Evaluation of the frequency and diagnostic delay of primary immunodeficiency disorders among suspected patients based on the 10 warning sign criteria: A cross-sectional study in Iran

INTRODUCTION

The prevalence of undiagnosed primary immunodeficiency diseases is remarkably high and contributes to increasing the rate of morbidity and mortality among this group of patients.

OBJECTIVE

To examine the 10 warning sign scoring system in patients suspected of primary immune deficiency and also estimate the diagnostic delay in patients with proven disease.

METHODS

This descriptive cross-sectional study was carried out during the years 2015-2016 in Ali Asghar (AS) Clinic and Hospital. Two hundred patients with suspected primary immune deficiency disease were eligible for inclusion in the study. Multivariable logistic regression analysis was used to determine the relation between findings.

RESULTS

In this study, the majority of suspected cases of immunodeficiency were males (57%) with a mean age of 3.33±2.89 years. Twenty-one (10.5%) patients were diagnosed with immunodeficiency disease. The mean diagnostic delay among primary immune deficient patients was 2.05±1.7 years. There was a significant relationship between having parental consanguinity (OR=2.68, 95% CI: 1.07-6.70), allergies (OR=5.03, 95% CI: 1.13-22.31), vaccine adverse effects (OR=9.31, 95% CI: 1.24-69.96) and primary immune deficiency diagnosis. No association was observed between age (OR=0.98, 95% CI: 0.84-1.14), gender (OR=0.99, 95% CI: 0.39-2.47), immune deficiency scoring (OR=0.68, 95% CI: 0.31-1.45) and primary immune deficiency diagnosis.

CONCLUSION

Ten warning sign scoring system is of less value to consider a patient suspected of having primary immune deficiency. There is a meaningful delay in diagnosis of primary immune deficiencies especially in antibody deficiency defects which seeks further upgrading of knowledge in physicians.

Experimental investigation of co-flow jet's airfoil flow control by hot wire anemometer

An experimental flow control technique is given in this paper to study the jet effect on the coflow jet's airfoil with injection and suction and compared with the jet-off condition. The airfoil is CFJ0025-065-196, and the Reynolds number based on the airfoil's chord length is 10⁵. To measure the turbulence components of flow, a hot wire anemometry apparatus in a wind tunnel has been used. In this paper, the effect of the average velocity and boundary layer thickness on the coflow jet's airfoil is analyzed. The test is done for two different coflow velocities and for different angles of attack. It is also shown that, by increasing the velocity difference between the jet and the main flow, separation is delayed, and this delay can be preserved by raising coflow velocity at higher angles of attack. So, this flow control method has a good efficiency, and it is possible to reach higher numbers of lift and lower numbers of drag coefficients.

Production of Brucella lumazine Synthase Recombinant Protein to Design a Subunit Vaccine against Undulant Fever

Brucella bacterium causes Brucellosis, an infectious disease spreading from animals to human. Brucella lumazine synthase (BLS) is a highly immunogenic protein with adjuvant properties, which has been introduced as an effective protein carrier for vaccine development. This protein also plays a significant role in inducing immune system. This study aimed to clone, express, and purify the BLS gene from Brucella melitensis Rev1. The BLS gene was amplified by particular primers with the restriction enzyme sites as a linker and it was inserted into pTZ57R/T vector. Subsequently, it was ligated into pET32(a)+ expression vector. Recombinant expression vector containing coding sequence of BLS was transformed into E. coli BL21 (DE3) host gene expression and stimulated by 0.1mM IPTG. The results of sequencing showed that there were not any mutations in BLS encoding sequence. The expression results were set by sequencing and endorsed using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analyses and western blotting that showed 35 kDa protein band appropriately.

Long-term follow-up of ninety eight Iranian patients with primary immune deficiency in a single tertiary centre

PURPOSE

The aim was to describe the clinical manifestations, complications and long-term outcome of a cohort of Iranian patients with primary immune deficiency (PID).

METHOD

We retrospectively studied the demographic, clinical and immunological characteristics of the PID patients in a single tertiary centre, from January 1989 to July 2014. The patients were classified according to the International Union of Immunological Societies Expert Committee on PID.

RESULTS

98 patients were diagnosed with and followed-up for 15 disorders. The mean age at onset and diagnosis and the diagnostic delay were 8±10, 14.2±13.1 and 6.1±7 years, respectively. Parental consanguinity rate was 57%. Predominantly Antibody Deficiency was the most common diagnosis (n=63), followed by congenital defects of phagocytes (n=16), combined immunodeficiencies (n=12), well defined syndromes (n=4) and defects in innate immunity (n=3). Recurrent sinopulmonary infection was the most common presentation. Active infections were treated appropriately, in addition to prophylactic therapy with IVIG and antimicrobials. Not all the patients were compliant with prophylactic regimens due to cost and unavailability. One SCID patient underwent successful bone marrow transplantation. The total mortality rate was 19% during the follow-up period (7.8±7.6 years). The mean age of living patients at the time of study was 23±11.7 years.

