The correlation between humoral immune responses and severity of clinical symptoms in COVID-19 patients.

The SARS-CoV-2 pandemic persists with global repercussions. Initial COVID-19 symptoms encompass pneumonia, fever, myalgia, and fatigue. The human immune system produces IgM and IgG antibodies in response to SARS-CoV-2. Despite previous research, a comprehensive understanding of the interplay between clinical manifestations and humoral immune responses remains elusive. This study aims to scrutinize this association. 134 COVID-19 patients were enrolled, and stratified into mild, moderate, and severe symptom groups. Serum IgM and IgG levels were assessed thrice at one-month intervals using ELISA. The findings reveal significant elevation in serum IgG levels in moderate compared to mild cases (P < 0.001). Additionally, IgG production was significantly heightened in severe cases compared to both mild (P < 0.0001) and moderate (P < 0.05) groups. IgM and IgG levels peaked initially and diminished over time. While anti-SARS-CoV-2 antibodies are expected to confer protection, the direct correlation between IgG levels and symptom severity may arise from delayed immune activation, resulting in an intense antibody response in severe cases. Given evidence linking delayed immune function with a dysregulated innate immune response, comprehensive data collection should encompass not only serum IgG and IgM, but also early measurement of type I interferons at symptom onset. This could provide a more thorough understanding of COVID-19 progression.

The effect of T helper (Th)/T cytotoxic (Tc) ratio on disease severity in type A hemophilia patients.

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the T helper (Th) to T cytotoxic (Tc) ratio in children suffering from type A hemophilia disease and to evaluate the correlation of this ratio with disease severity. MATERIAL AND METHOD: Two mls of EDTA anti coagulated whole blood was collected. Immunophenotyping of lymphocytes count was carried out by FACS analysis using a double CD4 and CD8 kit. The mean ± SD of absolute numbers of CD4 and CD8 lymphocytes/ml was calculated and the ratio of CD4/CD8 was evaluated by statistical method. RESULTS: Among 80 type A hemophilia patients, 66 (82.5%) were male. The mean age was 15 ± 3.51 years. 12 (15%) of them were suffering from mild disease and 68 (85%) had sever disease. The CD4 /CD8 ratio was obtained between 0.45 and 1.44 with mean1.79 ± 0.78. The correlation between this ration and disease severity was 0.019. CONCLUSION: The results showed that CD4/CD8 ratio has correlation with disease severity in type A hemophilia patients, however there was no association between this ratio and gender.

Correlation of bleeding score with frequency and severity of bleeding symptoms in FXIII deficiency assessing by the ISTH Bleeding Assessment Tool.

OBJECTIVES: The ISTH bleeding assessment tool (ISTH-BAT) is developed for standardization of bleeding symptoms in bleeding disorders. The aim of this study is to apply this bleeding score for FXIII deficient patients and its relation to the frequency and severity of symptoms. METHODS: In this cross-sectional study, 63 patients with severe FXIII deficiency were evaluated for the assessment of bleeding score according to the standard ISTH-BAT questionnaire. All patients were registered at two major thrombosis and hemostasis centers in Iran affiliated to Zahedan University of medical sciences (50 patients) and Shiraz University of medical sciences (13 patients). RESULTS: Significant correlations between the bleeding score and number of symptoms (r = 0.668, P < 0.001) and with a number of severe symptoms (r = 0.938, P < 0.001) were detected. There was no significant relationship between the mean bleeding score and CNS bleeding (P = 0.390). CONCLUSION: The ISTH-BAT score is an acceptable bleeding assessment tool for standardization and evaluation of patients with FXIII deficiency.

TLR9-based immunotherapy for the treatment of allergic diseases.

Toll-like receptors (TLRs), a family of pattern recognition receptors expressed on many cell types of innate immunity, recognize the pathogen-associated molecular patterns of microbes. The hygiene hypothesis suggests that a reduced microbial exposure in early childhood increases the susceptibility to allergic diseases due to deviation in development of the immune system. TLRs are key roles in the right and healthy direction of adaptive immunity with the induction of T-helper 2 toward Th1 immune responses and regulatory T cells. TLR ligand CpG-ODN-based immunomodulation is independent of allergen and it mainly affects innate immune system. While, CpG-oligodeoxynucleotide-based vaccination is allergen specific and induces adaptive immune system. The use of agonists of TLR9 in two distinct strategies of immunotherapy, immunomodulation and vaccination, could be presented as the curative method for the treatment of allergic diseases.

