Immunologic evaluation of patients with recurrent ear, nose, and throat infections

PURPOSE

In this study, we aimed to study the frequency of possible underlying immunodeficiency responsible for susceptibility to ear, nose, and throat (ENT) infection.

MATERIALS AND METHODS

One hundred three (72 males and 31 females) consecutive children and adult patients with history of recurrent or chronic ENT infections, referred by otolaryngologists to the Department of Allergy and Clinical Immunology, Children's Medical Center, Tehran University of Medical Sciences (Tehran, Iran), were enrolled to the study from March 2003 to March 2006. For each patient, demographic information and medical histories of any ENT infections were collected by reviewing the patient's records. We measured immunoglobulin isotype concentrations and immunoglobulin (Ig) G subclasses by nephelometry and enzyme-linked immunosorbent assay methods, respectively. Of 103 patients, 75 received unconjugated pneumococcus polyvalent vaccine, and blood samples were taken before and 21 days after vaccination. Specific antibodies against whole pneumococcal antigens were measured using enzyme-linked immunosorbent assay method. Existence of bronchiectasis was confirmed in each patient using high resolution computed tomography scan.

RESULTS

Among 103 patients, 17 (16.5%) patients were diagnosed to have defects in antibody-mediated immunity including 6 patients with immunoglobulin class deficiency (2 common variable deficiency and 4 IgA deficiency), 3 with IgG subclass deficiency (2 IgG2 and 1 IgG3), and 8 with specific antibody deficiency against polysaccharide antigens. In our series, bronchiectasis was detected in 5 cases associated with primary immunodeficiency.

CONCLUSIONS

Long-standing history of ENT infections could be an alarm for ENT infections associated with primary antibody deficiency.

Seroprevalence of HBV, HCV and HIV infection among intravenous drug users in Shahr-e-Kord, Islamic Republic of Iran

This study was conducted in 2004 to evaluate the prevalence of hepatitis B (HBV), hepatitis C (HBC) and human immunodeficiency (HIV) virus infection in 133 injecting drug users (IDUs) attending a voluntary rehabilitation centre in Shahr-e-Kord, and to identify risk factors for these infections in this group. Serum samples were screened for HBV, HCV and HIV infection. Only 1 participant (0.8%) was HIV positive, 15 (11.2%) were HCV positive and 8 (6.0%) were positive for HBV surface antigen. There was significant correlation between using shared syringes and infection with HIV, HCV and HBV.

Frequency conversion to the second harmonic in different-layer nonlinear media

The process of frequency conversion in a multilayer structure of different media with quadratic nonlinearity is investigated by using the constant-intensity approximation. The values of complex amplitudes of the fundamental radiation and the second harmonic at the outlet of each layer are the entrance values of the corresponding complex amplitudes of the next layer. Analytical expressions for second-harmonic conversion efficiency for the case of n layers are proposed. The factors restricting the efficiency of the process of frequency conversion are analyzed. In layered media, upon frequency conversion, from one layer to the next the optimum values of the phase mismatch between layers changes. The character of the process of frequency conversion of the fundamental radiation to the second harmonic depends not only on the value of the nonlinear coefficients of waves, the phase mismatch, but also on the signs of these parameters.

Concomitant carotid endarterectomy and coronary artery bypass grafting versus staged carotid stenting followed by coronary artery bypass grafting

AIM

Significant carotid stenosis (>or=70%) in patients undergoing coronary artery bypass grafting (CABG) can increase the risk of perioperative cerebral vascular accident (CVA). In this study, we compared the results of two common operative strategies: concomitant carotid endarterectomy and CABG versus carotid stenting and CABG.

METHODS

This cohort study was conducted from January 2001 to September 2006. Significant carotid artery stenosis was detected in patients who were candidates for CABG at the Tehran Heart Center. The stenosis was detected by carotid Doppler screening and was confirmed by magnetic resonance angiography. Reluctant patients or those with previous major CVA, significant bilateral carotid stenosis and intracranial lesions were excluded. Patients were divided into 2 groups. Group A underwent concomitant carotid endarterectomy and CABG (n=19), while carotid stenting and CABG were done in group B (n=28).

RESULTS

The mean age in group A was 67.37+/-7.09 years and 65.57+/-8.13 years in group B. The mean hospital stay (days) was 18.68+/-7.95 in group A and 26.35+/-77.04 in group B (P=0.01). The median charge was dollars 252.79 in group A and dollars 2206.66 in group B (P <0.0001). There was a significant difference in frequency of hypotension and bradycardia between the 2 groups (P <0.05). There were 2 cases of in-hospital mortality in each group (10.5% and 7.1%, respectively). Two postoperative strokes occurred in group A and 3 in group B (10.5% and 10.7%, respectively).

