High proviral load of human T cell lymphotropic virus type-1 facilitates coronary artery diseases.

OBJECTIVES: Coronary artery disease (CAD) is known as a life threatening disease, worldwide. In this study the role of HTLV-1 infection was evaluated on cardiac involvement in an endemic region of northeastern Iran. MATERIALS AND METHODS: Serologic and molecular tests for HTLV-1 infection were carried out in subjects who had coronary angiography. A real-time PCR, TaqMan method, to quantify HTLV-1 proviral load (PVL), and routine hematological and biochemical tests were performed for study subjects. RESULTS: Twenty nine patients were HTLV-1+CAD+ and 13 cases were HTLV-1+CAD-. Although, there were no significant differences for risk factors like FBS, HDL, triglyceride, systolic and diastolic blood pressure (Cbp, Dbp), waist circumference (WC), hip circumference (WL), cholesterol (P=0.003), and LDL (P=0.007) levels, and monocyte count (P=0.05) had meaningful differences. The mean HTLV-1 PVL in HTLV-1+CAD+ subjects was 992.62±120 which was higher compared with HTLV-1+CAD- group (406.54±302 copies/104 PBMCs). Moreover, HTLV-1 PVL in males (833±108) was lower compared with females (1218±141 copies/104 PBMCs) (P=0.05). Patients with HTLV-1-PVL of more than 500 copies/104 had more diffused atherosclerosis plaque than patients with less than 500 (OR=6.87, 95% CI=1.34-35.05; P=0.016). Furthermore, patients with diffused coronary atherosclerosis had significantly higher levels of HTLV-1 PVL than patients with middle, proximal, and normal location of coronary sclerotic lesions (P<0.05). CONCLUSION: Taken together, in endemic area, HTLV-1 infection, more likely is a facilitating factor for heart complications and the high HTLV-1 PVL might affect CAD manifestations.

Immunotherapy in Allergic Rhinitis: It's Effect on the Immune System and Clinical Symptoms.

BACKGROUND: Allergic rhinitis is one of the most common allergic diseases and characterised by sneezing, rhinorrhea, nasal congestion and nasopharyngeal itching. Subcutaneous immunotherapy (SCIT) for specific allergens is an effective treatment and induces the inhibitory effect of T regulatory lymphocytes and decreases clinical symptoms in allergic rhinitis. AIM: In this study effect of subcutaneous immunotherapy with specific allergens on clinical symptoms and T regulatory and T Helper cells cytokines, in patients with allergic rhinitis are evaluated. METHODS: In this study, 30 patients with moderate to severe allergic rhinitis according to clinical criteria and positive skin prick test for aeroallergens were selected and treated by SCIT. Clinical symptoms and T cells cytokines IL4, IL17, IFN gamma, TGF beta, GITR, FOXP3 and IL-10 (by RT-PCR) were evaluated before and one year after initiation of treatment. RESULTS: Thirty (30) patients with allergic rhinitis at age range 15-45 years old were treated by SCIT, and 23 (14 female, 9 male) patients continued the study, and 7 patients did not continue treatment. After immunotherapy, clinical symptoms decreased significantly. The specific cytokines TGF beta and IL10 levels increased and changes were statistically significant. (Respectively P = 0.013 and P = 0.05) The IL17 level was also increased, but not statistically significant. (P = 0.8) IFN gamma, IL4, GITR, FOXP3, all decreased, but the changes were not statistically significant (P > 0.05). CONCLUSION: Subcutaneous Immunotherapy for specific allergens decreases clinical symptoms in patients with allergic rhinitis and induces tolerance in T lymphocytes, especially by increasing T regulatory cells cytokines, TGF beta and IL10.

Expression of Th1 and Th2 Cytokine and Associated Transcription Factors in Peripheral Blood Mononuclear Cells and Correlation with Disease Severity.

