Investigating the relationship between the number and activity of natural killer cells with increased cytomegalovirus and CMV disease after kidney transplantation.

BACKGROUND: Cytomegalovirus (CMV) infections caused by the cytomegalovirus are one of the most common problems in patients after kidney transplant. We examined the association of the relationship between the number and activity of natural killer cells with increased cytomegalovirus and its related disease after kidney transplantation. MATERIAL AND METHODS: In this analytical study, 58 new transplant patients in the Labbafinejad Hospital, who did not have any evidence of CMV infection, were evaluated based on the number and percentage of CD56+/16+, CD56+/16-, and CD69+ Natural Killer (NK) cells. RESULTS: The results of this study showed that CD16+ and CD56+ cells in the group of CMV Ag-positive patients are less than negative patients (p = 0.003) and the difference between the two groups are significant (p = 0.01). However, CD69+ cells did not differ significantly between the two groups (p = 0.1). Moreover, the absolute number of CD16+ and CD56+ cells declined significantly after infection with CMV unlike the CMV Ag - group(p = 0.003). DISCUSSION: These results indicate that kidney transplant patients suffering from CMV infection after transplantation have a significantly reduced total number of NK cells. On the other hand, a slight decrease in the number of NK subgroups was observed with an increase in the peak serum levels of cyclosporine. As a consequence of these findings, it can be assumed that more dosage and a higher level of the drug will result in more severe immunosuppression and, consequently, increased susceptibility to CMV infections. Thus, taking the right dose of the drug would prevent viral infections and immune system from over-activation.

On-Admission Anemia and Survival Rate in COVID-19 Patients

Anemia often worsens the severity of respiratory illnesses, and few studies have so far elucidated the impact of anemia on COVID-19 infection. This study aimed to evaluate the effect of anemia at admission on the overall survival of COVID-19 patients using accelerated failure time (AFT) models.This registry-based, single-center retrospective cohort study was conducted in a university hospital in Ilam, the southwest of Iran, between March 2020 and September 2021. AFT models were applied to set the data of 2,441 COVID-19 patients. Performance of AFT models was assessed using Akaike's information criterion (AIC) and Cox-Snell residual. On-admission anemia was defined as hemoglobin (Hb) concentration <120 g/l in men, <110 g/l in women, and <100 g/l in pregnant women.The median in-hospital survival times for anemic and non-anemic patients were 27 and 31 days, respectively. Based on the AIC and Cox-Snell residual graph, the Weibull model had the lowest AIC and it was the best fitted model to the data set among AFT models. In the adjusted model, the results of the Weibull model suggested that the anemia (adjusted time ratio: 1.04; 95% CI: 1.00-1.08; p = 0.03) was the accelerated factor for progression to death in COVID-19 patients. Each unit of increase in hemoglobin in COVID-19 patients enhanced the survival rate by 4%.Anemia is an independent risk factor associated with the risk of mortality from COVID-19 infection. Therefore, healthcare professionals should be more sensitive to the Hb level of COVID-19 patients upon admission.

Association of IL-15 and IP-10 Serum Levels with Cytomegalovirus Infection, CMV Viral Load and Cyclosporine Level after Kidney Transplantation.

BACKGROUND: Cytomegalovirus (CMV) infection is the most common complications following kidney transplantation. Natural killer (NK) cells demonstrated critical anti-viral role in controlling and elimination of CMV after transplantation. Interleukin-15 (IL-15) is a pleiotropic cytokine that promotes the activity of NK cells and strengthens the acquired immune system. Also, IP10 (CXCL10) is a chemotactic factor which regulates NK cell recruitment and antiviral immune response. We aimed to determine the correlation between the serum levels of IL-15 and IP-10 cytokines with CMV infection, CMV viral load, and cyclosporine as a major immunosuppressive treatment after transplantation. METHODS: Fifty-eight kidney transplant recipient patients without evidence of CMV virus disease before transplantation surgery were included in the study. From the day of transplant surgery, the patients were evaluated based on the presence of CMV Ag pp65, CMV viral load, serum levels of IL-15 & IP-10, Cyclosporine levels (C0 & C2), Glomerular Filtration Rate (GFR), and hematological & biochemical Index, up to 75 days. RESULTS: Comparison analysis of serum levels of IL-15 and IP-10 showed no significant association with CMV infection in kidney transplant recipients. In addition, CMV viral load and cyclosporine levels at C0 and C2 did not affect patients' IL-15 and IP-10 levels. CONCLUSION: The levels of IP-10 and IL-15 cytokines are not affected with CMV infection, even if a viral infection occurs in the early days after transplantation or long afterwards. In addition, taking the different levels of cyclosporine did not affect the cytokines levels. Other mechanisms may play a role in maintaining the levels of these cytokines.

Subclinical Hypothyroidism Is a Risk Factor for Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus.