CONCLUSION

Concomitant carotid endarterectomy and CABG is as safe as carotid stenting and CABG, with fewer neurologic events and less hypotension, bradycardia, cost and shorter hospital stay.

Early mortality predictors in coronary artery bypass grafting patients required intra-aortic balloon pump in perioperative and postoperative periods

AIM

The intra-aortic balloon pump (IABP) is commonly used for decreasing myocardial oxygen demand by systolic unloading in perioperative heart failure. The aim of this study was to determine perioperative prognostic factors for in-hospital mortality in coronary artery bypass grafting patients who received the intraaortic balloon pump.

METHODS

A total of 271 patients who underwent coronary artery bypass grafting and received intra-aortic balloon pump perioperatively between January 2002 and September 2006 were studied. The preoperative, operative and postoperative risk factors for early death were evaluated.

RESULTS

Early mortality rate in the study population was 17.3%. From variables entered into multivariate logistic regression the following parameters were identified as prognostic factors for early death: left main disease, diabetes, postoperative renal failure and cardiac arrest (P<0.05). The minor and major intra-aortic balloon pump related complications were not significant in univariate and multivariate analysis and its rate was 3.6%.

CONCLUSION

According to our study the mortality of IABP group is low compared to other studies, as well as IABP-associated complications. Also it revealed that there is no correlation between IABP-associated complications and early mortality.

The effect of administration of different levels of GnRH on the day 0, 5 and 12 post-insemination on progesterone concentration in dairy heifers

This study was carried out to evaluate the effects of different levels of GnRH in different days of reproductive cycle on progesterone concentration in dairy heifers. Two hundred heifers were divided into ten experimental treatment: control group with no injection (1) administration of 2.5 mL Gonadorelin (a GnRH analogue) in day of insemination (2) administration of 5 mL GnRH in day of insemination (3) administration of 10 mL GnRH in day of AI insemination (4) administration of 2.5 mL GnRH in day 5 post-insemination (5) administration of 5 mL GnRH in day5 post-insemination (6) administration of 10 mL GnRH in day5 post-insemination (7) administration of 2.5 mL GnRH in day 12 post-insemination (8) administration of 5 mL GnRH in day 12 post-insemination (9) administration of 10 mL GnRH in day 12 post-insemination. Blood samples were collected in days 0, 5, 12 and 19 post insemination (AI = Day 0) for analysis of serum P4 concentration. There was no significant difference among experimental groups on day of insemination. Evaluation of P4 concentration on day 19 illustrated differences in progesterone concentration between groups on day 19 post-insemination. P4 concentration of serum in the day 19 post-insemination significantly increased in groups either by 5 or 10 mL injection of GnRH whether in day 5 or 12 post-insemination versus control group (9.24 +/- 2.2, 8.6 +/- 1.96, 9.43 +/- 2.15 and 9.42 +/- 2.14 versus 5.5 +/- 0.8, respectively; p < 0.05). GnRH administration in the day 5 and 12 post-AI significantly increased progesterone concentration that may decline early embryonic death and improve pregnancy rate.

Comparison between different protocols of synchronization and their efficiency on pregnancy rate of dairy cattle

In order to determine different protocols of synchronization and their efficiency on pregnancy rate after fixed-timed AI (TAI), 120 dairy Holstein cows (n=120) were assigned randomly to six groups: (1) two injections of Prostaglandin F(2alpha) (PG(f2alpha)) with 12 days apart as a control group, (2) two injections of Gonadotropin Releasing hormone (GnRH) with 9 days apart and an injection of PG(f2alpha) at day 7, (3) injection of GnRH and PG(f2alpha) with 7 days apart, then single injection of Estradiol Benzoate (EB) after 48 h, 4) injection of progesterone (P4) in conjugation with EB then after 7 days PG(f2alpha) injection and after 48 h an injection of GnRH were done, 5) as group 4 but EB was used instead of GnRH, 6)injections of PG(f2alpha) and EB conjugated with Human Chronic Gonadotrophin (hCG) with 12 h apart. Animals in group 1 (control), groups 2-5 and group 6 were inseminated after 72, 20 and 36 h, respectively. Serum P4 concentration of group 4 (4.43 +/- 1.50 ng mL(-1)) was higher than control group (2.34 +/- 1.36 ng mL(-1)) at day 5 after insemination (p < 0.05); P4 concentrations of groups 3 and 4 have significant differences with control group (2.69 +/- 2.64 and 2.56 +/- 1.40 versus 0.81 +/- 0.41 ng mL(-1), respectively, p < 0.05) at a day after second injection and groups 4 and 5 were in higher level of P4 concentration than control group at insemination time (3.14 +/- 1.9 and 2.89 +/- 1.8 versus 0.45 +/- 0.19 ng mL(-1) respectively, p < 0.05). Pregnancy rate were 0, 50, 45, 10, 30 and 45% for group 1 (control) through 6, respectively.