BACKGROUND: Psoriasis is a T cell-mediated autoimmune disease in patients with elevated levels of proinflammatory cytokines belonging mainly to the Th1 pathway. We investigated whether treatment of psoriasis patients with methotrexate (MTX), along with micronutrients, modulated mRNA expression of Th1 and Th2 components and whether expression of these components correlated with psoriasis severity. METHODS: Thirty plaque-type psoriasis patients with Psoriasis Area and Severity Index (PASI) scores greater than 10 were recruited; these were 15 non-micronutrients taking- (NMT) patients treated with MTX daily (0.2-0.3 mg/kg/week), and 15 micronutrients taking- (MT) patients treated with MTX plus a micronutrient supplement daily, for 12 weeks. Blood samples were collected immediately before treatment (baseline) and after 12 weeks of treatment. Taqman quantitative real-time polymerase chain reaction (qPCR) was applied to analyze the expression of the Th1 components T-bet, interleukin-12 (IL-12), and interferon-gamma (IFN-Υ), and the Th2 components GATA-3 and interleukin-4 (IL-4). Disease severity was measured using the PASI scoring system. RESULTS: Significant clinical improvement in the MT group coincided with significant down-regulation of Th1 and up-regulation of Th2 markers (P<0.05). With respect to the PASI-75, (defined as a 75% or greater reduction in the PASI score) cut-off point, expression of IFN-γ in the MT group with PASI scores above 75 was significantly less than that of patients in the NMT group (P=0.05). Also, GATA3 and IL-4 mRNA expression in the MT group with PASI scores greater than above 75 was significantly greater than that of patients in the NMT group (P=0.05 and 0.04, respectively). CONCLUSION: Based on significant attenuation of the PASI score, which correlated with upregulation of Th2 pathway markers in the MT group, we recommend administration of micronutrients combined with MTX for psoriasis patients. Our results contribute to a better understanding of methotrexate immunepathogenesis mechanisms and their correlations to clinical responses in psoriasis.

Investigation of dietary supplements prevalence as complementary therapy: Comparison between hospitalized psoriasis patients and non-psoriasis patients, correlation with disease severity and quality of life.

OBJECTIVES: Psoriasis patients are often displeased with traditional medical treatments and they may self-prescribe dietary supplements as an alternative or complementary treatments. We aimed to investigate the prevalence of self-medication of dietary supplements among psoriasis and non-psoriasis cases and its impact on disease severity and quality of life. DESIGN AND SETTING: This case-control study evaluated 252 records of psoriasis patients and 245 non-psoriasis cases. Dietary supplementation over last 30days and characteristics, including age, age at onset of disease, co-morbidities, smoking and education were recorded. Psoriasis area and severity index (PASI) and dermatology quality of life index (DLQI) were calculated. P value less than 0.05 was considered as significant level. RESULTS: This study consisted 138 psoriasis (females; 54) and 138 non-psoriasis cases (females; 50), aged between 21 and 91 years. Among psoriasis patients, 72% reported using at least one of dietary supplements, which was different from non-psoriasis cases (25.36%, P=0.01). Multivitamin/mineral supplements (MVM) were the most frequent used dietary supplements (26.81%) and the most common reasons for the consumption of these supplements were to maintain and improve health. The consumption of folic acid (21.73%), omega-3 fatty acids or fish oil (10.14%), herbs (12.31%) and vitamin E (1.44%) had the most frequencies after MVM. No significant differences in PASI and DLQI were found among patients with consumption of different supplements (P>0.05). There was non-significant and negative correlation between education and use of supplements (P=0.21, r=-0.02). CONCLUSIONS: Self-medicating of MVM over last 30days was prevalent among studied psoriasis patients. They took dietary supplements in order to improve and maintain their health.

Evaluation of psoriasis severity and inflammatory responses under concomitant treatment with methotrexate plus micronutrients for psoriasis vulgaris: a randomized double blind trial.

