Pulmonary function in children post -SARS-CoV-2 infection: a systematic review and meta-analysis.

OBJECTIVE: There are some concerns regarding long-term complications of COVID-19 in children. A systematic review and meta-analysis was performed evaluating the respiratory symptoms and pulmonary function, post-SARS-CoV-2 infection. METHODS: A systematic search was performed in databases up to 30 March 2023. Studies evaluating respiratory symptoms and pulmonary function after COVID-19 infection in children were selected. The major outcomes were the frequency of respiratory symptoms and the mean of spirometry parameters. A pooled mean with 95% confidence intervals (CIs) was calculated. RESULTS: A total of 8 articles with 386 patients were included in meta-analysis. Dyspnea, cough, exercise intolerance, and fatigue were the most common symptoms. The meta-mean of forced expiratory volume (FEV1) and forced vital capacity (FVC) was 101.72%, 95% CI= (98.72, 104.73) and 101.31%, 95% CI= (95.44, 107.18) respectively. The meta-mean of FEV1/FVC and Forced expiratory flow at 25 and 75% was 96.16%, 95% CI= (90.47, 101.85) and 105.05%, 95% CI= (101.74, 108.36) respectively. The meta-mean of diffusing capacity for carbon monoxide was 105.30%, 95%CI= (88.12, 122.49). There was no significant difference in spirometry parameters before and after bronchodilator inhalation. CONCLUSIONS: Despite some clinical respiratory symptoms, meta-results showed no abnormality in pulmonary function in follow-up of children with SARS-CoV-2 infection. Disease severity and asthma background had not confounded this outcome.

Diagnostic challenge in a 2-year-old boy poisoned with carbon monoxide: A case report.

Key Clinical Message: Carbon monoxide poisoning diagnosis is sometimes very difficult and should be considered in the differential diagnosis list of children's consciousness disorders even in summer. Abstract: Carbon monoxide poisoning is very dangerous, and sometimes, it is difficult to diagnose. Especially, this poisoning may have non-specific manifestations in children and can be confused with other diseases. Here we present a 2-year-old child who suffered a disturbance of consciousness during the summer season. He and his family were travelers who had come to Mashhad from Kerman and were staying in a hotel room, after various investigations. It has been found that he was poisoned with carbon monoxide gas due to the leakage of carbon monoxide gas from the chimney pipe of the engine room related to the hotel's water heating into the room. After receiving oxygen and supportive treatments, he recovered and was discharged with good health. Poisoning with carbon monoxide gas is very dangerous, and the awareness of health and medical personnel in this field is essential.

Efficacy and Safety of Angiotensin Receptor Blockers in Pediatric Patients (Aged 6 to 18) with Hypertension: A Systematic Review.

Angiotensin receptor blockers (ARBs) are commonly prescribed in pediatric hypertension because of the fundamental role of the renin-angiotensin-aldosterone system in the pathogenesis of hypertension. We, therefore, aimed to systematically review articles that investigated efficacy and safety of ARB agents in the pediatric population aged over six years. To do so, the databases of Web of Science, PubMed/MEDLINE, and Scopus were searched to conduct a systematic review by using the following keywords: ("angiotensin receptor blocker" OR "valsartan" OR "losartan") AND ("pediatric" OR "children" OR "child") AND ("high blood pressure" OR "hypertension"). Finally, 12 studies were included in our review, and we found that almost all of them supported the effectiveness and tolerability of different ARB agents. Candesartan cilexetil lowered blood pressure (BP), with a 9 mmHg decline in both systolic and diastolic BP, and proteinuria after four months of treatment. Valsartan and Losartan similarly were shown to be effective in lowering BP in a dose-dependent manner. Headache, dizziness, upper respiratory infection, and cough were the most reported side effects. However, almost all reviewed studies indicated that the safety profile was satisfactory. In conclusion, ARBs are beneficial and well-tolerated antihypertensive medications.  DOI: 10.52547/ijkd.7228.

The clinical relationship between histamine-1 receptor antagonists and risk of cancer: a systematic review and meta-analysis.