The Study of Interleukin-17 Level in Vernal Keratoconjunctivitis Disease and its Relationship between Symptom and Sign Severity.

INTRODUCTION: Vernal keratoconjunctivitis (VKC) is a bilateral multi-factorial disease. The pathogenesis of this disease is not obviously determined, but the role of various inflammatory cytokines has been specified. This study has provided a comparison between the level of interleukin-17 (IL17) in the serum and tears of case and control groups, and also the relationship between the level of this interleukin with severity of signs and symptoms of the disease. MATERIALS AND METHODS: This case-control study has been accomplished on 40 individuals (20 healthy people and 20 patients who suffer from VKC) in Al-Zahra Eye Center in 2014. The level of interleukin was isolated in an individual's tear by Schirmer strips; moreover, serum interleukin has been measured. RESULTS: The average of interleukin 17 in serum in the case group was 25.5±4.1 pg/dl and in the control group was 12.5±5.7 pg/dl. The average of interleukin 17 in the case group was 259.6±91.4 pg/dl in the tear and was 50.6±20.8 pg/dl for the control group; the signs and symptoms of the IL-17 disease were associated with the severity of Trantas dots. CONCLUSIONS: Interleukin-17 has a role in the pathogenesis of VKC and also has been proven in the former studies.

Cigarette Smoking and Skin Prick Test in Patients With Allergic Rhinitis.

BACKGROUND: Allergic Rhinitis (AR) is the most common allergic disease, affecting 30% of population around the world. The disease is predominantly associated with exposure to some aeroallergens like cigarette smoking. Skin Prick Test (SPT) is a method of detecting immediate allergic reactions and is applied for controlling disease and therapeutic modality. OBJECTIVES: This study was designed to investigate the effect of cigarette smoking on SPT results among male and female individuals with AR disease. PATIENTS AND METHODS: A total of 478 patients with AR admitted to the 2 main hospitals of Zahedan City from 2005 to 2012, were recruited in this analytic-descriptive study. Categories of smokers and never smokers were used based on patient's statements and their history of smoking. SPT was performed with panel of some allergens and results were recorded and analyzed statistically. Odds ratio and confidence interval method were calculated using univariate logistic regression. RESULTS: The results of this study indicated that 41.4% of patients with allergic rhinitis was smoker with ages ranged from 15 to 70 years. The result of this study also showed that smoking has no effect on SPT results of pollen and weeds aeroallergens conducted on male and female AR patients. However, male were significantly more sensitive than female in terms of sensitivity to the aspergillus, cladosporium, house dust mite, grasses, wheat, cockroach, and feather allergens. CONCLUSIONS: Our findings did not support the effect of cigarette smoking on SPT reactivity to pollen and weeds aeroallergens. However, male were significantly more sensitive than female in terms of sensitivity to some allergens.

Evaluation of haptoglobin phenotypes in association with clinical features of patients suffered from preterm labor disease.

Preterm birth means the birth before thirty seven week of pregnancy that causes a lot of complications for the baby. Variety factors are suggested to be involved in disease. In this study, we decided to evaluate haptoglobin (Hp) phenotypes association with clinical features of patients suffered from premature delivery to understand better the possible correlation of genetic and clinical features in this disease. This cross-sectional analytic descriptive study has been carried out in two groups of 120 women, 60 with preterm and 60 with term labor. Patients were selected with previously diagnosed by gynecologist with preterm birth in the labor during the study period. After performing diagnostic tests, the frequency of each haptoglobin phenotype in the two groups was analyzed using the Chi-square test (X2) test and SPSS software. The maximum serum haptoglobin phenotype frequency in patients with Hp2-2, was 43 (71.7%) whereas in healthy individuals, 35 (58.3%). No, statistically significant differences between the two groups were found (p=0.310). But based on some patients clinical features such as their history of preterm delivery, previous history of recurrent abortions and history of preterm delivery in their family, significant association was found with Hp2-2 compared with healthy control (p<0.003). This study showed that Hp2-2 phenotypes levels in the case group was higher than in control but the factors influencing the presence or absence of preterm labor is clinically various.