CONCLUSIONS

Physicians awareness of PID has been rising dramatically in Iran, ensuring an increasing number of patients being diagnosed and treated. More effective treatment services, including health insurance coverage and drug availability are needed to improve the outcome of PID patients.

The association between polymorphism of the GH1 gene and changes in protein structure and carcass traits in Mehraban sheep (Ovis aries)

The present study indicates an association between carcass traits and genetic polymorphism and changes in the protein structure of the growth hormone 1 (GH1) gene in Mehraban sheep. Polymorphism of the GH1 gene was detected by polymerase chain reaction–single strand conformation polymorphism (PCR–SSCP) and DNA sequencing methods in 463 individuals. Two different structures in the GH1 protein and six single nucleotide polymorphisms were identified. The association of these SSCP patterns and protein structures with carcass traits was analysed. The SSCP patterns were shown to be associated with carcass traits. Individuals with AB SSCP pattern and Type B protein structure had significantly higher fat-tail weight and volume (P < 0.05) than did those individuals with CC SSCP pattern and Type A protein structure. Moreover, CC SSCP pattern and Type A protein structure contributed to low concentration of blood triglycerides (P = 0.004). The results confirmed the importance of GH1 as a candidate gene for marker-assisted selection for carcass-trait variations in sheep.

Postoperative pyoderma gangrenosum: a rare complication after appendectomy

Pyoderma gangrenosum (PG) is an uncommon inflammatory ulcerative skin disease. It is characterized by painful progressive necrosis of the wound margins. Rarely, postoperative pyoderma gangrenosum (PPG) manifests as a severe disturbance of wound healing following surgical interventions. Only rare cases of this complication have been reported after appendectomy. We report a case of PPG in a 29-year-old female after appendectomy. She was successfully treated with oral prednisolone. Postoperative pyoderma gangrenosum should be kept in mind in the differential diagnosis of any postoperative delayed wound healing, because this disease is simply distinguished from a postoperative wound.

The simultaneous efect of extrusion and T6 treatment on the mechanical properties of Al-15wt.%Mg2Si composite

This article investigates the simultaneous efect of extrusion ratio and T6 heat treatment on microstructure and mechanical properties of in-situ Al-15wt.%Mg2Si composite. his composite has already been introduced as a new class of light materials but the brittle structure of the primary Mg2Si which is formed during solidiication limits its application. As-cast composite was directly extruded as rod by using three diferent dies. Ater T6 heat treatment on extruded samples, microstructure was studied by optical and scanning electron microscopy. Results demonstrated that extruded and heat treated composite possesses considerably higher strength and enhanced ductility in comparison with the as-cast samples. It was also found that heat treatment and extrusion processes change the primary Mg2Si morphology considerably and its size increases as extrusion ratio decreased. Fracture surface examinations revealed a transition from brittle fracture mode in as-cast composite to ductile fracture in heat treated and extruded specimens. his can be attributed to the changes in size and morphology of Mg2Si intermetallics and porosity content.

Serial tumour markers serum carcinoembryonic antigen and cancer antigen 15-3 assays in detecting symptomatic metastasis in breast cancer patients

The value of serum tumour markers in the prognosis of patients with breast cancer is controversial. This prospective study in Yazd, Islamic Republic of Iran, assessed the value of the tumour markers carcinoembryonic antigen (CEA) and cancer antigen (CA) 15-3 in 159 patients with primary breast cancer. CEA and CA15-3 assays (mean 14 per patient) were performed at diagnosis, end of surgery and chemotherapy and every 3 months in the first 2 years and every 6 months in second 2 years of the follow-up period. During follow-up, 33 patients (20.8%) presented symptomatic metastasis. A significant relationship was seen between metastasis status and positive CEA and CA15-3 levels. The sensitivity and specificity were 66.7% and 98.4% for CEA respectively and 84.8% and 91.3% for CA15-3 respectively. Optimum cut-offs were 4.95 ng/mL and 30.5 U/mL for CEA and CA15-3 respectively.