Diabetic retinopathy (DR) is one of the most common complications of diabetes. The known risk factors for microvascular complications are uncontrolled diabetes, duration of diabetes, dyslipidemia, and hypertension. In addition to these conventional risk factors, other risk factors, such as hypothyroidism have recently been suggested. Adult patients with type 2 diabetes mellitus (T2DM) were recruited. All patients were evaluated for retinopathy. Various clinical and biochemical parameters, including thyroid function tests, were assessed and compared between groups. In this study, 928 patients with (T2DM) were included. Of all patients, 376 (40.52%) had DR. In patients with retinopathy, 115 (30.58%) had proliferative and 261 (69.42%) had nonproliferative retinopathy. In patients with nonproliferative DR, 34.48%, 32.95%, and 32.57% had mild, moderate, and severe nonproliferative DR, respectively. Of all patients, 91 (9.8%) had subclinical hypothyroidism. There was a significant relationship between subclinical hypothyroidism (SCH) and DR in these patients. In patients with retinopathy, 14.4% and in patients without retinopathy, 6.7% had SCH (p<0.001). In univariate logistic regression analysis, the chance of developing DR in patients with SCH was 2.33 times higher than patients without subclinical hypothyroidism, each unit increase in the thyroid-stimulating hormone significantly increases the chance of developing DR by 13%. The present study showed that in the population of patients with (T2DM), SCH is associated with DR, regardless of the conventional risk factors.

Predictive Value of Exercise Stress Test-Induced ST-Segment Changes in Leads V1 and avR in Determining Angiographic Coronary Involvement.

BACKGROUND: The significance of electrocardiographic changes during exercise tolerance testing for distinguishing occluded artery is not well known. We tried to determine the role of ST elevation in leads aVR and V1 during exercise in detecting stenosis of left main coronary artery and proximal left anterior descending artery. METHODS: ST segment changes during exercise in 230 patients, who underwent diagnostic angiography, were documented. The association of ST elevation in lead aVR, V1 , leads aVR + V1 , and STE in leads aVR + V1 with ST depression in other leads with pattern of coronary stenosis were investigated. RESULTS: Left main and proximal left anterior artery stenosis were more common in patients with ST elevation in lead aVR (P < 0.001 for both). Similar association was found in the presence of ST elevation in lead V1 . The presence of ST elevation ≥1 mm in lead aVR had a sensitivity of 100% and 94.3% for detecting left main and left anterior descending artery stenosis, respectively. The specificity was 33.5% and 26.6%, respectively. ST elevation in leads aVR + V1 had a sensitivity of 74.4% and 65.9% and a specificity of 68.5% and 64.4% for detecting left main and left anterior descending arteries stenosis, respectively. CONCLUSION: ST elevation in lead aVR is highly sensitive for left main and proximal left anterior descending artery lesions. Using ST elevation in lead V1 in addition to lead aVR as a positive finding increases the specificity with a further decrease in sensitivity.

Vitrification affects the expression of matrix metalloproteinases and their tissue inhibitors of mouse ovarian tissue.

BACKGROUND: One of the most major obstacles of ovarian tissue vitrification is suboptimal developmental competence of follicles. Matrix metalloproteinases 2 (MMP-2) and 9 (MMP-9) and their tissue inhibitors TIMP-1 and TIMP-2 are involved in the remodeling of the extracellular matrix in the ovaries. OBJECTIVE: This study aimed to evaluate the expression of MMP-2, MMP-9, TIMP-1, and TIMP-2 genes in the preantral follicles derived from vitrified mouse ovaries. MATERIALS AND METHODS: In this experimental study, the gene expression of MMP-2, MMP-9, TIMP-1, and TIMP-2 in the isolated preantral follicles derived from fresh and vitrified ovaries of 14-16 days old female mice through real time qRT-PCR was evaluated. Developmental parameters, including survival rate, growth, antrum formation and metaphase II oocytes were also analyzed. RESULTS: The developmental parameters of fresh preantral follicles were significantly higher than vitrified preantral follicles. The TIMP-1 and MMP-9 expression levels showed no differences between fresh and vitrified preantral follicles (p=0.22, p=0.11 respectively). By contrast, TIMP-2 expression significantly decreased (p=0.00) and MMP-2 expression increased significantly (p=0.00) in vitrified preantral follicles compared with to fresh ones. CONCLUSION: Changes in expression of MMP-2 and TIMP-2 after ovarian tissues vitrification is partially correlated with decrease in follicle development.

Differences in cardiovascular disease risk factors associated with maximum and mean carotid intima-media thickness among hemodialysis patients.

INTRODUCTION: Carotid intima-media thickness (CIMT) could be used as a surrogate marker of atherosclerosis in hemodialysis patients. Since different mechanisms are involved in the atheroma formation and arterial wall thickness, we assessed the relationship between the maximum and the mean CIMT with different cardiovascular risk factors in dialysis patients. MATERIALS AND METHODS: The mean and the maximum CIMT were measured using a B-mode ultrasonography in 75 hemodialysis patients, and the correlation between CIMT and cardiovascular risk factors were assessed. RESULTS: The mean and maximum CIMT measurements were 0.5 mm (range, 0.2 mm to 1 mm) and 3.4 mm (1.4 mm to 5.6 mm), respectively. Among all the studied variables, age (P = .04, r = 0.238), HS-CRP (P = .01, r = 0.284), mean arterial blood pressure (P = .003, r = 0.343), and DM (P = .02) had significant correlations with the mean CIMT, while only age (P = .02, r = 0.473) and serum creatinine levels (P = .02, r = -0.493) were significantly associated with the maximum CIMT. A positive nonsignificant correlation was observed between the mean and maximum CIMT values (P = .08, R2 linear = 0.214). CONCLUSIONS: These findings suggest that in dialysis patients, effects of cardiovascular risk factors on the mean and maximum CIMT might be different. Further studies are recommended to evaluate the prediction impact of each risk factor in end-stage renal disease patients compared with otherwise healthy individuals.