Primary immunodeficiency disorders in Iran: update and new insights from the third report of the national registry.

BACKGROUND: Primary immunodeficiency disorders (PID) are a group of heterogeneous disorders mainly characterized by severe and recurrent infections and increased susceptibility to malignancies, lymphoproliferative and autoimmune conditions. National registries of PID disorders provide epidemiological data and increase the awareness of medical personnel as well as health care providers. METHODS: This study presents the demographic data and clinical manifestations of Iranian PID patients who were diagnosed from March 2006 till the March of 2013 and were registered in Iranian PID Registry (IPIDR) after its second report of 2006. RESULTS: A total number of 731 new PID patients (455 male and 276 female) from 14 medical centers were enrolled in the current study. Predominantly antibody deficiencies were the most common subcategory of PID (32.3 %) and were followed by combined immunodeficiencies (22.3 %), congenital defects of phagocyte number, function, or both (17.4 %), well-defined syndromes with immunodeficiency (17.2 %), autoinflammatory disorders (5.2 %), diseases of immune dysregulation (2.6 %), defects in innate immunity (1.6 %), and complement deficiencies (1.4 %). Severe combined immunodeficiency was the most common disorder (21.1 %). Other prevalent disorders were common variable immunodeficiency (14.9 %), hyper IgE syndrome (7.7 %), and selective IgA deficiency (7.5 %). CONCLUSIONS: Registration of Iranian PID patients increased the awareness of medical community of Iran and developed diagnostic and therapeutic techniques across more parts of the country. Further efforts must be taken by increasing the coverage of IPIDR via electronically registration and gradual referral system in order to provide better estimation of PID in Iran and reduce the number of undiagnosed cases.

Comparison of Effect of One Course of Intense Exercise (Wingate test) on Serum Levels of Interleukin-17 in Different Groups of Athletes.

BACKGROUND: Research on the effects of exercise on immune function, has a wide range of sporting activities. Study on the long-term effects of regular exercise on serum levels of cytokines such as interleukin-17 have shown that moderate and regular exercise, has an important role in the prevention and treatment of many diseases. OBJECTIVES: Exhaustive exercise has a deep effect on cellular, humoral, innate immunity and the amount of cytokines of an athlete's immune system. So this study was designed to compare the effect of one course of exhaustive exercise on serum levels of interleukin (IL)-17 in different groups of athletes. PATIENTS AND METHODS: Forty professional athletes with a mean age of 25.1 ± 5.0 years, divided equally in 4 groups (handball, volleyball, Sepak-takraw and climbing) were selected for this purpose. 30 second Wingate test for each athlete was used to assess anaerobic power. Blood samples before, immediately after and 2 hours after exercise was collected and the amount of serum IL-17 was measured. RESULTS: The results showed that the level of IL-17 in the study groups before and after the two hours exercise did not significantly change in all four groups. CONCLUSIONS: The results showed that short anaerobic exercise has no effect on the level of IL-17.

Association of haptoglobin phenotypes with clinical features of preterm labor disease.

Preterm birth means the birth before thirty seven week of pregnancy that causes a lot of complications for the baby. Variety factors are suggested to be involved in disease. In this study, we decided to evaluate haptoglobin (Hp) phenotypes association with clinical features of patients suffered from premature delivery to understand better the possible correlation of genetic and clinical features in this disease. This cross sectional analytic descriptive study has been carried out in two groups of 120 women, 60 with preterm and 60 with term labor. Patients were selected with previously diagnosed by a gynecologist with preterm birth in hospital during the study period. After performing diagnostic tests, the frequency of each haptoglobin phenotype in the two groups was analyzed using the X2 test and SPSS software. The maximum serum haptoglobin phenotype frequency in patients with Hp2-2, was 43 (71.7%) whereas in healthy individuals, 35 (58.3%). No statistically significant differences between the two groups was found (P=0.310). But based on some patients clinical features such as their history of preterm delivery, previous history of recurrent abortions and history of preterm delivery in their family, significant association was found with Hp2-2 compared with healthy control (P<0.003). This study showed that Hp2-2 phenotypes levels in the case group was higher than in control but the factors influencing the presence or absence of preterm labor is clinically various.

