HLA-DRB1*04 may predict the severity of disease in a group of Iranian COVID-19 patients.

Human leukocyte antigen (HLA) genes with extreme diversity can make a contribution for individual variations to the immune response against SARS-COV-2 infection. This study aimed to explore the distributions of HLA class II alleles frequencies and their relations with disease severity in a group of Iranian COVID-19 patients. This prospective and case-control study was conducted on 144 COVID-19 patients including 46 cases with moderate form, 54 cases with severe and 44 cases with critical disease. HLA-DRB1 and -DQB1 allele families were determined by PCR-SSP method and compared between three groups of the patients and in comparison to 153 ethnic-matched healthy controls. The patients group showed lower frequencies of HLA-DRB1*15 (OR = 0.57, P = 0.06), DRB1*15 ~ DQB1*05 haplotype (P = 0.04) and DRB1*15/DRB1*04 genotype (P = 0.04) in compare with healthy controls. Moderate COVID-19 patients had higher frequencies of HLA-DRB1*04 (P = 0.03), HLA-DRB1*10 (P = 0.05) and DRB1*04/DRB1*11 genotype (P = 0.01). Also, a higher significantly frequency of HLA-DRB1*03 allele group was observed in the critical patients versus controls (P = 0.01). Multiple logistic regression analysis revealed that the presence of DRB1*04 allele group was negatively associated with development of severe and critical disease (OR: 0.289, P = 0.005). Our results indicate a possible contribution of some HLA class II alleles in disease severity and clinical features of COVID-19 disease.

Oral warty dyskeratoma: An unusual presentation.

Warty dyskeratoma is an uncommon benign skin lesion, which is mostly limited to the head or neck and is rarely seen in other areas of the skin or mucous membranes. Although it is clinically similar to many skin lesions, its distinctive histopathologic features help distinguish it from other identical lesions. Herein, we report a case of warty dyskeratoma in a very unusual site (lateral border of the tongue) in a 56-year-old woman.

Comparison of the serum level of interleukin-4 in patients with brucellosis and healthy controls.

INTRODUCTION: Evaluation of cytokines such as interleukin-4 (IL-4) can be an important tool in examining immune responses to brucellosis. Also, determining the response rate to treatment is necessary for controlling and eradicating of disease. The review of previous studies reveals contradictory results that require further research in this regard. The aim of this study was to compare the serum level of IL-4 in patients with brucellosis and healthy controls. MATERIAL AND METHODS: In this descriptive-analytical study for comparison of two groups, a total of 165 participants, including 83 patients with brucellosis and 82 non-infected people, were evaluated after matching of sex and age in Hamadan (northwest of Iran) in 2017 and the serum level of IL-4 was compared by ELISA method. The collected data were analyzed by SPSS software version 21 at 95% significant level. RESULTS: Mean of age in the case and control groups were 50.25 ± 16.01 and 43.26 ± 15.6 years, respectively. The serum levels of IL-4 in the case and control groups were 1.42 ± 0.51 pg/mL and 1.31 ± 1.02 pg/mL, respectively. Based on the non-parametric Mann-Whitney test, the IL-4 level was significantly higher in the case group, compared with the control (P < .001), but no statistically significant relationship was found between serum levels of IL-4 with age, sex, and serologic titers of Wright and 2ME. CONCLUSION: In patients with brucellosis, the level of IL-4 increases independently of the duration and severity of the disease, which indicates the role of this cytokine of immune system in this infectious disease.

Microbiological study of dacryocystitis in northwest of Iran.