INTRODUCTION: We evaluated the effectiveness of concomitant treatment with methotrexate (MTX) plus micronutrients in comparison with monotherapy with MTX only in psoriasis patients. Plasma levels of interleukin-1 beta (IL-1ß) and tumor necrosis factor alpha (TNF-α) were also measured and their association with clinical severity was evaluated. METHODS: Thirty psoriasis patients 20 to 50 years old with a PASI score > 10 were divided randomly into two groups. Both groups were given oral methotrexate (0.2-0.3 mg/kg/week) for 12 weeks. In addition, Group B received one tablet of micronutrient supplement daily. Disease severity was calculated using the psoriasis area and severity index (PASI) score before and after 12 weeks. Levels of IL-1ß and TNF-α were measured using enzyme-linked immunosorbent assay (ELISA). RESULTS: We found that 13 (86.6%) patients in Group B and 8 (53.3%) patients in Group A attained a mild PASI score (≤ 10% body involvement). IL-1ß and TNF-α levels were significantly decreased in favor of Group B (p < 0.05). There was a significant correlation between changes in both IL-1ß and TNF-α levels and PASI score after the study (p < 0.05). CONCLUSION: The results obtained were positive, and therefore double-blind randomized trials with a larger sample size are highly suggested to confirm or reject these results.

Sensitivity Comparison of the Skin Prick Test and Serum and Fecal Radio Allergosorbent Test (RAST) in Diagnosis of Food Allergy in Children.

BACKGROUND: Diagnosis of food allergy is difficult in children. Food allergies are diagnosed using several methods that include medical histories, clinical examinations, skin prick and serum-specific immunoglobulin E (IgE) tests, radio-allergosorbent test (RAST), food challenge, and supervised elimination diets. In this study we evaluated allergies to cow's milk, egg, peanut, and fish in children with suspected food allergies with skin prick tests and serum and feces RAST. METHODS: Forty-one children with clinical symptoms of food allergies were enrolled in the study. Skin prick tests and serum and fecal RAST were performed and compared with challenge tests. RESULTS: The most common sites of food allergy symptoms were gastrointestinal (82.9%) and skin (48.8%). 100% of the patients responded to the challenge tests with cow's milk, egg, peanut, and fish. 65% of the patients tested positive with the skin prick test, 12.1% tested positive with serum RAST, and 29.2% tested positive with fecal RAST. CONCLUSION: The skin prick test was more sensitive than serum or fecal RAST, and fecal RAST was more than twice as sensitive as serum RAST.

Prevalence of Hepatitis B and C among Patients Looking for Hospital Care; Five Years' Study in Mashhad, Iran.

This study was conducted to find out the prevalence, viral load and co-infection of HBV and HCV infection among patients seeking to hospital care in Mashhad, Iran. A total of 402 samples (349 samples for HBV and 53 for HCV) were received and were screened for hepatitis B and C during 2004 to 2014. Viral loads of HBV DNA and HCV RNA were quantified by real-time PCR. Among 349 collected samples, 229 (65.61%) were positive for HBV DNA and 36 (67.92%) for HCV RNA. Among the ones positive for HBV DNA and HCV RNA, HCV was more prevalent (86.11% Vs 58%) ,in male patients, a higher incidence was attributed to HBV than HCV (34.42 Vs 13.88%%). The incidence of co-infection of HBV and HCV was in 5 (1.88%) patients. Association of age and load of HBV, HCV showed that higher marginal viral loads found to be more common in the age groups of upper 30 years old (P=0.064, P=0.079, respectively). The present study provides the preliminary information about high HCV and HBV prevalence. Findings from the current study will be helpful for the better management and control of viral hepatitis among patients looking for hospital care.

Epidermal hydration and skin surface lipids in patients with long-term complications of sulfur mustard poisoning.