Evaluation of natural regulatory T cells in subjects with selective IgA deficiency: from senior idea to novel opportunities.

BACKGROUND: Selective IgA deficiency (SIgAD) is the most common primary immunodeficiency disorder, which is characterized by significantly decreased serum levels of IgA. Abnormalities of CD4+CD25(high)forkhead box P3 (FoxP3)+ regulatory T cells (T(reg)) have been shown in association with autoimmune and inflammatory disorders. METHODS: In order to evaluate the relationship between autoimmunity and T(reg) in SIgAD, we studied 26 IgA-deficient patients (aged 4-17 years) with serum IgA levels <7 mg/dl, 26 age- and sex-matched healthy controls and 26 age- and sex matched idiopathic thrombocytopenic purpura cases with normal immune system. T(reg) were determined by flow cytometry using T(reg) markers, including CD4, CD25 and FoxP3. RESULTS: The mean percentage of CD4, CD25+FoxP3+ T(reg) from all CD4+ cells was 4.08 ± 0.86 in healthy controls, which was significantly higher than in SIgAD patients (2.93 ± 1.3; p = 0.003). We set a cutoff point (2.36%) for T(reg), which was two standard deviations lower than the mean of normal controls. According to this cutoff point and in order to assess the role of T(reg) in clinical SIgAD manifestation, we classified patients into two groups: 16 patients in G1 with T(reg) <2.36% and 10 patients in G2 with T(reg) >2.36%. Autoimmunity was recorded in 9 patients (53.3%) of G1 and only 1 patient of G2, respectively (p = 0.034). Although a defect in class switching recombination was observed in 40% of the patients in G1, none of the G2 patients had such a defect (p = 0.028). CONCLUSION: This study showed decreased proportions of T(reg) in SIgAD patients, particularly in those with signs of chronic inflammation.

Association of haptoglobin phenotypes with serum levels of IgE and IgA in allergic rhinitis patients.

BACKGROUND: Allergic rhinitis (AR) is an allergic disorder of the nasal tissue that underlies diseases such as sinusitis, otits and asthma. Different predisposing factors including immunological and non-immunological factors contribute to the disease pathogenesis. OBJECTIVE: To investigate association of haptoglobin (Hp) phenotypes (Hp1-1, 2-1 and 2-2) with serum immunoglobulins A and E levels in patients suffering from AR in comparison with healthy individuals. METHODS: Two hundred and forty patients and 240 healthy individual entered in this case-control study. Serum levels of IgE and IgA were measured and haptoglobulin phenotypes were determined by electrophoresis. The results were evaluated by χ2 statistical test using SPSS software. RESULTS: Serum electrophoresis showed that the distribution of haptoglobin phenotypes of Hp1-1, Hp2-1 and Hp2-2 among 240 patients were 11.3%, 37.9% and 50.8%, respectively. The distribution of different haptoglobin phenotypes in healthy controls were 88.7%, 36.6% and 54.7%, respectively. However, the difference between patients and controls was not statistically significant (p=0.136). The mean of IgE level was significantly higher in patients than controls in association with all three phenotypes (p<0.001). Mean of IgA serum level was also significantly different between case and control groups for Hp1-1 (p<0.048) and Hp2-2 phenotypes (p<0.027). CONCLUSION: We conclude that there is an association of all three haptoglobin phenotypes with IgE level. Hp1-1 and Hp2-2 phenotypes showed association with IgA in allergic rhinitis, as well. However, we cannot solely attribute these associations to the pathogenesis of allergic rhinitis.

Human leukocyte antigen profile of two ethnic groups in Southeast of Iran.