BACKGROUND: A systematic research was performed to review the relationship between use of histamine-1 receptor antagonists and cancer risk. METHOD: Databases were searched up to December 2021. Case-control and cohort studies evaluating the relationship between use of histamine-1 receptor antagonists and risk of cancer were selected. The major outcome was cancer risk. Odds ratio (OR) with 95% confidence intervals (CIs) was calculated. Subgroup, cumulative, and sensitivity analysis and Egger test were performed. RESULTS: Five case-controls and one cohort study were included. According to cohort study, use of antihistamines were not associated with cancer risk (RR = 0.92, 95% CI = (0.78-1.07). In case-controls, the frequency of antihistamine use in cases and controls was 11.28% and 14.82% respectively which was associated with decreased cancer risk (p value = 0.02, OR = 0.93, 95%CI = (0.87, 0.99)). Sensitivity analysis showed a change in direction of pooled OR by omitting some studies. Sub-group analysis according to type of cancer showed a decrease in cancer risk in antihistamine users in glioma (p value = 0.03). CONCLUSION: Antihistamines might reduce the risk of certain cancers. More studies with defined background of allergy are needed which can clarify the relevancy of different types of cancer with anti-H1 receptors.

Diversity of malignancies in patients with different types of inborn errors of immunity.

Genetic defects in the development, maturation, and/or function of the immune cells can lead to Inborn errors of immunity (IEI) which may predispose patients to malignancies. The overall risk for cancer in children with IEI ranges from 4 to 25% and the type of malignancy is highly dependent on the specific mutant gene underlying IEI. We investigated 3056 IEI patients registered in the Iranian national registry between the years 1999 and 2020 in this retrospective cohort study. The frequency of malignancy and its association with the type of IEI in these patients were evaluated. A total of 82 IEI patients with malignancy were enrolled in this study. Among them, predominantly lymphoma was the most common type of malignancy (67.1%), followed by leukemia (11%), and cancers of the head and neck (7.3%). Among identified lymphoma cancers, non-Hodgkin's lymphomas were the most frequent type (43.9%) followed by different subtypes of Hodgkin's lymphoma (23.2%). Solid tumors (18.3%) appeared to be very heterogeneous by type and localization. The correlation between the type of malignancy and survival status and the association between the type of malignancy and IEI entities were unremarkable. The awareness of the association between the presence of IEI and cancer highlights the importance of a synergistic effort by oncologists and immunologists in the early diagnosis of malignancy and personalized therapeutic strategies in IEI patients.

The Potential of Probiotics for Treating Skin Disorders: A Concise Review.

Probiotics are defined as "live microorganisms that confer a health benefit on the host when administered adequately." In recent years, the cosmetic industry has tried to develop many products classified as probiotics. They can exert their benefits at the skin level because of their favorite properties, and they could prevent and treat skin diseases and represent an emerging area for skin health. The antibacterial and immunomodulatory properties make them promising candidates to target skin disorders including acne, psoriasis, and atopic dermatitis and aid wound healing. The scientific reports show that specific probiotic strains can modulate cutaneous microflora, skin immune system, lipid barrier, and skin health preservation. This review summarizes the most relevant evidence from scientific literature concerning potential topical applications of probiotics in dermatology. Altogether, the evidence reported here affords the possibility of designing new strategies based on a topical approach to prevent and treat cutaneous disorders.

COVID-19 in children with inborn errors of immunity: clinical scenarios.

The new emerging virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes a huge burden of morbidity and mortality worldwide. One of the predisposing factors which might increase the infection susceptibility and its complications can be the Inborn Errors of Immunity (IEI). One hundred and seventeen primary immunodeficient (PID) pediatric patients were monitored from March to December 2020 for any signs and symptoms of SARS-CoV-2 infection. Among them twenty-eight children were symptomatic and nineteen out of the twenty-eight patients took the coronavirus PCR test. Out of them, the PCR test results of 9 patients were positive. Herein, we report the nine cases of pediatric patients with IEI who were also infected with SARS-CoV-2 with a positive PCR test. We observed a variation in clinical manifestations, clinical courses, and outcomes among IEI pediatric patients affected with COVID-19. In our survey, prompt diagnosis and appropriate monitoring for possible complications were shown to be effective in reducing the mortality rate of the SARS-CoV-2 affected patients with IEI. Although there is no approved treatment for SARS-CoV-2 infection, supportive treatment might reduce the complications and lead to better outcomes. This study received approval from the Research Ethics Committee of Mashhad University of Medical Science with the ethics code of IR.MUMS.REC.1399.155. (https://ethics.research.ac.ir/EthicsProposalViewEn.php?id=129963).

Adverse reactions in a large cohort of patients with inborn errors of immunity receiving intravenous immunoglobulin.

