Anaphylaxis reaction to Samsum ant (Pachycondyla sennaarensis): a case series study.

Summary: Background. Anaphylaxis is a life-threatening hypersensitivity reaction. The present study aimed to investigate the cases of anaphylaxis to ant stings in Iran to determine the characteristics of patients, geographical distribution and the type of ants that cause anaphylaxis. Methods. Patients with a history of anaphylaxis to ant sting underwent skin allergy test with extracted substance from Solenopsis invicta. Samples of ants were collected from the sites where each patient was bitten and their species were identified by a medical entomologist. Results. Nineteen patients (mean age: 26.2 years; range: 4-48 years) were included in the study. Most patients (89.5 percent) were female. The lower limb was the most common site of the sting and most stings had occurred in the morning (31.6 %) and evening (31.6%). Skin manifestations were the most common clinical symptoms (94.7%). Most cases of stings were observed in the Hormozgan province (89.5%) located in southern Iran. Sixteen patients had positive skin prick test for ant venom. All collected ants that caused anaphylaxis belonged to the Pachycondyla sennaarensis species. Conclusions. Ant sting anaphylaxis is not uncommon in Iran, especially in its southern regions. All cases of anaphylaxis in this study were due to samsum ant sting (Pachycondyla sennaarensis), which is a species similar to the fire ant (Solenopsis invicta). Allergy skin testing with fire ant extract was positive and helpful in identifying samsum ant allergy in all cases.

Evaluation of patients with primary immunodeficiency associated with Bacille Calmette-Guerin (BCG)-vaccine-derived complications

BACKGROUND: Bacille Calmette-Guerin (BCG) vaccination has a great impact on the prevention of severe complications of tuberculosis. However, in patients with primary immunodeficiencies (PID), it can lead to severe complications such as severe combined immunodeficiency, chronic granulomatous disease, and Mendelian susceptibility to mycobacterial disease. This study highlights the demographics, clinical complications and laboratory parameters among PID patients associated with BCG vaccination side effects. METHODS: One hundred and thirty-seven PID patients with BCGosis were evaluated in this study, based on the complications following BCG vaccination. RESULTS: The mean age of the patients with BCG complications at the time of the first visit was five years. The within-group comparison of patients showed a highly significant incidence of pneumonia and hepatomegaly in severe combined immunodeficiency patients. Furthermore, the immunologic data showed an increase in the overall rates of lymphocytes such as CD3+, CD4+ and CD8 + T cells in Mendelian susceptibility to mycobacterial disease patients. The level of immunoglobulins has also increased in chronic granulomatous disease patients. CONCLUSION: The high rate of undiagnosed PIDs predisposes individuals to a high risk of severe side effects as a result of BCG vaccination, as well as infants that are less than one month of age. Therefore, there is a need for early screening and diagnosis of PIDs before exposing unknown PID status patients to BCG vaccination. The benefits of screening and early diagnosis of PID cannot be overemphasized, especially in patients with a previous family history of immunodeficiency

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Evaluation of patients with primary immunodeficiency associated with Bacille Calmette-Guerin (BCG)-vaccine-derived complications.

BACKGROUND: Bacille Calmette-Guerin (BCG) vaccination has a great impact on the prevention of severe complications of tuberculosis. However, in patients with primary immunodeficiencies (PID), it can lead to severe complications such as severe combined immunodeficiency, chronic granulomatous disease, and Mendelian susceptibility to mycobacterial disease. This study highlights the demographics, clinical complications and laboratory parameters among PID patients associated with BCG vaccination side effects. METHODS: One hundred and thirty-seven PID patients with BCGosis were evaluated in this study, based on the complications following BCG vaccination. RESULTS: The mean age of the patients with BCG complications at the time of the first visit was five years. The within-group comparison of patients showed a highly significant incidence of pneumonia and hepatomegaly in severe combined immunodeficiency patients. Furthermore, the immunologic data showed an increase in the overall rates of lymphocytes such as CD3+, CD4+ and CD8 + T cells in Mendelian susceptibility to mycobacterial disease patients. The level of immunoglobulins has also increased in chronic granulomatous disease patients. CONCLUSION: The high rate of undiagnosed PIDs predisposes individuals to a high risk of severe side effects as a result of BCG vaccination, as well as infants that are less than one month of age. Therefore, there is a need for early screening and diagnosis of PIDs before exposing unknown PID status patients to BCG vaccination. The benefits of screening and early diagnosis of PID cannot be overemphasized, especially in patients with a previous family history of immunodeficiency.