BACKGROUND: Despite almost the three decades passed since the chemical attacks of Iraqi's army against the Iranian troops, some veterans are still suffering from long-term complications of sulfur mustard (SM) poisoning, including certain skin complaints specially dryness, burning, and pruritus. We thus aimed to evaluate the skin's water and lipid content in patients with a disability of >25% due to complications of SM poisoning and compare them with a matched control group. MATERIALS AND METHODS: Sixty-nine male participants were included in this study; 43 SM-exposed patients, and 26 normal controls from their close relatives. The water and lipid content was measured in four different locations: Extensor and flexor sides of forearms and lateral and medial sides of legs by the Corneometer CM 820/Sebumeter SM 810. Collected data was analyzed and P ≤ 0.05 was considered as statistically significant. RESULTS: The mean age of the patients and controls was 49.53 ± 11.34 (ranges: 40-71) and 29.08 ± 8.836 (ranges: 15-49 years), respectively. In the veterans group, the main cutaneous complaint was itching and skin dryness. Cherry angioma, dry skin, and pruritus were significantly more common in the SM-exposed cases than in the controls. (P = 0.01, 0.05, and 0.04, respectively). The moisture and lipid content of all areas were lower in the SM-exposed group, but it was only significant in skin sebum of lateral sides of legs (P = 0.02). CONCLUSION: Exposure to SM could decrease the function of stratum corneum and lipid production as a barrier, even after several years of its exposure.

Comparison of lesion improvement in lupoid leishmaniasis patients with two treatment approaches: trichloroacetic Acid and intralesional meglumine antimoniate.

BACKGROUND: There are several therapies for treating lupoid leishmaniasis. We compared the effectiveness of intralesional meglumine antimoniate (MA) and topical application of trichloroacetic acid (TCA) 50% solution. METHODS: This study was a randomized clinical trial comprising 60 lupoid leishmaniasis patients. The first group received intralesional MA once a week, and the second group was treated once weekly with TCA 50% topical solution. The results were recorded once after 8 weeks and then 3 months after the termination of treatment. RESULTS: The total clearance rates after treatment and after the 3-month follow-up were, respectively, 48.1% and 40% in the first group and 44.4% and 36.6% in the second group. There was no significant difference between the two treatment groups (p=.25 and p=.26). In both groups, the most common side effect was scarring. CONCLUSION: Having almost the same efficacies, TCA as a topical approach could be as effective as MA in the lupoid leishmaniasis treatment plan.

Association between Cytokine production and disease severity in Alzheimer's disease.

The role of transforming growth factor (TGF)-ß1, interferon (IFN)-γ, interleukin (IL)-2, IL-3, and IL-6 in the pathogenesis of Alzheimer's Disease (AD) has long been reported in literature. In this case-control study, the concentrations of these cytokines in altered T lymphocytes, as well as serum vitamin B12, have been compared in terms of factors such as, age, the clinical course and the patients' disease risk. 40 patients who met the DSM-IV-TR criteria of AD were selected and an age- and gender-matched control group was recruited. The participants' cognitive performance was measured according to the Mini Mental State Examination (MMSE), the Global Deterioration Scale (GDS) and Clinical Dementia Ratio (CDR). The levels of cytokines were measured in supernatants of lymphocytes culture, using assays of ELISA and atomic absorption. Higher levels of IL-6 and IFN-γ were found more in the altered T lymphocytes of the AD patients rather than in the control individuals. Furthermore, a marginal significant difference was found between the TGF-ß levels of the two study groups. Regression analysis of CDR score and cytokines showed the inverse significant correlation between CDR score and IFN-γ levels. Furthermore, the relation between MMSE scores and IFN-γ was significant, meaning that by increasing MMSE score, IFN-γ level was significantly increased. This study suggests that the levels of IL-6 and IFN-γ are significantly increased in altered T lymphocytes of AD patients, as compared to those who are not inflicted with AD, and that they are related to the patient's age. Also, IFN-γ is related to the severity stage of the AD.