BACKGROUND: The prevalence of bacterial pathogens isolated from patients with acute and chronic dacryocystitis and the pattern of antibiotic susceptibility tests are varied in each region. Moreover, the management of dacryocystitis is only based on clinical observations without microbiological evaluation. The present study aimed to identify epidemiologic and etiologic factors of dacryocystitis in our geographical area. MATERIALS AND METHODS: This cross-sectional and analytical study was carried out in the ophthalmology department of Hamadan University of Medical Sciences (northwest of Iran) during 2016-2017. Nasolacrimal duct discharges were inoculated to culture media including blood agar, eosin methylene blue, chocolate agar, and Sabouraud agar for the determination of microbial agents. Disc diffusion method with MAST antibiogram discs was used for antibiotic susceptibility tests, according to the Clinical and Laboratory Standards Institute, 2017. RESULTS: Of the total 129 patients enrolled in the study, 34.1% had acute dacryocystitis and 65.9% showed chronic type. The result of culture was positive in 75.2% of patients. Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Pseudomonas spp., and Candida albicans were the most prevalent microorganisms. The most sensitive antibiotics used against prevalent bacteria were ciprofloxacin (75.9%), ceftriaxone (73.6%), vancomycin (67.8%), and chloramphenicol (60.9%), respectively. CONCLUSION: The present study is useful for determining the appropriate antibiotic for systemic treatment of dacryocystitis in our region. Ciprofloxacin and vancomycin are the most sensitive antibiotics against the most common isolated microorganisms in both age groups (under and above 10 years) that can be used for empirical therapy of dacryocystitis in both acute and chronic type.

Association of serum procalcitonin and C-reactive protein levels with CURB-65 criteria among patients with community-acquired pneumonia.

BACKGROUND: The concentration of diagnostic markers such as inflammatory biomarkers including procalcitonin (PCT) and C-reactive protein (CRP) increases in bacterial infections. The aim of this study was to compare serum PCT and CRP levels with CURB-65 ranking, in the patients with community-acquired pneumonia (CAP). PATIENTS AND METHODS: In a cross-sectional study, 93 hospitalized patients with a definite diagnosis of CAP, considering inclusion and exclusion criteria, were enrolled. Serum PCT and CRP levels and their relations with CURB-65 criteria were assessed. RESULTS: The mean serum levels of PCT and CRP were 3.64±12.32 ng/mL and 75.01±51.93 mg/L, respectively. There was a statistically significant association between CURB-65 criteria and serum levels of PCT (P=0.0001) and CRP (P=0.007), which means that the concentration of these two inflammatory biomarkers increased with an increase in the score of CURB-65 criteria. Moreover, there was a statistically significant association between the serum level of PCT and the outcomes of the disease (P<0.001). CONCLUSION: According to the results, the serum level of PCT or CRP is a strong prognostic factor for evaluating severity of CAP and is a suitable factor for the CURB-65 criteria in the decision making of whether a patient with CAP in the ICU should be admitted.

Are quantitative histopathologic criteria capable of differentiating psoriasis from chronic dermatitis?

BACKGROUND: There are overlapping features in histopathologic characteristics of psoriasis and chronic dermatitis, which sometimes make the correct diagnosis difficult. OBJECTIVE: The aim of this study was to compare the histopathologic diagnostic features of psoriasis with chronic dermatitis quantitatively. PATIENTS AND METHODS: In this study, 30 patients with psoriasis and 30 patients with chronic dermatitis were included. Diagnosis of psoriasis or chronic dermatitis was based on clinicopathologic correlation. Photos of histopathologic slides were provided by LABOMED Digital Camera and LABOMED Microscope. Width and length of rete ridges, minimal thickness of suprapapillary plates, thickness of epidermis, thickness of hyperkeratotic layer, and minimal thickness of granular layer were determined using Pixel Pro software on micrometer scale. RESULTS: Suprapapillary plates and granular layer were significantly thicker in patients with chronic dermatitis compared with patients with psoriasis. The rete ridges were longer and wider, the epidermis was thicker, and the parakeratotic layer was also thicker in patients with psoriasis compared with patients with chronic dermatitis, and the difference between these corresponding parameters in the two groups was statistically significant except for thickness of parakeratotic layer. Moreover, the mean ratio of minimal suprapapillary plate's thickness to epidermal thickness and the mean ratio of minimal granular layer's thickness to parakeratotic layer's thickness were significantly higher in patients with chronic dermatitis compared with those with psoriasis. CONCLUSION: Despite overlapping histopathologic features in psoriasis and chronic dermatitis, quantitative histopathologic criteria might be valuable for differentiation of these two conditions. Ratios of minimal suprapapillary plate's thickness to epidermal thickness and minimal granular layer's thickness to parakeratotic layer's thickness can be particularly helpful in this regard.