Both stiff and compliant: morphological and biomechanical adaptations of stick insect antennae for tactile exploration.

Active tactile exploration behaviour is constrained to a large extent by the morphological and biomechanical properties of the animal's somatosensory system. In the model organism Carausius morosus, the main tactile sensory organs are long, thin, seemingly delicate, but very robust antennae. Previous studies have shown that these antennae are compliant under contact, yet stiff enough to maintain a straight shape during active exploration. Overcritical damping of the flagellum, on the other hand, allows for a rapid return to the straight shape after release of contact. Which roles do the morphological and biomechanical adaptations of the flagellum play in determining these special mechanical properties? To investigate this question, we used a combination of biomechanical experiments and numerical modelling. A set of four finite-element (FE) model variants was derived to investigate the effect of the distinct geometrical and material properties of the flagellum on its static (bending) and dynamic (damping) characteristics. The results of our numerical simulations show that the tapered shape of the flagellum had the strongest influence on its static biomechanical behaviour. The annulated structure and thickness gradient affected the deformability of the flagellum to a lesser degree. The inner endocuticle layer of the flagellum was confirmed to be essential for explaining the strongly damped return behaviour of the antenna. By highlighting the significance of two out of the four main structural features of the insect flagellum, our study provides a basis for mechanical design of biomimetic touch sensors tuned to become maximally flexible while quickly resuming a straight shape after contact.

A Wireless Electronic Esophageal Stethoscope for Continuous Monitoring of Cardiovascular and Respiratory Systems during Anaesthesia.

BACKGROUND: The basic requirements for monitoring anesthetized patients during surgery are assessing cardiac and respiratory function. Esophageal stethoscopes have been developed for this purpose, but these devices may not provide clear heart and lung sound due to existence of various noises in operating rooms. In addition, the stethoscope is not applicable for continues monitoring, and it is unsuitable for observing inaccessible patients in some conditions such as during CT scan. OBJECTIVE: A wireless electronic esophageal stethoscope is designed for continues auscultation of heart and lung sounds in anesthetized patients. The system consists of a transmitter and a receiver. The former acquires, amplifies and transmits the acquired sound signals to the latter via a frequency modulation transmitter. The receiver demodulates, amplifies, and delivers the received signal to a headphone to be heard by anesthesiologist. RESULTS: The usability and effectiveness of the designed system was qualitatively evaluated by 5 anesthesiologists in Namazi Hospital and Shahid Chamran Hospital, Shiraz, Iran on 30 patients in several operating rooms in different conditions; e.g., when electro surgery instruments are working. Fortunately, the experts on average ranked good quality for the heard heart and lung sounds and very good on the user friendly being of the instrument. CONCLUSION: Evaluation results demonstrate that the developed system is capable of capturing and transmitting heart and lung sounds successfully. Therefore, it can be used to continuously monitor anesthetized patients' cardiac and respiratory function. Since via the instrument wireless auscultation is possible, it could be suitable for observing inaccessible patients in several conditions such as during CT scan.

Resilin microjoints: a smart design strategy to avoid failure in dragonfly wings.

