Investigation of the Relationship between Aspirin-Sensitivity and Poor Response to Medical Management in NSAIDs-exacerbated Respiratory Disease Patients with Sinonasal Polyposis.

Background: NSAID-exacerbated respiratory disease (N-ERD) is a highly heterogeneous disorder with various clinical symptoms. The aspirin challenge test is a gold standard method for its diagnosis, and there are still no reliable in vitro diagnostic biomarkers yet. Oral challenge tests are time-consuming and may be associated with a risk of severe systemic reactions. This study aimed to evaluate whether patients with poor responses to medical management are more susceptible to being aspirin-sensitive. Methods: In this cohort study, after CT scanning of all patients and subject selection, conventional medical treatment was started as follows and continued for three consecutive months: at first, saline nose wash twice per day, intranasal beclomethasone spray one puff in each nostril twice per day, montelukast 10 mg tablet once daily, a ten-day course of oral prednisolone starting with the dose of 25 mg per day and taper and discontinued thereafter. Sinonasal outcome test 22 (SNOT22) was used for the evaluation of symptom severity. Statistical analyses were performed with SPSS version 23, and data were analyzed using an independent samples T-test, paired T-test, and Receiver operating curve analysis. Results: 25 males and 53 females were enrolled in this study, with an average age of 41.56 ± 11.74 years old (18-36). Aspirin challenge test results were positive in 29 (37.2%) patients. The average SNOT22 scores before the treatment were 52.97 ± 17.73 and 47.04 ± 18.30 in aspirin-sensitive and aspirin-tolerant patients, respectively, and decreased to 27.41 ± 16.61 and 24.88 ± 16.72 in aspirin-sensitive and aspirin-tolerant patients after the treatment, respectively. There was no significant difference in SNOT22 scores between the groups. Conclusion: The severity of symptoms before treatment and clinical improvement after treatment are not good predictors of N-ERD.

The role of JAK-STAT signaling pathway and its regulators in the fate of T helper cells.

The Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway plays critical roles in orchestrating of immune system, especially cytokine receptors and they can modulate the polarization of T helper cells. This pathway is regulated by an array of regulator proteins, including Suppressors of Cytokine Signaling (SOCS), Protein Inhibitors of Activated STATs (PIAS) and Protein Tyrosine Phosphatases (PTPs) determining the initiation, duration and termination of the signaling cascades. Dysregulation of the JAK-STAT pathway in T helper cells may result in various immune disorders. In this review, we represent how the JAK-STAT pathway is generally regulated and then in Th cell subsets in more detail. Finally, we introduce novel targeted strategies as promising therapeutic approaches in the treatment of immune disorders. Studies are ongoing for identifying the other regulators of the JAK-STAT pathway and designing innovative therapeutic strategies. Therefore, further investigation is needed.

Toxic reaction of a 3-year-old boy due to Hornet multiple stings in Kerman-Iran province: A case report.

A three-year-old boy was attacked by a group of hornets and the head, arms, back and buttocks of the child were targeted to various stings. The child was first taken to a rural clinic and then to a hospital in Baft city. At arrival to rural clinic, the child was conscious and approximately 30 hyperpigmented, painful and itchy papular lesions was seen on his body. Head and neck weren't erythematous and edematous. However gradually, the face, lips, eyelids, and neck became swollen. The child became restless and itchy in the sting sites. Stress induced hyperglycemia occurred. Despite supportive treatments, the clinical conditions get worse and progressed. He referred to the pediatric ward of Afzalipour hospital in Kerman and admitted to intensive care unit (ICU). The child was ill and oliguric. The treatment was started including: hydration with normal saline and diuretic agent (furosemide), insulin, corticosteroid, dopamine and calcium. But a systemic toxic reaction occurred during the hospitalization. Hemolysis, hematuria, anemia, thrombocytopenia and rhabdomyolysis, myoglobinuria, acute renal failure, hepatic injury, epistaxis and respiratory distress was happened. In order to urine alkalinization, sodium bicarbonate was added to his treatments. Also, plasmapheresis was performed. Then according to acute tubular necrosis (ATN) (due to intravascular hemolysis and rhabdomyolysis), pleural effusion and respiratory distress, intermittent hemodialysis was started one day in between. After five intermittent hemodialysis sessions and nineteen days after hospitalization, the patient was discharged in relatively good general condition.

Anthropometric Parameters in Asthmatic Children and the Relationship of Childhood Asthma with Height, Weight and Body Mass Index.

Background: Asthma as a chronic disease may affect the growth process. The aim of this study was to investigate the anthropometric indices in 2-18 years old children with asthma and compare them with the control group. Patients and Methods: In a case-control study, 150 asthmatic children with age of 2-18 years as case group and 300 age- and sex-matched healthy children as control group were randomly included. The height, weight, and body mass index (BMI) of both group measured by the standard method and Z score was calculated. Data were analyzed using SPSS, chi-square and analysis of variance. Results: Totally, 290 boys (64.4%) and 160 girls (35.6%) with mean age of 6.58±2.82 years were evaluated. Case group had significantly lower height compared to the healthy control group (117.00±0.17 cm vs. 121.00±0.15 cm respectively, P=0.025). No significant differences were detected in weight (23.13±9.75 kg vs. 24.62±10.36 kg, P=0.145) and BMI (16.32±3.10 kg/m2 vs. 16.28±3.16 kg/m2, P=0.900) between case and control groups, respectively. There were no significant relationships between normal and abnormal Z scores of height, weight and BMI in case and control group (P>0.05). Conclusion: Despite 4 cm difference between the age of two groups, no differences in height, weight ad BMI between two groups may be due to good control of the disease in the case group or lack of significant growth related effect of asthma.