Myeloperoxidase deficiency in neutrophils of diabetic patients with and without infectious diseases

Myeloperoxidase [MPO], an iron-containing protein, is found in the azurophilic granules of neutrophils [PMNs], and catalyzes the conversion of hydrogen peroxide and chloride ions [Cl] into hypochlorous acid, which plays an important role in oxygen-dependent bacterial killing. The enzyme was first isolated in 1941, and deficiency of MPO was first described in 1954. Fewer than 5% of patients with MPO deficiency contract severe infections, which are usually fungal infections in diabetes mellitus [DM] patients. Besides the disorder in antifungal activity, diminished rate of bacterial [S. aureus] killing, and carcinogenesis, it seems that MPO deficiency is also related to atherosclerosis, degenerative neurologic diseases, as well as other disorders. In this study, we compared the levels of the MPO enzyme in the peripheral neutrophils of infected and non-infected DM patients at Imam Khomeini Hospital during 2005-2006. We compared these two groups the prevalence of MPO deficiency in each group, in order to then determine any correlations this may have with infection. In this case-control study, 50 patients were in the infected group [case group] and 50 were in the control group. Patients were chosen using simple sampling methods. Data was gathered from blood samples, using a qualitative test to determine MPO deficiency [Kaplow stain], laboratory results [BUN, Cr, PMN, HbA1c], interviews and completion of a questionnaires, as well as hospital records. Data were analyzed with SPSS software using T test and chi-square test, with a confidence index of 0.05. In spite of differences seen in stained slides, the MPO enzyme was positive in all of the patients, and no differences were seen between the two groups. The average patient age and the duration of DM in the case group were more than those of the control group. No statistical differences in the type of DM and glycosylated hemoglobin [HbA1c] levels were found between the two groups. Body mass indexes [BMI] and PMN counts were higher in the case group. The most prevalent infections were in the skin and soft tissue, bones and joints, as well as chronic respiratory infections [TB], pneumonia, urinary infections, CNS infections, gastrointestinal and intra-abdominal infections, mucormycosis, and sepsis. We found no correlation between MPO enzyme deficiency and age, sex, type or duration of DM, HbA1c levels and BMI

[Evaluation of gasteroesophageal reflux in infants with cow milk allergy]

Cow milk allergy can present as many gasteroenterological manifestations like gasteroesophageal reflux [GER]. The aim of this study was to investigate the prevalence of GER in infants with CMA in Imam Khomeini Hospital [2002-2003]. 51 children with CMA were evaluated. Radiographic and endoscopic assessments were performed in GER suspected cases. These cases underwent challenge test and after 2 weeks with cow milk-free diet, they were evaluated again. 5 cases [10%; 3 females and 2 males] had concomitant GER [age ranged 3-17 months, mean age: 10.6 months]. 3 patients took only mother's milk and 2 cases were fed with both mother's milk and formula. All mothers took dairy cow products in their daily diet. Skin prick test was positive in only one infant. Interestingly, after 2 weeks of cow milk protein-free diet both allergic and GER manifestations disappeared. Evaluation of children with CMA for concurrent GER seems to be necessary, because treating CMA can control GER as well, suggesting an association between the two conditions. Thus an additional antireflux treatment in these patients can be prevented

Lymphocytic interstitial pneumonia: a pediatric case from Iran

We describe a 12-year-old girl with lymphocytic interstitial pneumonia [LIP] with common variable immunodeficiency [CVI]. The patient was under closely followed during acute and remission phases, especially in her last year of life. We believe this case is an informative example of LIP in Iran

[Evaluation of Cow's milk allergy among infants with bloody stools]

Cow's milk allergy [CMA] is an immunologic phenomenon to the proteins present in Cow's milk. It frequently appears with gastrointestinal [GI] problems such as abdominal pain, diarrhea and bloody stool. Its frequency is about 1.9 - 7.5% and symptoms usually appear in early months of life. In this study, we assess CMA in infants with rectorrhagia. In this study infants [< 2years] with complaints of rectorrhagia reporting at the children's clinic at Imam Khomeini Hospital were included. Inclusion criteria comprised of parents' report of passage of bloody stools, absence of infeetion and local conditions such as anal fissure, acidic PH and lactase deficiency. Then formal consents were taken, skin prick test and open food challenge test were performed. Those who were refractory to diet without cow's milk protein were assessed by colonoscopic procedure. Among 198 infants with rectorrhagia, 51 patients were eligible for this study [41% bo1.s . 58.8% girl and with mean age of 5.3 month] . Besides rectorrhagia other manifestation was: diarrhea [80%], abdominal pain [56.9%]. Atopic dermatitis [21.6%] and recurrent vomiting [10%]. Skin prick test were done in 37 cases which was positive in 18 pts. 47 patients had positive challenge tests, in 4 patients with negative challenge test was colonsopy performed. Two cases had nodularity with eosinophilia infiltration, allergic colitis were reported in the others. All patients [including these 4 cases] reponded well to exclusion diet. It has been shown in this study that Cow's Milk Allergy [CMA] has a significant prevalence in infants [<2 years] with rectorrhagia . The definite diagnosis is made by challenge test and the treatment is exclusion diet. According to the results, it is recommended that CMA should be taken in to consideration in children exhibiting gastrointestinal symptoms

[Ocular disorders in a patient with Chronic Granulomatous Disease [CGD]]

The major underlying pathology in chronic granulomatous disease is a primary defect in membranous oxidase of phagocytic cells. Affected patients suffer from recurrent cutaneous and visceral abscess formation by catalase positive micro-organisms. The other characteristic features of the disease are granulomas in gastrointestinal, respiratory and urinary tracts. In this study we review the natural course of the disease in a 12 year old boy. He had a violaceous chronic granuloma on his nose since 7 yr of age. Recently the redness of his eyes and photophobia has been worsened. An ophthalmologic consultaion confirmed a chronic keratitis, and ultimately immunological and bacteriological tests coupled with a pathology specimen documented the diagnosis of chronic granulomatosis. With appropriate treatment, the clinical symptomatology of the child improved

Shwachman syndrome. Report of three cases

Shwachman syndrome, next to cystic fibrosis, is the second cause of congenital exocrine pancreatic insufficiency in children. It appears as steatorrhea, recurrent infections and hematologic abnormalities such as neutropenia, skeletal dysplasia and short stature. In this study, we reviewed 3 patients' histories. All of them showed cellular chemotaxic defect. One of them had been affected by nephrotic syndrome and finally succumbed to septic shock. This patient suffered from skeletal disorders