Serum levels of vascular endothelial growth factor in chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a third leading cause of death. METHODS: In this case control study, we prepared 5 cc bloods from the antecubital vein of 100 COPD patients and 40 healthy individuals as control group. Vascular endothelial growth factor (VEGF) expression protein level was measured by ELISA in both groups. RESULTS: We found that concentration of VEGF in blood serum of patients with COPD (189.9±16pg/ml) was significantly higher than the control group (16.4±3.48pg/ml) (p<0.001). While VEGF serum level in emphysematous patients wasn't significantly different with control group (p=0.07). Furthermore VEGF serum level in COPD patients was proportionally increased with severity of disease (p<0.001). Besides all COPD patients, regardless of their smoking status, were experienced significantly higher levels of VEGF than healthy ones (p=0.001; z=4.3). CONCLUSION: Our results suggest VEGF serum concentration as the sensitive index for severity and activity of COPD and its prognosis.

Outcome of Intravenous Immunoglobulin-Transmitted HTLV-I, Hepatitis B, Hepatitis C, and HIV infections.

OBJECTIVE(S): Since each unit of Intravenous Immunoglobulin (IVIG) is obtained from different blood donors, blood-borne viral diseases is of high importance. We aimed at investigating the prevalence of various viral infections: Human T-cell Lymphotropic Virus Type 1 (HTLV-I), Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV) among patients referred for IVIG therapy section in Mashhad University of Medical Sciences, Mashhad, Iran. MATERIALS AND METHODS: A prospective study was conducted on 130 IVIG recipients admitted to different wards of our Medical Centre: Immunology, Hematology, and Neurology, in 2010. After filling the informed consent form, a 5 cc blood sample was initially taken from each patient. Viral infections including HTLV-I Ab, HIV-Ab, HBsAg, HBc-Ab, and HBV-Ab were assessed using the ELISA technique before and after six three months treatment. RESULTS: Test results for HTLV-I Ab, HBsAg, HBc Ab, HIV Ab, and HCV Ab were negative in all cases before IVIG therapy. After receiving IVIG, two female cases with CIDP showed positive results for HBV Ab (0.8%) and HBS Ag (0.8%) with ELISA and only one patient confirmed with PCR. There was not any significant relation between HBV Ag (P=0.14) and HBC Ab with type of disorder (P=0.66). CONCLUSION: This study showed that HTLV-I viral replication and the other investigated viral transmissions do not occur in plasma; therefore, the IVIG products are safe.

Comparative study of topical 80% trichloroacetic acid with 35% trichloroacetic acid in the treatment of the common wart.

BACKGROUND: Common warts caused by the human papillomavirus (HPV) are considered to be the most common infectious skin disease. No individual treatment for common warts is effective as monotherapy in eradicating the lesions. The aim of this study is to evaluate the clinical efficacy of a 35% and an 80% trichloroacetic acid (TCA) solution in the treatment of the common wart. METHODS: In this single-blinded clinical trial, 62 eligible patients with common warts referred to the dermatology clinic of Ghaem Hospital in Mashhad, Iran. Patients were randomly divided into two groups, each treated with a TCA solution (group A, TCA 80%; group B, TCA 35%) once per week until complete clearance of the lesions or for a maximum duration of six weeks. Seven patients were excluded from the final analysis (one patient in group A and six patients in group B) for various reasons, including irregular follow-up, using physical tools such as razor blades to remove the lesion, and failure to complete treatment; and 55 patients were included in the final analysis. RESULTS: Improvement to treatment responses was classified as: no change (no changes in the number of warts), mild (clearing of less than 25% of warts), moderate (clearing of 25% to 75% of warts), and good (clearing of more than 75% of warts). At the end of follow-up, the clinical improvement of group A (n=30) was: 10 patients (33.3%) with a mild response, 6 patients (20%) with a moderate response, and 14 patients (46.7%) with a good response. In group B (n=25), 16 patients (64%) showed a mild response, 6 patients (24%) a moderate response, and 3 patients (12%) a good response. There was a statistically significant difference in improvement between the two treatment groups (P=.017). Improvement was greater with a higher concentration of TCA solution. CONCLUSION: This study showed that a different concentration of TCA solution was an effective form of treatment for common warts. Trichloroacetic acid 80% is more effective, but this solution must be used only with careful consideration by a physician.