The relationship between mitotic rate and depth of invasion in biopsies of malignant melanoma.

BACKGROUND: Malignant melanoma of the skin is a potentially lethal neoplasm that generally originates from atypical melanocytes in the dermal-epidermal junction. When the neoplasm penetrates into the dermis, several variables can affect the extent of its spread, among which depth of invasion has the most important prognostic value. Mitotic rate is another prognostic factor that reflects the biological behavior of the neoplasm. OBJECTIVE: This study was designed to evaluate the probable relationship between the depth of invasion of malignant melanoma and its mitotic rate. MATERIALS AND METHODS: This study was performed on 50 excisional biopsy specimens that had received the diagnosis of malignant melanoma histopathologically. Tumor characteristics including Breslow thickness, Clark level, T-stage, and tumor mitotic rate were recorded. RESULTS: We observed that at higher Clark levels and higher T-stages, and the mean mitotic rate was significantly increased. Moreover, there was a positive and significant correlation between Breslow thickness and mitotic rate. We demonstrated that one unit increase in mitotic rate was correlated with 0.8 mm increase in Breslow thickness of the tumor. CONCLUSION: In malignant melanoma, mitotic activity may probably indicate the depth of tumor invasion. Therefore, in incisional biopsies where depth of invasion cannot be accurately determined, the mitotic activity may be used to estimate Breslow thickness, which is necessary for planning surgical management.

Effect of hydroxychloroquine on treatment and recurrence of acute brucellosis: a single-blind, randomized clinical trial.

Brucellosis is associated with a high recurrence rate and requires more than one course of standard treatment; therefore, more research is required to find more effective treatments that lead to prompt recovery, and reduce the relapse of disease. This single-blind, randomized study was designed to evaluate the effect of the standard treatment for brucellosis in combination with hydroxychloroquine. A total of 177 patients with acute brucellosis were randomly assigned to one of two treatment groups: doxycycline-streptomycin (DS) and doxycycline-streptomycin-hydroxychloroquine (DSH). Clinical symptoms and signs, serological tests, and side effects of therapy were compared between the two groups during the treatment course and at three and six months after the end of drug therapy. Of the 177 patients, with a mean age of 40.5 ± 16.9 years, 66.1% were males. The mean duration of clinical signs prior to admission was 43.4 ± 41.1 days. Appropriate clinical responses, relapse, treatment failure, and adverse drug reactions were seen in 98.9%, 1.2%, 0.0%, and 12.6% of patients, respectively, in the DSH group vs. 86.7%, 11.6%, 2.3%, and 19.8% of patients, respectively, in the DS group. There were significant differences in clinical response and relapse rates between the two groups. The addition of hydroxychloroquine to a doxycycline-streptomycin regimen appears to increase the efficacy of treatment, accelerate improvement of clinical symptoms, and significantly reduce the rate of relapse of brucellosis.

Association between serum concentration of 25-hydroxyvitamin D and community-acquired pneumonia: a case-control study.

BACKGROUND: Community-acquired pneumonia (CAP) is a common disease with significant morbidity and mortality. There is evidence that vitamin D deficiency can be associated with infectious diseases. The aim of this study was to compare the levels of vitamin D between patients with CAP and healthy controls. METHODS: In a case-control study on 73 patients with CAP and 76 healthy controls, the serum concentration of 25-hydroxyvitamin D (25[OH]D) was measured. Severity and outcomes of disease and also duration of hospital stay were compared in patients with different levels of 25(OH)D. The severity of CAP was assessed using the CURB-65 score (confusion, uremia, respiratory rate, low blood pressure, age ≥65 years) and was also reflected by the length of hospital stay, admission to intensive care unit (ICU), and 30-day mortality. RESULTS: In total, 81.2% of the study population had vitamin D levels <30 ng/dL. The risk of pneumonia among subjects with deficient vitamin D levels was 3.69 (95% CI: 1.46, 9.31) times of those with sufficient vitamin D level (P=0.006). Prevalence of severe deficiency of vitamin D in scores three and four of CURB-65 (59.38%), was far more than scores one and two (31.71%). Also, results indicated patients with severe deficiency had a higher risk for ICU admission, 30-day mortality, and longer hospitalization stay, but these were not statistically significant. CONCLUSION: According to findings, a low level of 25(OH)D is associated with a higher incidence of CAP and more severe disease. It is recommended to pay more attention to vitamin D deficiency in infectious diseases, particularly in CAP patients.