ENT manifestations in Iranian patients with primary antibody deficiencies

OBJECTIVE

One hundred and nine patients with primary antibody deficiencies were selected in order to determine the frequency of ENT complications.

METHOD

Demographic information and ENT medical histories were collected for each patient. Duration of study for each patient was divided into two periods of before diagnosis and after diagnosis and the initiation of treatment.

RESULTS

Eighty-two of 109 patients (75.2 per cent) experienced ENT infections during the course of the disease (63: otitis media, 75: sinusitis and nine: mastoiditis). At the time of diagnosis, 52 (47.7 per cent) out of 109 patients presented with an ENT symptom. The frequencies of episodes were 27 for sinusitis and 25 for otitis media (one complicated with mastoiditis). After immunoglobulin replacement therapy the incidence of otitis media was reduced from 1.75 before treatment to 0.39 after treatment per patient per year (p = 0.008). The incidence of sinusitis also significantly decreased from 2.38 to 0.78 (p value = 0.011).

CONCLUSION

ENT infections are common medical problems in primary antibody deficiency patients. Persistent and recurrent ENT infections should be suspected as originating from a possible underlying immunodeficiency.

Acute optic nerve infarction demonstrated by diffusion-weighted imaging in a case of rhinocerebral mucormycosis

SUMMARY

A 60-year-old woman developed right-eye vision loss secondary to rhinocerebral mucormycosis. Routine MR imaging sequences including enhanced MR imaging showed normal optic nerves, but a diffusion-weighted sequence and apparent diffusion coefficient maps revealed markedly restricted diffusion in the right optic nerve. This MR imaging abnormality of optic nerve infarction due to mucormycosis has not been reported previously.

Cell-Free Plasma DNA: A Marker for Apoptosis during Hemodialysis

Background: We evaluated whether cell-free plasma DNA might be an appropriate marker for cell damage during hemodialysis (HD) and whether it correlated with annexin V expression and 7-amino-actinomycin D (7AAD) nuclear staining of blood leukocytes.

Methods: Circulating DNA, annexin V, and 7AAD were measured in HD patients before HD, 20 min after start of HD, and after HD had ended. Healthy volunteers provided control measurements. Necrosis and apoptosis were monitored by gel electrophoresis.

Results: Plasma DNA concentrations were not significantly different between controls and patients before HD. Circulating DNA increased significantly (P &lt;0.05) after 20 min of treatment with HD. Post-HD concentrations of DNA were significantly higher compared with pre-HD and controls (P &lt;0.005). Agarose gel electrophoresis showed ladders typical of apoptosis in post-HD samples. Two subpopulations of CD45+ leukocytes were defined by flow cytometry: annexin V+/7AAD+ population for apoptosis, and annexin V+/7AAD− for early apoptosis. Compared with healthy controls, mean fluorescence (MF) of 7AAD+ apoptotic cells in the annexin V+/7AAD+ subpopulation before HD was not significantly increased. HD increased MF of 7AAD+ cells in the annexin V+/7AAD+ subpopulation. In this subpopulation, MF of annexin V+ cells was significantly higher (P &lt;0.01). MF of annexin V+ cells in the annexin V+/7AAD+ subpopulation increased during HD.

Conclusions: During HD, cell-free plasma DNA concentrations, annexin V expression, and 7AAD uptake in leukocytes increases. The increase in plasma DNA, appearing as ladders typical of apoptosis, and the 7AAD uptake in leukocytes demonstrate that the predominant portion of circulating DNA in HD patients originates from apoptotic leukocytes.

Differentiation of human umbilical cord blood CD133+ stem cells towards myelo-monocytic lineage

BACKGROUND

Characterisation of stem cells by flow cytometry, their expansion and differentiation are presently of major interest for cell engineering as the basis of a therapeutic concept for transplantation. Haematopoietic stem cells (HSC) express CD34, the adhesion structure which binds 2L-selectin, CD117, a receptor for stem cell factor (SCF; c-kit ligand), and CD133, a transmembrane protein belonging to the family of mucoproteins.

METHODS

The aim of the present investigation was the systematic investigation of proliferation and differentiation characteristics of umbilical cord blood stem cells (UCBSC) isolated by an immmunomagnetic separation system using CD133 antibody-coated microbeads and to evaluate the effects of different sera and various concentrations, as well as the effects of IL-3 and IL-6 on total cell expansion and differentiation of isolated CD133+ cells. Differentiation patterns were measured by flow cytometry.