Efficacy of atorvastatin and antihistamines in comparison with antihistamines plus placebo in the treatment of chronic idiopathic urticaria: a controlled clinical trial.

Chronic idiopathic urticaria is defined as recurrent hives occurring for at least 6 weeks. In the majority of cases, there is no identifiable underlying etiology despite extensive evaluation. A subset of these patients is classified as having autoimmune urticaria defined by the presence of a functional IgG antibody to the α subunit of the high-affinity IgE receptor (FceRIa) or to IgE. The aim of this study was to evaluate the effects of the drug atorvastatin in patients with chronic urticaria compared to the placebo.In this single-blind study, 50 patients suffering from chronic urticaria (15-45 years old) were selected and divided into two groups by simple randomization method. The first group was treated with atorvastatin and antihistamines and the second group (control group) was treated with placebo and antihistamines for 3 months. Urticaria severity was measured by score index, before and after the treatment course: ASST (autologous serum skin test) was performed for all patients and sera were collected to measure cytokines. In cases, IL-5 decreased and IL-10 increased after treatment compared to the time point before treatment (p<0.05). All patients with severe utricaria according our scoring, had positive ASST.The patients with severe urticaria identified by urticaria score and ASST positivity had chronic idiopathic urticaria. By prescribing the atorvastatin plus antihistamines in severe and resistant forms of urticaria, the use of more toxic medications like cytotoxic drugs may be avoided.

Comparison of oral zinc sulfate with systemic meglumine antimoniate in the treatment of cutaneous leishmaniasis.

The purpose of this study was to investigate comparison between oral zinc sulfate and meglumine antimoniate in the treatment of cutaneous leishmaniasis (CL). So 100 patients with CL were included and randomly divided into two groups. The first group was treated with oral zinc sulfate (10 mg/kg/day during 45 days period), and the second group was treated with systemic meglumine antimoniate (20 mg/kg/day intramuscularly for 20 days). Acceptable cure after completing 45 days of followup occurred in 30.2% of lesions in first group, while this was 35.5% for the second group. There is not any significant difference between the two treatment groups (P = 0.42). Serious side effects resulting in treatment discounting occurred in only meglumine antimoniate group. Although cure rate of systemic meglumine antimoniate group was better the treatment with zinc sulfate is much easier, cheaper, more convenient in consumption, safer, and nearly close cure percentage to systemic meglumine antimoniate injections without serious side effect.

Evaluation of the effect of formic acid and sodium formate on hair reduction in rat.

Hirsutism is a common problem in dermatology that imposes high socioeconomical costs on medical care. Consequently, researchers are actively searching for cheaper and safer methods for therapeutic treatment. The objective of the present study is to evaluate formic oil, enriched from formic acid, for the removal of unwanted hair. In this study, 32 female rats (150-200 g) were randomly divided into four groups and maintained with normal water and food availability. A patch of skin was shaved on each rat for application of test solutions. The control group was treated with local once-daily applications of normal saline. The formic acid, acetic acid, and sodium formate groups were treated with once-daily applications of formic acid (pH 5.5), acetic acid (pH 5.5), or sodium formate, respectively. After 2 weeks, horizontally cut sample biopsies were removed, and the numbers of hair follicles were counted under high field microscopy by a specialist blinded to the treatments. Kolmogorov-Smirnov test results indicated a nonparametric distribution for the rat groups. ANOVA analysis indicated no statistically significant differences between groups (P < 0.05). There weren't any side effects or evidence for toxicity during the study period. However, hair follicle counts showed a descending order of control, acetic acid, formic acid, and sodium formate. Although the sodium formate group had the lowest hair follicle numbers, the difference was not statistically significant (P > 0.05). Formic acid was not effective in reducing hair follicle numbers in rats.