Associations of growth hormone secretagogue receptor (GHSR) genes polymorphisms and protein structure changes with carcass traits in sheep

Growth hormone secretagogue receptor (GHSR), a G protein-coupled receptor that binds ghrelin, plays an important role in the central regulation of pituitary growth hormone secretion, food intake, and energy homeostasis. Ghrelin receptor (GHSR) modulates many physiological effects and therefore is a candidate gene for sheep production performance. Polymorphism of the GHSR gene was detected by PCR-SSCP and DNA sequencing methods in 463 individuals. Two different structures in protein and nine single nucleotide polymorphisms (SNPs) were identified. The evaluation of the associations between these SSCP patterns with carcass traits suggests a positive effect of genotype TT and B structure on carcass weight, and body length (P<0.05). In addition, the animal with TC had greater abdominal fat than those with TT and CC (P<0.05) while CC genotype contributed to low blood cholesterol (P=0.04). The results confirm the hints suggesting that GHSR is a preferential target for further investigation on mutations that influence carcass trait variations.

The effect of hydro alcoholic nettle (Urtica dioica) extract on oxidative stress in patients with type 2 diabetes: a randomized double-blind clinical trial

Diabetes type 2 is a metabolic disorder that characterized by hyperglycemia and insulin resistance. Hyperglycemia and impairment of oxidant/antioxidant balance, can increase oxidative stress and increase risk of cardiovascular disease. In the present study, Effects of hydro alcoholic extract of Nettle on oxidative stress in type 2 diabetes were evaluated. Fifty patients (27 men, 23 women) with type 2 diabetes patients were studied. They received 100 mg kg(-1) of nettle extract of body weight hydro alcoholic for 8 weeks. At the baseline and end of 8th weeks of intervention blood levels of oxidative stress markers were measured. Data was analyzed by SPSS version 18, p < 0.05 was considered significant for all variables. After 8 weeks, Total Antioxidant Capacity (TAC) and Superoxidant Dismutase (SOD) showed a significant increase in the intervention group compared to the control group (p < 0.05). The findings showed that the hydro alcoholic extract of nettle has increasing effects on TAC and SOD in patients with type 2 diabetes without no changes in Malondialdehyde (MDA) and Glutathione Peroxides (GPX) after eight weeks intervention.

The effect of hydro alcoholic Nettle (Urtica dioica) extracts on insulin sensitivity and some inflammatory indicators in patients with type 2 diabetes: a randomized double-blind control trial

Type 2 diabetes is a metabolic disorder that is strongly associated with cardiovascular risk. Inflammation is a potential risk factor for cardiovascular disease. In this study, hydro alcoholic extract of Nettle (Urtica dioica) on insulin sensitivity and some inflammatory indicators in type 2 diabetic patients were studied. A randomized double-blind clinical trial on 50 men and women with type 2 diabetes was done for 8 weeks. Patients were adjusted by age, sex and duration of diabetes, then randomly divided into two groups, an intervention and control group. They received, 100 mg kg-1nettle extract or placebo in three portions a day for 8 weeks. Interleukin 6 (IL-6), Tumor Necrosis Factor-alpha (TNF-alpha), High Sensitive C-Reactive protein (hs-CRP) and Fasting Insulin concentration were measured. Insulin Sensitivity was calculated, at the beginning and the end of the study. The data were analyzed by SPSS version 18, p<0.05 was considered significant for all variables. After 8 weeks, IL-6 and hs-CRP showed a significant decrease in the intervention group compared to the control group (p<0.05). The findings showed that the hydro alcoholic extract of nettle has decreasing effects on IL-6 and hs-CRP in patients with type 2 diabetes after eight weeks intervention.

The effect of different levels of organic and inorganic chromium supplementation on production performance, carcass traits and some blood parameters of broiler chicken under heat stress condition

A total of 250 broilers in a completely randomized design selected to evaluate the effect of different levels of chromium (Cr) supplementation on performance, carcass traits and some blood parameters of heat-stressed broiler chicks. All birds were kept under heat stress temperature (33 ± 3°C) and divided into five treatments groups. Each treatment consisted of five pens with 10 birds in each pen. The basal diets were supplemented with 0 ppb (control), 800 ppb Cr-L-Met (T(1)), 1,200 ppb Cr-L-Met (T(2)) or 800 ppb CrCl(3) (T(3)), and 1,200 ppb CrCl(3) (T(4)). The feed intake and body mass were measured at 10, 21, and 42 days of age. Blood samples were collected from two birds in each replicates to determine biological and hematological values at 28 and 42 days of age. There were no significant difference in mass gain and feed conversion of broilers that received Cr supplementations compared with controls. The serum glucose concentration decreased in broilers received organic chromium methionine supplements compared with other treatments groups. Slight but not significant increases were observed in serum high-density lipoprotein (HDL) concentration of treated groups than controls while the mean serum HDL concentration was significantly higher in T(2) group compared with control group. Serum low-density lipoprotein level decreased in broiler received organic Cr supplements (p < 0.05).