Dragonflies are fast and manoeuvrable fliers and this ability is reflected in their unique wing morphology. Due to the specific lightweight structure, with the crossing veins joined by rubber-like resilin patches, wings possess strong deformability but can resist high forces and large deformations during aerial collisions. The computational results demonstrate the strong influence of resilin-containing vein joints on the stress distribution within the wing. The presence of flexible resilin in the contact region of the veins prevents excessive bending of the cross veins and significantly reduces the stress concentration in the joint.

Effect of microstructure on the mechanical and damping behaviour of dragonfly wing veins.

Insect wing veins are biological composites of chitin and protein arranged in a complex lamellar configuration. Although these hierarchical structures are found in many 'venous wings' of insects, very little is known about their physical and mechanical characteristics. For the first time, we carried out a systematic comparative study to gain a better understanding of the influence of microstructure on the mechanical characteristics and damping behaviour of the veins. Morphological data have been used to develop a series of three-dimensional numerical models with different material properties and geometries. Finite-element analysis has been employed to simulate the mechanical response of the models under different loading conditions. The modelling strategy used in this study enabled us to determine the effects selectively induced by resilin, friction between layers, shape of the cross section, material composition and layered structure on the stiffness and damping characteristics of wing veins. Numerical simulations suggest that although the presence of the resilin-dominated endocuticle layer results in a much higher flexibility of wing veins, the dumbbell-shaped cross section increases their bending rigidity. Our study further shows that the rubber-like cuticle, friction between layers and material gradient-based design contribute to the higher damping capacity of veins. The results of this study can serve as a reference for the design of novel bioinspired composite structures.

Numerical investigation of insect wing fracture behaviour.

The wings of insects are extremely light-weight biological composites with exceptional biomechanical properties. In the recent years, numerical simulations have become a very powerful tool to answer experimentally inaccessible questions on the biomechanics of insect flight. However, many of the presented models require a sophisticated balance of biomechanical material parameters, many of which are not yet available. In this article we show the first numerical simulations of crack propagation in insect wings. We have used a combination of the maximum-principal stress theory, the traction separation law and basic biomechanical properties of cuticle to develop simple yet accurate finite element (FE) models of locust wings. The numerical results of simulated tensile tests on wing samples are in very good qualitative, and interestingly, also in excellent quantitative agreement with previously obtained experimental data. Our study further supports the idea that the cross-veins in insect wings act as barriers against crack propagation and consequently play a dominant role in toughening the whole wing structure. The use of numerical simulations also allowed us to combine experimental data with previously inaccessible data, such as the distribution of the first principal stress through the wing membrane and the veins. A closer look at the stress-distribution within the wings might help to better understand fracture-toughening mechanisms and also to design more durable biomimetic micro-air vehicles.

Primary Antibody Deficiency in a Tertiary Referral Hospital: A 30-Year Experiment.

BACKGROUND: Primary antibody deficiency (PAD) is the most common group of primary immunodeficiency disorders (PID), with a broad spectrum of clinical features ranging from severe and recurrent infections to asymptomatic disease. OBJECTIVES: The current study was performed to evaluate and compare demographic and clinical data in the most common types of PAD. MATERIALS AND METHODS: We performed a retrospective review of the medical records of all PAD patients with a confirmed diagnosis of common variable immunodeficiency (CVID), hyper IgM syndrome (HIgM), selective IgA deficiency (SIgAD), and X-linked agammaglobulinemia (XLA) who were diagnosed during the last 30 years at the Children's Medical Center, Tehran, Iran. RESULTS: A total number of 280 cases of PAD (125 CVID, 32 HIgM, 63 SIgAD, and 60 XLA) were enrolled in the study. The median (range) age at the onset of disease in CVID, HIgM, SIgAD, and XLA was 2 (0-46), 0.91 (0-9), 1 (0-26), and 1 (0-10) years, respectively. Gastrointestinal infections were more prevalent in CVID patients, as were central nervous system infections in XLA patients. Autoimmune complications were more prevalent in HIgM patients, malignancies in CVID patients, and allergies in SIgAD patients. The mortality rate for CVID, HIgM, and XLA was 27.2%, 28.1%, and 25%, respectively. No deaths were reported in SIgAD patients. CONCLUSIONS: SIgAD patients had the best prognosis. While all PAD patients should be monitored for infectious complications, special attention should be paid to the finding of malignancy and autoimmune disorders in CVID and HIgM patients, respectively.