White Sponge Nevus: Report of a Case and Review of the Literature.

White sponge nevus is a rare benign autosomal dominant disorder with variable penetrance. It is characterized by asymptomatic white plaques affecting mainly the oral mucosa. Careful clinical and histopathological examination is indicated to exclude other more serious conditions presenting as oral white lesions. Herein, we present a new case of oral white sponge nevus in a 17-year-old Iranian male with no familial background.

Hepatoprotective effects of Vaccinium arctostaphylos against CCl4-induced acute liver injury in rats.

BACKGROUND: This study was carried out to evaluate the antioxidant and hepatoprotective effects of Vaccinium arctostaphylos (V.a) methanolic extract on carbon tetrachloride (CCl4)-induced acute liver injury in Wistar rats. METHODS: Total phenolic and total flavonoid contents as well as antioxidant activity of V.a were determined. Extracts of V.a at doses of 200 and 400 mg/kg were administered by oral gavage to rats once per day for 7 days and then were given an intraperitoneal injection of 1 mL/kg CCl4 (1:1 in olive oil) for 3 consecutive days. Serum biochemical markers of liver injury, oxidative markers, as well as hydroxyproline (HP) content and histopathology of liver were evaluated. RESULTS: The obtained results showed that V.a had strong antioxidant activity. Treatment of rats with V.a blocked the CCl4-induced elevation of serum markers of liver function and enhanced albumin and total protein levels. The level of hepatic HP content was also reduced by the administration of V.a treatment. Histological examination of the liver section revealed that V.a prevented the occurrence of pathological changes in CCl4-treated rats. CONCLUSIONS: These findings suggested that V.a may be useful in the treatment and prevention of hepatic injury induced by CCl4.

Correlation between the Intensity of Helicobacter pylori Colonization and Severity of Gastritis.

BACKGROUND: The most common cause of chronic gastritis is infection with Helicobacter pylori. Identifying the relationship between intensities of colonization and activity of gastritis helps the clinician in more effective treatment and posttreatment follow-ups. METHODS: In this cross-sectional study, endoscopic gastric biopsy samples of 544 patients who complained symptoms of dyspepsia for more than three months referring to the laboratory were studied. To determine the colonization rate of H. pylori and other pathological findings, Giemsa and H&E stains were, respectively, used. RESULTS: Among 544 subjects, 47 (8.64%) patients had no gastritis, 203 (37.32%) had mild gastritis, 278 (10.51%) suffered moderate gastritis, and 16 (2.94%) had severe gastritis. In this study, patients with mild H. pylori colonization rates had the highest level of mild activity (33.52%); in contrast, those with severe H. pylori colonization had the highest level of severe activity (43.75%). 93.96% of people with severe H. pylori colonization suffered from moderate and severe chronic gastritis. There is a significant statistical relationship between the intensity of H. pylori colonization and histopathological findings including intestinal metaplasia, atrophy, and lymphoid follicle formation. CONCLUSIONS: According to the present study, with increasing intensity of H. pylori colonization, chronicity and activity of gastritis and its complications increase.

Cancer problem in Peutz-Jeghers syndrome.

Peutz-Jeghers syndrome is a rare autosomal dominantly inherited condition, characterized by the presence of hamartomatous gastrointestinal polyps and mucocutaneous pigmentation. Patients with this syndrome can be associated with other neoplasms such as ovarian neoplasms known as sex-cord tumor with annular tubules that are associated in one third of the cases with this syndrome and other types of malignancies. We report a 42-year-old woman with a history of Peutz-Jeghers Syndrome and bilateral breast cancer that presented with abnormal uterine bleeding. Total abdominal hysterectomy with bilateral salpino-oophorectomy was done and an ovarian sex cord tumor with annular tubules was incidentally diagnosed. By reviewing literatures and in agreement with previous studies we suggest routine screening for malignancies in patients with Peutz-Jeghers syndrome.