[Streptococcus super antigen in polyp tissue of patients with nasal polyposis and chronic rhinosinusitis in comparison to normal population]

Nasal polyp [NP] is a benign mucosal mass located in both sinuses and nares which is mostly seen in association with cystic fibrosis, asthma or oversensitivity to aspirin. The prominent histological feature of NP is inflammatory cell infiltration with eosinophil predominance. Superantigens role in causing NP complications is already proven. Superantigens, which are mostly originated from Streptococci and Staphylococci, activate T cells strongly and increase the process of production and release of cytokines, and secretion of IgE from B cells, which in turn directly affects proinflammatory cells such as eosinophils, both in their tissues infiltration and functions. The samples are collected from patients referring to ENT clinic in Rasoul Akram training Hospital in Tehran after thorough clinical and paraclinical examinations. For control group the samples collected from patients undergoing rhinoplasty. All the samples kept frozen and sent to immunology lab. The DNA of the excised tissues extracted and amplified by using the superantigens specific primers and PCR product detected by gel electrophoresis. The date analyzed by using mean and SD and CHI[2] analytical tools. Fifteen healthy individuals, 25 patients with rhinosinusitis and 24 with polyposis entered this trial. Group A Streptococcus toxin detection was significantly more frequent in those with nasal polyp and rhinosinusitis compared to healthy individuals [P=0.001 and 0.005, respectively], but the results were almost the same for those with nasal polyp and rhinosinusitis [P=0.4]. Streptococci may play an important role in induction or clinical exacerbation of polyposis and group A Streptococcus pyogenes exotoxin [SPEs] with superantigenic effects may have a crucial role in etiology and pathogenesis of polyps with or without rhinosinusitis. It is postulated that, T cells polyclonal activation by SPEs may cause recruitment of inflammatory cells in nasal mucosa. These inflammatory cells include IgE producing B cells leading to allergic and inflammatory reactions in NP.

[Inflammatory cytokine detection in adenotonsill and peripheral blood mononuclear cells-culture in adenotonsillectomy patients: a comparative study]

Tonsils and adenoid hypertrophy is a major respiratory symptom in children which is partly due to recruitment of inflammatory cells in upper airway lymph nodes as a result of the effects of synthesis and release of different inflammatory cytokines. It seems that infections play role in concert with these cytokines leading to tonsilar hypertrophy and other pathologic consequences. It is proposed that cellular infiltrate of tonsils and adenoids may secrete different quantities of these cytokines compared with peripheral blood mononuclear cells [PBMC] cultures. Among patients who were admitted for adenotonsillectomy to the ENT ward, 37 patients, under 1-12 years old patients with fulfill criteria selected to include the study. Excised adenoid and tonsils cultured and inflammatory cytokines Interferon-gamma [INF-gamma], Interlukine-1 [IL-1], IL-6, IL-8 and tumor necrosis factor-alpha [TNF-alpha] measured in cellular culture supernatant. The same cytokines measured in PBMC cultures. The data shows that there is a significant difference between IFN-gamma and IL-8 amounts in adenoid tissue culture supernatant and PBMC culture of our patients. Furthermore, the amounts of IFN-gamma, IL-1 and IL-8 showed considerable difference between tonsilar tissue culture supernatant and PBMC culture of these patients. Although there is a significant correlation between IL-6 amounts in tissue culture supernatant and PBMC culture [P=0.02], the respective data for TNF is only almost significant. Inflammatory cytokines may have significant role in the early provoke of inflammation occurred in hypertrophied tonsils and adenoid. The majority of these cytokines increase the expression of adhesion molecules on epithelial cells and influence the recruitment of leucocytes and inflamed tonsils. On the other hand lack of sufficient cytokine release may lead to persistent infections and may cause chronic inflammation and hypertrophied tissue

[Superantigens in polyp tissue of patients with chronic rhino-sinusitis, a comparative study: a brief report]