BACKGROUND: Intravenous immunoglobulins (IVIg) are the major treatment in inborn errors of immunity (IEI) disorders; However, IVIg infusions show some adverse effects. We aimed to assess the adverse reactions of IVIg infusions. METHODS: Data of IVIg infusions in IEI patients were collected from 2011 to 2021. Totally, 363 IEI patients received IVIg regularly in Iran entered the study. The adverse reactions are classified regarding their severity and chronicity. RESULTS: 22,667 IVIg infusions were performed in the study. 157 patients (43.2%) and 1349 (5.9%) infusions were associated with at least one type of adverse reaction. The highest rates of adverse reactions were seen in severe combined immunodeficiency. Myalgia, chills, headache, fever, and hypotension were the most frequent adverse effects of IVIg. CONCLUSION: The reactions affect almost half of the patients mainly in the first infusions which necessitate the close observation of IEI patients receiving IVIg.

Epidermal growth factor receptor inhibitor in advanced basal cell carcinoma.

Cetuximab can be used for the treatment of advanced basal cell carcinoma, especially when the patient cannot tolerate routine chemotherapy. Future studies are needed to confirm it.

COVID-19 in a child with primary antibody deficiency.

Although presentation of COVID-19 in patients with immunodeficiency could be mild, it should not be missed, while early diagnosis and appropriate treatment can survive infected patients. Because even severe infections in PID patients may be presented with few symptoms and signs, this diagnosis should be considered in those immunocompromised patients who have exacerbating preexisting symptoms.

Prevalence of IgE-Mediated Food Hypersensitivity to Cereals and Beans Based on Skin Prick Test in Children with Celiac Disease.

BACKGROUND Celiac disease is a non-IgE mediated food allergy, which can cause extensive villus atrophy. Because of increased food allergen absorption, there are elevated IgA and IgG antibodies in these patients, so there is a concern about IgE antibody production against wheat and other cereals. METHODS In this study, we evaluated IgE-mediated hypersensitivity to wheat, rice, and other cereals in children with celiac disease. RESULTS 22 patients (50%) had at least one positive skin prick test to food allergens. The most frequent food allergen was peanut (31.8%), followed by wheat (18.2%), corn (9.1%), and rice (4.5%). The results revealed no significant correlation between age, sex, and the results of the skin prick test (p >0.05). The correlation between diagnosis time of celiac disease and results of skin prick test was also not significant statistically (p >0.05). CONCLUSION Because of the high prevalence of IgE mediated hypersensitivity to cereals and beans in children with celiac disease, a skin prick test might be considered in these patients, especially in refractory cases.

Impact of SARS-CoV-2 Pandemic on Patients with Primary Immunodeficiency.

Although it is estimated that COVID-19 life-threatening conditions may be diagnosed in less than 1:1000 infected individuals below the age of 50, but the real impact of this pandemic on pediatric patients with different types of primary immunodeficiency (PID) is not elucidated. The current prospective study on a national registry of PID patients showed that with only 1.23 folds higher incidence of infections, these patients present a 10-folds higher mortality rate compared to population mainly in patients with combined immunodeficiency and immune dysregulation. Therefore, further management modalities against COVID-19 should be considered to improve the survival rate in these two PID entities using hematopoietic stem cell transplantation and immunomodulatory agents.

Death Due to COVID-19 in an Infant with Combined Immunodeficiencies.

BACKGROUND: Severe Acute Respiratory Syndrome Coronavirus 2 has affected millions of people, and especially in adult patients with underlying diseases lead to death. Meanwhile pediatric patients with inherited defects of T cell should be prone to viral diseases. CASE PRESENTATION: Herein, we report an infant with severe combined immunodeficiencies, who were affected and died because of COVID-19. CONCLUSION: Considering the importance of finding how immune system can affect the viral infection, presentation of COVID-19 in immune deficient patients can be valuable.

How to Boost our Immune System Against Coronavirus Infection?

New emerging viruses like coronavirus 2019 (COVID-19) infections are always frightening. We know little about their transmission, behaviors, clinical manifestations, and outcomes. There is no vaccine or therapeutic strategies to deal with these infections yet. In this situation, preventive measures may be promising. Hand hygiene is a very important issue in preventing viral infection; however, there are other entities that can enhance the immune response and help in infection prevention. Herein we review some measures for boosting the immune system.

Rhinitis as the Presenting Symptom of Pineal Region Epidermoid Tumor: A Case Report.