This study was performed to determine the genetic diversity of HLA class I and II alleles among two ethnic groups in Southeastern Iran. HLA profiles were determined in 71 Iranian populations (41 Zaboli and 30 Baloch). The frequencies of HLA-A02 (p=0.017), -Cw4 (p=0.003), and -DR8 (p=0.025) in the Zaboli populations were significantly higher than that in Baloch ethnic group. In contrast, the frequency of HLA-A23 allele was more frequent in Baloch than Zaboli (p=0.020). This report represents an important resource for investigators in the fields of transplantation immunology and population genetics from widely dispersed areas of Iran.

Epidemiology of tuberculosis in the Southeastern Iran.

In order to study the epidemiology of tuberculosis (TB) in Zabol, situated in the Southeast of Iran, this study was performed. Two thousand seven hundred and twenty-nine cases of tuberculosis disease were identified during 1998-2002. The notification rate was 135/100,000 population in 2002, which was higher than this rate in previous years. The notification rate of TB in Afghan population was significantly higher than Iranian population (202 cases/100,000 in Afghan and 122 cases/100,000 in Iranian population. The case notifications in 1998-2001 were 134, 131, 130, and 130 in 100,000 populations, respectively. The prevalence of smear-positive cases was 76/100,000 population in 2002 and the ratio of smear-positive cases to smear-negative and extrapulmonary cases was 1.46. This region remains high TB rates. It is necessary to pay attention to the detection of TB, by making their register in order to enhance the effectiveness and to reduce the cost of existing methods.

A six-year study on Vibrio cholerae in southeastern Iran.

Cholera continues to be an important public health problem among many poorer communities. In order to determine the epidemiology of Vibrio cholerae in southeastern Iran, 3,594 patients with watery diarrhea, who were referred to the hospitals from Zabol city and 45 neighboring rural populations of Sistan-Blouchestan province, were investigated over a period of 6 years (1997 - 2002). V. cholerae strains were isolated from 362 samples (10.07%). Isolation of V. cholerae in this sample decreased from 22.47% in 1997 to 0% in 2002. Individuals of all ages and social and economic strata were affected. Among the patients with cholera in the present study, only 24 (6.6%) lived in an urban area; 270 (74.6%) of the patients had been referred from rural areas, and the remaining 68 (18.8%) were from neighboring Afghanistan. V. cholerae O1 Ogawa and NAG vibrios were found in 92.8 and 7.2% of patients, respectively. Among the 362 samples, 244 were collected from inpatients and 118 were from outpatients. Twelve of these patients died because of the severity of their disease, severe dehydration and electrolytes imbalance. The priorities for cholera control remain public health interventions through improved water and sanitation, improved surveillance and access to health care facilities, and further development of appropriate vaccines.

Human leukocyte antigen profile in the Zaboli ethnic group living in the South-East region of Iran.

The human leukocyte antigen has become a key component in investigating the genetic relationships between populations. The aim of this study was to determine the genetic diversity of HLA class I and II alleles among Zaboli ethnic group of South-east Iran to establish a database for further investigations on ancestry and the genetic factors contributing to complex diseases in this region.Unrelated individuals from the Southeast geographic location throughout Iran were serologically typed using standard microcytotoxicity assays with commercial and local trays. The ethnic background of each individual was self-defined. HLA profiles were determined in 41 Zaboli populations. The most frequent class I alleles of the Zaboli ethnic group being the following: HLA-A1 (34.1%), -A2 (58.5%), -A11 (29.3%), -A24 (23.9%), -B5 (70.7%), -B16 (26.8%), and -Cw4 (24.4%). The class II alleles more frequently observed in this group were HLA-DR1 (26.8%), -DR2 (26.8%), -DR3 (31.7%), -DR4 (29.3%), -DR7 (24.4%), -DR8 (22%), -DR11 (48.8%), -DRw52 (73.2%), -DRw53 (53.7%), -DQ1 (53.7%), -DQ2 (31.7%), and -DQ3 (29.3%). This report utilized a first study of HLA class I and II typed individuals, from widely dispersed areas of Iran. This will help in studies related to disease associations and cadaver organ allocation programmes.