Environmental exposure to xylenes in drivers and petrol station workers by urinary methylhippuric Acid

BACKGROUND

The aims of this study were evaluation of exposed to xylenes in low concentration and compare urinary level of methyl hippuric acid in taxi drivers and petrol stations workers in West of Iran.

METHODS

This observation study was carried out on samples of the exposed men to xylenes in two occupational groups in Hamadan City (west of Iran) from March 2003 to March 2004. Subjects included 45 taxi drivers and 25 petrol station workers. The study group was selected from 54 workers at petrol stations and 300 drivers by simple random sampling. Xylenes was analyzed using gas chromatography equipped with a Flame Ionization Detector (FID). The urinary methyl hippuric acid (MHA) was analyzed with High performance Liquid Chromatography (HPLC) equipped with an ultraviolet (UV) detector.

RESULTS

Total xylene exposure was 1.05±0.55 ppm (mean±SD) with a range of 0.20-2.55 ppm that was about 4 times more than taxi drivers' exposure. The poor correlation coefficient was seen between xylenes concentration and urinary MHA for drivers (r2= 0.09 to 0.42) but significant associations were noted between urinary MHA and xylene in the breathing zone of petrol station workers (r2= 0.69 to 0.77; P< 0.05).

CONCLUSION

High xylenes levels are emitted in petrol stations at Iran. Urinary MHA level has a poor correlation with exposure to xylenes in drivers but has good correlation in petrol station workers.

Effects of velocity and particles load on efficiency of cyclone in the stone crushing units at azendarian area

BACKGROUND

The traditional cyclone has been developed for the removal of airborne silica particles from local exhaust ventilation (LEV). The objective of this research was to evaluate the effects of velocity and particles load on efficiency of cyclone in the Stone Crushing Units at Azendarian Area.

METHODS

After the designing and installing the traditional cyclone, downstream and upstream samples of the apparatus were obtained. The mass of all samples collected was determined gravimetrically using EPA method with cascade Impactor.

RESULTS

The relation between inlet total and respirable dust concentration to cyclone and cyclone overall efficiency is statistically significant (P= 0.005) and the relation between inlet air velocity to cyclone and cyclone pressure loss is statistically significant (P= 0.002). There was a significant correlation between the inlet concentration loaded to cyclone and the efficiency of cyclone.

CONCLUSION

Increase of respirable dust concentration and also total concentration cause to increase efficiency of cyclone.

A randomized, double-blind trial of bromocriptine efficacy in nonfluent aphasia after stroke

The authors assessed the efficacy of bromocriptine in nonfluent aphasia after stroke in a 16-week, randomized, double-blind, placebo-controlled clinical trial conducted from June 2002 to April 2004. In all 38 patients after 4 months of treatment, improvement in both the bromocriptine and placebo treatment groups was observed (p < 0.001). The analysis of repeated-measures analysis of variance revealed bromocriptine did not improve nonfluent aphasia.

Modified Sleeve Anastomosis in Large Muscular Arteries of Sheep

OBJECTIVE

The purpose of this investigation was to test a modified telescopic anastomosis in large muscular arteries.

MATERIAL AND METHODS

The right carotid arteries in 30 sheep (average weight 57+/-5.7 kg) were transected and anastomosed end to end using two guided sutures and compared with a control group (10 sheeps) using two external sutures (Lauritzen method).

RESULTS

The mean time to complete the anastomosis (4.5 min) and hemostasis (4.3 min) in the experimental group was less than the control group (17.3 min for anastomosis and 6.4 min for hemostasis) (P<0.05). In addition, the total amount of blood loss during the modified anastomosis was significantly lower than Lauritzen method (3.8 versus 8 ml). In both experimental and control groups the scanning electron microscopy (SEM) at 90th day post-operation revealed a continuous smooth layer of endothelial cells covering the anastomotic junction.

CONCLUSIONS

Anastomosis with two guided sutures is easy and faster to perform and could be applicable to an acutely transected vessel.