Staphylococcus aureus secretes numerous superantigenes which trigger the inflammatory mechanisms of sinus mucosa and cause chronic rhino-sinusitis. This study was designed to evaluate the role of staphylococcus aureus superantigens in polyp tissues of patients with chronic rhino-sinusitis in comparison with a control group. Polyp tissue samples of 28 patients and mucosal specimens of 19 healthy individuals were evaluated for staphylococcus aureus bacterium superantigens, exotoxins A, B, C and D and TSST-1 with RT-PCR and ELISA methods Rasoul Akram Hospital during 2 years. Polymerase chain reaction [PCR] results revealed that 88.2% of the patients and 45.5% of the controls had at least one type of superantigen [P=0.03]. Evaluation of superantigens using ELISA method showed presence of at least one type of superantigen in the nasal samples of all patients and in 35.3% of the controls [P < 0.001]. A relationship between staphylococcal superantigens and nasal polyps is concluded from this study which indicates the probable role of these superantigens in the pathogenesis of nasal polyposis

[ comparison of TH1 and TH2 cytokines gene expression in allergic and non-allergic patients with nasal polyps by PCR]

Too many studies are in the process of determining the probable role of immune system in the etiopathogenesis of nasal polyposis. This study was designed to identify the probable participation of Th1, Th2 lymphocytes in the induction and progression of nasal polyposis. Seventy-five patients, 42 male and 33 female, with nasal polyposis were examined for total serum IgE, specific serum IgE and reaction to skin test for differentiating allergic from non-allergic participants in Rasoul Akram Hospital during 2010. To determine the possible correlation of allergic reactions in the upper respiratory tract and nasal polyposis, cytokine gene expression was evaluated on the extracted RNA by RT-PCR. The data were analyzed by using c2, independent t-test, correlation and Receiver operating characteristic [ROC] curve. The mean age of participants was 38 years [18-81 years]. IFN-gamma and IL-4 gene expressions were more prevalent in allergic than non-allergic individuals [IFN-gamma: 39.5% vs. 14.2%, P=0.3 and IL-4: 44.7% vs. 18.9%, P=0.02, respectively]. IL-10 and IL-12 [P35 and P40 fractions] genes were not significantly different between the two groups. IL-10 and IL-12 [P35, P40] genes did not differ significantly either. This research suggests that overproduction of cytokines and an imbalance of Th1 and Th2 cell production may play an important role in the pathophysiology of allergic or non-allergic nasal polyp formation. Thus, although nasal polyposis is a multifactorial disease with several different etiological factors, chronic persistent inflammation is undoubtedly a major factor irrespective of the etiology

Procalcitonin in diagnosing the diabetic foot infection

Diabetic foot infection is a debilitating disease that requires prompt diagnosis and treatment. In this study, we assessed inflammatory markers; serum Procalcitonin [PCT], c-reactive protein [CRP], erythrocyte sedimentation rate [ESR] and leukocyte counts in two groups of patients with infected and non-infected diabetic foot ulcer. A descriptive cross-sectional study was carried out on diabetic patients during 18 months in Firoozgar Hospital. Patients were divided in two groups according to Infectious Disease Society of America [IDSA] guideline for diagnosis and treatment of diabetic foot infections. Blood samples were drawn from venous lines for measurement of complete blood count [CBC], ESR, CRP, and PCT. Diagnostic values of serum PCT Levels were determined by immunoluminometric assay. SPSS version 15.0 software was used for analysis. Sixty adult patients were considered for this study. Thirty patients with infected ulcer with mean age of 57.5 +/- 2.09 years and 30 with non- infected ulcers with mean age of 61.1 +/- 1.9 years were evaluated. Patients with infected ulcers had significantly elevated levels of CRP, ESR and leukocyte counts in comparison with the non- infected ulcers. Serum PCT levels did not differ between the two groups. Our study suggests CRP, ESR and Leukocyte counts can be used to diagnose of infected ulcers. The role of PCT in localized infections should be determined in further studies