Patients who Underwent Elective Cesarean Section.

Cesarean section (CS) is an important challenge for a pregnant woman and her newborn. The most common anesthesia techniques used for CS are general anesthesia (GA) and spinal anesthesia (SA). This study was designed to compare the modulation of genes whose expression level is indicative of the immune system following exposure to GA and SA. The present study was performed on 40 women who were scheduled for elective CS receiving GA or SA. The expression levels of the relative mRNA of Interleukin (IL)-4, IL-6, IL-10, IL-17, Interferon (IFN)-γ, and tumor growth factor (TGF)-ß before anesthesia (T0) and 24 hours post-anesthesia (T1) were analyzed by real-time polymerase chain reaction (RT-PCR) technique.  Twenty-four hours post-anesthesia, the expression levels of IL-10, IL-17, and IFN-γ genes were decreased while the expressions of IL-4, IL-6, and TGF-ß genes were upregulated in two groups, however, the differences were not significant. The mRNA level of IL-4 was increased in the SA group significantly. The post-CS mRNA levels of IL-4 in the SA group may indicate that SA is more appropriate than GA for the initiation of tissue repair pathways.

Cesarean or Cesarean Epidemic?

Due to advances in surgical procedure, anesthesia techniques, blood transfusion and antibiotic therapy, the technique of cesarean section has been progressing over the time. However, cesarean section is still a risk-specific operation, with long-term and shortterm consequences for the mother and neonate. The rate of cesarean surgery is constantly growing due to both justifiable and nonjustifiable medical and non-medical reasons. There is evidence indicating that efforts are made in many countries to reduce the rate of cesarean delivery. In this review article, we try to assess the frequency of cesarean section in different countries, especially Iran. We searched several keywords, including cesarean section prevalence, cesarean section rate, world, delivery, Iran and health policies within the newest articles published in Google Scholar, PubMed, and ISI/Web of Sciences, as well as Iranian databases (Magiran, SID), from January 2017 to April 2019. The results show that there is still a high prevalence of C-section. In Iran, the highest rate of cesarean was in Tehran province (62.1%-72.1%) and the lowest was in Sistan and Baluchestan province (12%). It appears necessary to plan for effective interventions in terms of painless vaginal delivery, improving the quality of vaginal delivery services, proper culture and education.

Vitiligo and social acceptance.

BACKGROUND AND AIM: Vitiligo is a chronic skin disease characterized by a total or partial loss of melanocytes from the epidermis and other tissues of the skin. It is placed in the class of secondary psychiatric disorders and can also lead to psychological problems. The main aim of this study was to assess social acceptance in vitiligo patients. METHODS: This cross-sectional study was conducted on all of the patients (n=150) with vitiligo who were referred to dermatology clinics in Rafsanjan, Iran. The patients completed a social acceptability questionnaire (Marlowe-Crowne Social Desirability Scale), and information regarding their demographic characteristics was also collected. Data were gathered and analyzed with descriptive and inferential statistics using SPSS-19 software. RESULTS: The mean age of the patients was 27.56±10.53 years and 65.9% were female. Mean score of social acceptance among the patients was 13.51±7.08. The results showed that the mean scores of social acceptance were significantly lower in women, in those with single marital status, in those with face and neck lesions, and in those with disease duration less than 5 years. CONCLUSION: The results showed that certain groups of patients with vitiligo are at greater risk of experiencing lower social acceptance.

Staphylococcus aureus nasal carriage and patterns of antibiotic resistance in bacterial isolates from patients and staff in a dialysis center of southeast Iran.

BACKGROUND AND OBJECTIVES: Staphylococcus aureus is an important infection in hemodialysis patients. We studied the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) and its antibiotic resistance pattern in patients receiving hemodialysis as well as in dialysis unit staff. MATERIALS AND METHODS: From June to September 2012, we evaluated 74 cases including 61 patients on hemodialysis and 13 dialysis unit staff. Nasal swabs were taken from all cases and were cultured on a blood medium agar. We identified S. aureus based on conventional laboratory methods. For antimicrobial resistance patterns, we used disk diffusion method. Oxacillin MIC, oxacillin and cefoxcitin disk diffusion methods were used for detection of MRSA. Disk approximation test (D-test) was applied for the frequency of erythromycin induced clindamycin resistance. RESULTS: S. aureus carrier state was determined in 12 of the 61 patients on hemodialysis (19.67%) and 5 of the 13 dialysis unit staffs (38.46%). In hemodialyzed patients, MRSA and MSSA carrier of S. aureus were 6.56% and 13.11%, respectively. All nasal carriage states in studied staffs were MSSA. All isolated S. aureus were found to be sensitive to vancomycin, teicoplanin, and rifampin. However, reduced sensitivity of MRSA isolates to other antibiotics was noted. Resistance frequencies to tested antibiotic was as follows: cefteriaxone and penicillin (100%), tetracycline and doxycilin (75%), gentamicin, cloxacillin, and cefazolin (50%), ciprofloxacin, trimethoprim-sulfamethoxazol, erythromycin, and clindamycin (25%). The resistance rate of isolated MSSA against tested antibiotics was lower than isolated MRSA. Inducible clindamycin resistance was shown in 25% of identified MRSA strains. CONCLUSION: S. aureus nasal carrier state was lower than former reports from other parts of Iran. The antibiotic resistance patterns also differed, perhaps due to different pattern of administering antibiotics at our hospital. Screening of these patients should be noted as a health priority and microbial sensitivity tests should be considered in order to optimize treatment options.

Etiologies and contributing factors of perinatal mortality: a report from southeast of Iran.

OBJECTIVE: The aim of this study was to investigate the etiology and risk factors of perinatal mortality in Rafsanjan, Iran. MATERIALS AND METHODS: This case-control prospective study was conducted on 321 perinatal deaths (as case group) and 321 live births who were alive until 28 days after birth (as control group) during a 2-year period. Data about demographic characteristics of mother, fetus, and newborn and also mother's obstetrics and clinical status was recorded in a questionnaire. RESULTS: The most important causes of newborn death were prematurity (63.24%), cardiac arrest (11.49%), and septicemia (5.75%) as well as premature rupture of membrane, pregnancy-induced hypertension, placenta decolman, and congenital abnormality for stillbirth. A significant association was found among the fetal weight, gestational age, and amniotic fluid volume with stillbirth. CONCLUSION: Prematurity, cardiac arrest, and septicemia were the most important causes of neonatal mortality. It is concluded that attention to the following points is very important: adopting program for pregnancy care improvement, finding and removing risk factors of premature birth, control of infection in mother's and newborn's wards, examining of personnel skill about correct newborn resuscitation methods, and arrangement of training courses.