Evaluation of availability, accessibility and prescribing pattern of medicines in the Islamic Republic of Iran

Prescribing, dispensing, availability and affordability of drugs were evaluated in 100 primary health care centres in 5 provinces of the Islamic Republic of Iran using WHO indicators. On average, 92% of the 12 essential drugs monitored were available in the health centre pharmacies and 95% of the drugs prescribed by the physician were dispensed by the health centre pharmacy. The stock-out duration was less than 1 month on average. A complete treatment for pneumonia cost only 2% of the lowest weekly government salary. The national average number of drugs per prescription was 3.4. Prescription of antibiotics and injectable drugs was very high [58% and 41% respectively]. Although availability and affordability of essential drugs is good in this country, rational use of drugs needs to be emphasized

Evaluation of availability, accessibility and prescribing pattern of medicines in the Islamic Republic of Iran

Prescribing, dispensing, availability and affordability of drugs were evaluated in 100 primary health care centres in 5 provinces of the Islamic Republic of Iran using WHO indicators. On average, 92% of the 12 essential drugs monitored were available in the health centre pharmacies and 95% of the drugs prescribed by the physician were dispensed by the health centre pharmacy. The stock-out duration was less than 1 month on average. A complete treatment for pneumonia cost only 2% of the lowest weekly government salary. The national average number of drugs per prescription was 3.4. Prescription of antibiotics and injectable drugs was very high (58% and 41% respectively). Although availability and affordability of essential drugs is good in this country, rational use of drugs needs to be emphasized.

Over-expression of recombinant human interferon-gamma in high cell density fermentation of Escherichia coli

Human interferon-gamma (hIFN-gamma) was expressed in Escherichia coli BL21(DE3) under the control of the T7 promoter. Glucose was used as the sole source of carbon and energy with simple exponential feeding rate in fed-batch process. Cell density of recombinant E. coli was reached to 100 g dry wt l(-1) under both constant (0.12 h(-1)) and variable (0.12-0.52 h(-1)) specific growth rates. In the variable specific growth rate fed-batch process, plasmid stability and specific yield of rhIFN-gamma were greater than constant specific growth rate fed-batch process. The final specific yield and overall productivity of rhIFN-gamma were 0.35 +/- 0.02 g rhIFN-gamma g(-1) dry cell wt and 0.9 +/- 0.05 g rhIFN-gamma l(-1) h(-1) in the variable specific growth rate fed-batch process, respectively.

Process development for production of recombinant human interferon-? expressed in Escherichia coli

A simple fed-batch process was carried out using constant and variable specific growth rates for high-cell-density cultivation of Escherichia coli BL21 (DE3) expressing human interferon-gamma(hIFN-gamma). The feeding rate was adjusted to achieve an appropriate specific growth rate. The dissolved oxygen level was maintained at 20-30% of air saturation by control of airflow and stirrer speed and, where necessary, by enrichment of inlet air with pure oxygen. Glucose was the sole source of carbon and energy and was provided by following a simple exponential feeding rate. The final cell density in the fed-batch fermentation with constant and variable specific growth rate feeding strategies was ~100 g dry cell wt l(-1) after 36 and 20 h, respectively. The final specific yield and overall productivity of recombinant hIFN-gamma in the variable specific growth rate strategy were 0.35 g rHu-IFN-gamma g(-1) dry cell wt and 0.9 g rHu-IFN-gamma l(-1) h(-1), respectively. A new chromatographic purification procedure involving anion exchange and cation exchange chromatographies was developed for purification of rHu-IFN-gamma from inclusion bodies. The established purification process is reproducible and the total recovery of rHu-IFN-gamma was ~30% (100 mg rHu-IFN-gamma g(-1) dry cell wt). The purity of the rHu-IFN-gamma was determined using HPLC. Sterility, pyrogenicity, and DNA content tests were conducted to assure the absence of toxic materials and other components of E. coli in the final product. The final purified rHu-IFN-gamma has a specific antiviral activity of ~2 x 10(7) IU/mg protein, as determined by viral cytopathic effect assay. These results certify the product for clinical purposes.

Impairment of neuromotor and cognitive development in iodine-deficient schoolchildren with normal physical growth

In order to detect somatic and psychomotor disturbances in children and adolescents residing in areas of iodine deficiency, schoolchildren from three areas with different degrees of iodine deficiency were studied. In Randan, the prevalence of severe endemic goiter was accompanied by alteration in thyroid function, increased thyrotropin levels and retardation of both bone and psychomotor age and decreased intellectual quotient. In Tehran, where iodine deficiency is mild, visible goiter was present in 15% of schoolchildren but no alterations in thyroid function, serum thyrotropin, somatic or psychomotor development could be detected. In Zagoon, where the prevalence and severity of goiter was less than Randan but more than Tehran, thyroid function was normal but slightly decreased as compared to Tehran; somatic development was unaltered, but retardation in psychomotor development was evident and the mean intellectual quotient was less than that of Tehranian schoolchildren. These findings indicate the occurrence of physical and psychomotor disturbances in apparently normal schoolchildren from areas of iodine deficiency. Alteration in psychomotor development may occur in children with normal physical growth, due to iodine deficiency.