Primary antibody deficiency in a tertiary referral hospital: a 30-year experiment

Background: Primary antibody deficiency (PAD) is the most common group of primary immunodeficiency disorders (PID), with a broad spectrum of clinical features ranging from severe and recurrent infections to asymptomatic disease. Objectives: The current study was performed to evaluate and compare demographic and clinical data in the most common types of PAD. Materials and Methods: We performed a retrospective review of the medical records of all PAD patients with a confirmed diagnosis of common variable immunodeficiency (CVID), hyper IgM syndrome (HIgM), selective IgA deficiency (SIgAD), and X-linked agammaglobulinemia (XLA) who were diagnosed during the last 30 years at the Children’s Medical Center, Tehran, Iran. Results: A total number of 280 cases of PAD (125 CVID, 32 HIgM, 63 SIgAD, and 60 XLA) were enrolled in the study. The median (range) age at the onset of disease in CVID, HIgM, SIgAD, and XLA was 2 (0-46), 0.91 (0-9), 1 (0-26), and 1 (0-10) years, respectively. Gastrointestinal infections were more prevalent in CVID patients, as were central nervous system infections in XLA patients. Autoimmune complications were more prevalent in HIgM patients, malignancies in CVID patients, and allergies in SIgAD patients. The mortality rate for CVID, HIgM, and XLA was 27.2%, 28.1%, and 25%, respectively. No deaths were reported in SIgAD patients. Conclusions: SIgAD patients had the best prognosis. While all PAD patients should be monitored for infectious complications, special attention should be paid to the finding of malignancy and autoimmune disorders in CVID and HIgM patients, respectively (AU)

Antecedentes: Las inmunodeficiencias humorales primarias (PAD) es el grupo más frecuente de inmunodeficiencias primarias (IDP), y engloba un amplio espectro de características clínicas, que van desde los pacientes con infecciones graves y recurrentes a los casos asintomáticos. Objetivos: El presente estudio se realizó para evaluar y comparar los datos demográficos y clínicos de los tipos más comunes de PAD. Materiales y Métodos: Se revisaron retrospectivamente, las historias clínicas de todos los pacientes con PAD con un diagnóstico confirmado de: inmunodeficiencia variable común (CVID), síndrome de hiper IgM (HIgM), deficiencia selectiva de IgA (SIgAD),y de agammaglobulinemia ligada al cromosoma X (XLA), que fueron diagnosticados durante los últimos 30 años, en el Centro Médico de Niños, Teherán, Irán. Resultados: Se incluyeron en este estudio un total de 280 casos de PAD, englobando 125 pacientes con CVID, 32 HIgM, 63 SIgAD, y 60 pacientes con XLA. La mediana (rango) de edad al inicio de la enfermedad en la CVID, HIgM, SIgAD y XLA fue: 2 (0-46), 0,91 (0-9), 1 (0-26) y 1 (0-10) años, respectivamente. Las infecciones gastrointestinales fueron más frecuentes en los pacientes con CVID, mientras que las infecciones del sistema nervioso central lo fueron en la XLA. Las complicaciones autoinmunes fueron más prevalentes en los pacientes con HIgM, los tumores malignos en las CVID y las enfermedades alérgicas en las SIgAD. La tasa de mortalidad de CVID, HIgM y XLA fue 27,2%, 28,1% y 25%, respectivamente. No hubo mortalidad en el grupo de pacientes con SIgAD. Conclusiones: Los pacientes con SIgAD tuvieron el mejor pronóstico. Aunque todos los pacientes con PAD deben ser controlados estrechamente para evitar las complicaciones infecciosas, se debe prestar especial atención a la aparición de enfermedades malignas y autoinmunes en los pacientes con CVID y HIgM, respectivamente (AU)

Experimental and numerical investigations of Otala lactea's shell-I. Quasi-static analysis.