Brain tumors are the rarest cause of cerebrospinal fluid rhinorrhea. Non-traumatic cerebrospinal fluid rhinorrhea is also a relatively rare condition. It may be misdiagnosed as allergic rhinitis or chronic sinusitis and lead to unsuitable treatment. We described a 34-year-old man who came to our allergy clinic with a chief complaint of clear rhinorrhea from his left nostril with more than four years of duration. Onlyhypertrophy of left inferior concha was found in the clinical examination. His rhinorrhea aggravated when bending forward. So we were suspicious of CSF rhinorrhea. MRI was done for him and demonstrated a large tumor in the pineal region. The patient underwent surgery with resection of the mass via an infratentorial-supracerebellar approach. This case showed the role of maintaining differential diagnosis for a common complaint; rhinitis which is seen as usual.

COVID-19 Associated Multisystem Inflammatory Syndrome: A Systematic Review and Meta-analysis.

The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19. This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. The screening was done by using the following keywords: ("novel coronavirus" Or COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus) and ("MIS-C" or "multisystem inflammatory" or Kawasaki). Data on gender, ethnicity, clinical presentations, need for mechanical ventilation or admission to intensive care unit (ICU), imaging, cardiac complications, and COVID-19 laboratory results were extracted to measure the pooled estimates. Out of 314 found articles, 16 articles with a total of 600 patients were included in the study, the most common presentation was fever (97%), followed by gastrointestinal symptoms (80%), and skin rashes (60%) as well as shock (55%), conjunctivitis (54%), and respiratory symptoms (39%). Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%). The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.

A significant decrease in the gene expression of interleukin-17 following the administration of synbiotic in patients with allergic rhinitis who underwent immunotherapy: A placebo-controlled clinical trial.

BACKGROUND: Allergic Rhinitis (AR) is the most common allergic disease worldwide. The present study, evaluated effects of synbiotic on gene expression of interferon-gamma (IFN-γ), interleukin-4 (IL-4), interleukin-10 (IL-10), interleukin-17 (IL-17), transforming growth factor beta (TGF-ß), and forkhead box P3 (FoxP3) in AR patients who received concomitant immunotherapy in a placebo-controlled clinical trial. MATERIALS AND METHODS: Twenty AR patients were randomized in synbiotic and placebo groups and received cluster immunotherapy for 2 months. RNA was extracted from peripheral PBMCs, then the cDNA synthesized. Subsequently, SYBR Green real-time Reverse transcription polymerase chain reaction technique was employed for studying the expression of mentioned genes. In addition, SNOT-22 and mini-Rhinoconjunctivitis Quality of Life Questionnaire questionnaires were completed by patients. Data were analyzed before and also 2 and 6 months after intervention. RESULTS: Clinical symptoms and quality of life were improved with immunotherapy, but there was no significant difference between the placebo and synbiotic groups. Gene expression of IFN-γ, TGF-ß, and FoxP3 was increased whereas the gene expression of IL-4 and IL-10 decreased, but not significant. Interestingly, the gene expression of IL-17 in the synbiotic group was significantly decreased versus placebo after 2 months (P = 0.001) and also at the end of intervention (P = 0.0001) comparing with the time zero. CONCLUSION: Significant reduction in the IL-17 gene expression following administration of synbiotic versus placebo shows the importance of synbiotic in control of the immunopathogenesis of AR. Further studies with more samples are recommended. In addition, evaluating the effects of synbiotic in patients who do not undergo immunotherapy is suggested to get a better conclusion.

Inflammatory myofibroblastic tumor of salpinx: a very rare case treated with a less aggressive method.

Inflammatory pseudotumour describes as a wide range of neoplastic and reactive lesions. One of the rare presentations of these tumors is found in the salpinx. This case report characterizes a thirty six year old woman with a history of left sided abdominal pain for a few months. Further examinations revealed that she had a complex cyst in her left salpinx. The patient had normal levels of tumor markers such as CA125, Alfa Fetoprotein (AFP), and Human Chorionic Gonadotropin (hCG), while other paraclinical test were in normal values Additionaly The patient underwent left salpingectomy by a gynecologist. The pathological diagnosis of the lesion was inflammatory myofibroblastic tumor (IMT). In immunohistochemistry the tumor stains was moderately positive in anaplastic lymphoma kinase (ALK) and also actin positive. Total resection of tumor was performed with no complications and remained disease free during follow up for 40 months. Although Inflammatory Myofibroblastic Tumor (IMT) is benign in nature, but in order to improve the prognosis, this tumor requires low intensity surgical treatment.