RESULTS

After the immmunomagnetic separation the yield of CD133+ cells was 0.45+/-0.17 x 10(6) cells/ml; the purity of isolated CD133+ cells was 95.79+/-1.86%. The majority of CD133+ cells coexpressed CD117. The most pronounced expansion during cultivation of 2 weeks was achieved in media supplemented with 12.5% horse serum plus 12.5% fetal calf serum (FCS) with stem cell factor and interleukine 3; the fold-expansion was 16.67+/-6.20. During the cultivation period, UCBSC were constantly loosing stem cell markers and differentiated towards myelo-monocyte lineage (granulocytes and/or monocytes).

CONCLUSIONS

These in vitro results demonstrate that thorough investigation of various cultivation conditions is needed for successful expansion and differentiation of stem cells towards different lineages to be used therapeutically for replacement of damaged cells.

Cell cycle analysis of the CD133+ and CD133- cells isolated from umbilical cord blood

BACKGROUND

Umbilical cord blood cells (stem/progenitor cells) exhibit high proliferative capacities leading to a large expansion of cells in appropriate cell culture conditions. The aim of this study was to evaluate by flow cytometry the cycling status of CD133+ and CD133- cells depending on various culture conditions, such as sera, stem cell factor (SCF), interleukin 3 (IL-3) and interleukin 6 (IL-6).

METHODS

An immunomagnetic system was used for cell separation. CD133+ and CD133- cells were seeded in Iscove's Modified Dulbecco's Medium (IMDM) with different serum concentrations and were stimulated with SCF (100 ng/ml), IL-3 (50 ng/ml) and IL-6 (50 ng/ml).

RESULTS

Our experiments demonstrated that immediately after separation, 96.75+/-0.58% of CD133+ cells and 97.04+/-1.76% of CD133- cells were in G0/G1-phase, while 2.02+/-0.38% and 0.88+/-0.52% were in the S-phase, respectively. Our data documented that CD133+ cells are more active than CD133- cells after the first week of cultivation (p<0.01). Statistically significant difference was found for CD133+ cells vs. CD133- cells after second week of cultivation in G0/G1- and S-phases under all tested conditions. A combination of 12.5% FCS+12.5% HS yielded the highest cell expansion for CD133+ cells; this was concomitant with highest percentage of S-phase and G2M-phase. Our data show that the medium with 25% HS was the best for cell expansion and cycling of the CD133- cells for the first week, followed by the 12.5% FCS+12.5% HS. After 2 weeks of cultivation, obviously 12.5% HS and 12.5% FCS+12.5% HS exhibited similar S-phase amounts in CD133- cells. A decrease of HS concentrations seemed to stimulate CD133- cells' S-phase after the second week.

CONCLUSIONS

Our data indicate that the source and the concentration of the serum used for cultivation have an impact on both cell populations: CD133+ cells are most comfortable with a combination of FCS and HS; CD133- cells prefer media-containing HS. Cell cycle status may be an important factor for defining cultivation strategies for stem cell expansion.

Prevalence of measles antibody in children of different ages in Shiraz, Islamic Republic of Iran

An outbreak of measles due to secondary vaccine failure prompted this investigation into the prevalence of measles antibody in children. We studied 608 children in 7 different age groups:6, 9, 14 and 18 months and 6, 10 and 15 years. Children in the 2 youngest groups received no vaccination; the rest were vaccinated at 9 months and 15 months. The 15-year-old age group received an additional vaccination. Transplacental measles antibody [Ab] decreased from 10.0% at 6 months to 0% at 9 months. Measles Ab was positive in 52.9% [14 months], 89.4% [18 months], 60.8% 96 years], 45.0% [10 years] and 96.8% [15 years]. To increase Ab levels, a booster vaccination is recommended, administered either with the second DPT booster or at pre-high school age

Prevalence of measles antibody in children of different ages in Shiraz, Islamic Republic of Iran

An outbreak of measles due to secondary vaccine failure prompted this investigation into the prevalence of measles antibody in children. We studied 608 children in 7 different age groups: 6, 9, 14 and 18 months and 6, 10 and 15 years. Children in the 2 youngest groups received no vaccination; the rest were vaccinated at 9 months and 15 months. The 15-year-old age group received an additional vaccination. Transplacental measles antibody (Ab) decreased from 10.0% at 6 months to 0% at 9 months. Measles Ab was positive in 52.9% (14 months), 89.4% (18 months), 60.8% 96 years), 45.0% (10 years) and 96.8% (15 years). To increase Ab levels, a booster vaccination is recommended, administered either with the second DPT booster or at pre-high school age.