At the first glance, mollusk shells may seem complex spatial structures with interesting shapes, forms and colors. However, from an engineering point of view, they are mechanical barriers which provide remarkable protection against environmental factors. These biological composites which exhibits an attractive combination of stiffness, strength and toughness, may be mimicked in bio-inspired materials. In the present work, a mathematical method is used to develop comprehensive three-dimensional (3D) numerical models of mollusk shells. The models are employed to study the mechanical behavior of the shells under static loading conditions. Numerical analyses are conducted using ANSYS finite element (FE) codes. A combination of indentation testing and scanning electron microscopy (SEM) is utilized to confirm the validity of the models and the solving procedures. A good agreement is observed between the shape, size and location of the failure obtained from experimental tests and numerical predictions. The results indicate that the columella increases the ability of mollusk shells to withstand applied mechanical forces without failure. Further, it can be concluded that the coiling geometry of the shells adequately modifies the stress distribution and reduces the stress concentration.

The frequency and predictors of helmet use among Iranian motorcyclists: A quantitative and qualitative study.

OBJECTIVE: This study examines the rate of helmet use and identifies barriers and facilitators of wearing helmets among Iranian motorcyclists. A mixed-method approach was used, including a structured seasonal survey with specific observations of a random sample of 6010 riders and qualitative methods that included 29 in-depth interviews and seven focus groups (n=31). RESULTS: Only 10% of motorcyclists wear a standard helmet while riding. However, another 23% of motorcyclists used non-standard or partial helmets that covered only part of the head and do not prevent head trauma injuries effectively. We observed only 2 of 264 child passengers and 22 of 1951 adult passengers wearing helmets. Almost no one used protective pants or clothing made to be more visible in traffic. Themes emerged from qualitative interviews and were grouped into three main categories: (1) helmet characteristics; (2) social and cultural factors; and (3) personal and psychological factors. CONCLUSION: Overall, the motorcyclists in our study believed that wearing a safety helmet protects them against serious injuries or death during a crash; however, only a small percentage of the motorcyclists used safety helmets. National intervention programs addressing motorcycle safety should aim to overcome barriers to and promote facilitators of helmet use, including providing inexpensive standard helmets, banning manufacturing/using unsafe partial or dummy helmets, as well as enforcing helmet use on a consistent basis.

Renal amyloidosis in common variable immunodeficiency

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A randomised, double-blind, controlled trial of a killed L. major vaccine plus BCG against zoonotic cutaneous leishmaniasis in Iran.

Safety and efficacy of killed (autoclaved) L. major promastigotes, ALM, mixed with BCG against zoonotic cutaneous leishmaniasis was tested in healthy volunteers (n = 2453) in a randomized double blind trial vs. BCG as control. Side-effects were similar in both groups but tended to be slightly more frequent and prolonged in the ALM + BCG group. Leishmanin skin test conversion (induration > or =5 mm) was significantly greater in the ALM + BCG than in the BCG group (36.2% vs. 7.9% on day-80 and 33% vs. 19%, after 1 year, respectively). Cumulative incidence rates for 2 years, were similar in both groups (18.0% vs. 18.5%). However, LST responders on day 80 (> or =5 mm) had a significantly lower incidence (35%) of CL during the first year than non-responders. A single dose of ALM + BCG is not sufficiently immunogenic to provide a measurable response when compared to BCG alone. A single dose of this vaccine has been shown to be safe with no evidence of an exacerbating response following natural infection; hence, multiple doses or other adjuvants should be considered to increase its immunogenicity.