Possible immunological mechanisms in COVID-19 patients with immune thrombocytopenic purpura

Millions of people around the world were, or are still involved with COVID-19 due to infection with SARS-CoV-2. In addition to hallmark symptoms, thrombotic problems, lymphopenia, and thrombocytopenia have also been reported in COVID-19 patients, of which ITP is the most common and occurs in more than one-third of COVID-19 patients. Hyperinflammation, cytokine storms, and generally immune dysregulation in a percentage of patients develop the main consequences of diseases such as ALI, ARDS and multiple organ failure. Some of the important events in the immunopathogenesis of this disease are disruption of T-cell effector differentiation and the destructive role of Th17 lymphocytes, neutrophil function and inflammatory macrophages. NLRP3-inflammasome hyperactivity causes serious dysfunction of innate immune cells and, consequently, T lymphocytes in many inflammatory disorders, most notably in the COVID-19. A closer look at the immunopathogenesis of ITP and COVID-19 brings us to common ground. The purpose of this study was to review and summarize the findings of various studies on the immunopathogenesis of ITP and its possible causes in COVID-19. Finally, enhanced differentiation of Th17 and Th1, the cell death called as pyroptosis, hyperinflammation and dysfunction of inflammatory neutrophils and macrophages, and NLRP3- inflammasome hyperactivity are important factors in the development of thrombocytopenia in patients with COVID-19. Further studies are needed to better understand immunopathogenesis and effective treatments for ITP, especially in inflammatory disorder

Values of Urinary Mineral Excretion in Healthy Iranian Children

Introduction: Normal values of urinary mineral excretion differ in different geographic parts. The aim of this study was to determine age-related reference intervals for urinary minerals in healthy children in the south-west of Iran. Materials and Methods: Midstream non-fasting urine samples were collected and the amount of calcium, oxalate, uric acid, phosphate, magnesium, citrate, and creatinine was measured in all urine samples. The urinary mineral concentrations were reported as mineral to creatinine ratios (mg/mg). Data were analyzed by SPSS software version 16 and independent t-test and T-Hoteling test was used.Results: The study involved 232 children aged 7 to 10 years. The 5th and 95th percentile values of urinary minerals to creatinine ratios were determined. The mean urinary Ca/Cr ratio was 0.14± 0.18 with a 95th percentile value of 0.295. For oxalate to creatinine ratio, the mean value was 0.068± 0.09 mg/mg with a 95th percentile value of 0.23. The mean uric acid to creatinine ratio was 0.358±0.211 mg/mg with an upper 95th percentile value of 0.69 and the mean Ph/Cr ratio was 0.439 and the 95th percentile was 1.01 mg/mg. Conclusions: We found out that the normal values of random urinary mineral to creatinine ratio differ in our region from the other countries and even from the other regions in Iran. We concluded that child's age and ethnicity should be taken into consideration when assessing the urinary mineral to creatinine ratio.Keywords: Urine Specimen Collection; Urine minerals; Child; Iran; Calcium; Oxalate; Citrate; Uric Acid; Phosphate

Keep the corners; impact of chemotherapy on renal function

Implication for health policy/practice/research/medical education: Due to kidneys’ role in metabolism and excretion of toxic waste, they are subjects to drug toxicity. keywords: Cancer, Chemotherapy, Malignant tumor, Reactive oxygen species, Renal toxicity, Tubulointerstitial injur

Effect of Aquatic Extract of Ferulago angulata Boiss With Aerobic Exercises on Serum Levels of Interleukin-10 and C-Reactive Protein of Obese Males

Objectives: The aim of the present study was to evaluate the impacts of chavir aquatic extract (Ferulago angulata Boiss) along with aerobic exercises on serum levels of interleukin-10 (IL-10) and C-reactive protein (CRP) of obese males. Materials and Methods: In this study, 40 males with body mass index (BMI) > 30 kg/m(2) and average age of 33.63 +/- 4.78 years were randomly categorized into 4 groups of 10 individuals as control, combination (using the aquatic extract of chavir along with aerobic exercises), consumption of chavir aquatic extract, and aerobic exercises. The aerobic exercises in both groups of combination and aerobic exercises consisted of running on treadmill for 20 minutes in 60%-70% maximum oxygen uptake (VO2max). The aquatic extract consumption and the combination groups had to take 50 mg/mL/d of chavir aquatic extract every time. The control group received no intervention. Results: Based on intragroup comparisons, body weight and BMI significantly decreased in the combination group; the content of body fat and waist-hip ratio (WHR) also reduced significantly in the aerobic, combination, and aquatic extract groups. In intergroup and intragroup comparison, CRP faced with a significant decrease in all groups (aerobic exercises, Ferulago aqueous extraction, and combination groups) and a considerable increase was also observed in the combination group regarding IL-10 variable. Conclusions: Therefore, the effectiveness of the combination group regarding increasing IL-10 and decreasing CRP is more than other groups. As a result, using aqueous extract of F. angulata and doing aerobic exercise for 3 months reduced risk factors-cardiovascular, body composition, and increasing anti-inflammatory in obese men. Consequently, the effect of combination group to reduce the proinflammatory indexes and body factors of obese males was more compared to that of the other groups

Effect of White Tea (Camellia sinensis) Extract on Skin Wound Healing Process in Rats

BACKGROUND White tea (Camellia sinensis) has anti-inflammatory and antioxidant properties and a protective effect against wrinkles, sunburn and UV damages on the skin. Thus, we aimed to evaluate the effect of white tea extract on the healing process of skin wounds in rats. METHODS This study was done in the Research Center of Shahrekord University of Medical Sciences, Shahrekord, Iran in 2019. Excisional skin wounds were created on five groups of healthy male Wistar rats (200-250 g, n=21) including control group, Eucerin-treated group, white tea 5% ointment (Eucerin) treated group, gel-treated group, white tea 5% gel treated group. Treatment was begun on day 1 and repeated every day at the same time until day 15. Pathologic samples were taken on days 4, 7 and 15 for histopathological examinations. Kruskal-Wallis test was used to analyze data by SPSS. Statistical significance was defined as P<0.05. RESULTS Wound closure rate of control group was more than other groups on day 4 (P<0.05). On day 7, reepithelisation and granulation tissue of control group were more than white tea 5% ointment-treated and its inflammation was less than others (P<0.05). Neo-vascularization of white tea 5% ointment-treated group was more than control group on days 4 and 15 (P<0.05). On day 4, intact mast cells of control group were more than white tea treated groups (P<0.05). Degranulated mast cells of white tea 5% gel treated group was significantly (P<0.05) more than control group on days 4 and 15. CONCLUSION Five percent white tea extract could not help the skin wound healing process

Religious beliefs; Barrier or mainspring to organ donation

Implication for health policy/practice/research/medical education: More studies are needed to characterize the associated factors in each unique culture and society for promoting the positive attitudes regarding tissue and organ transplantation for various life threatening and incurable disease

Metformin protects renal tubular cells; mechanisms and new concepts

Context: The prevalence of diabetes markedly increased in recent decades. It is well accepted that the risk of morbidity and fatality increases in patients with type 2 diabetes (T2DM). Evidence Acquisition: An electronic search was performed to detect suitable studies, with keywords of metformin, prediabetes, diabetes Mellitus, Gentamicin and lactic acidosis. Results: Metformin (biguanide) is widely used as the first pharmacological option in pre-diabetic subjects and patients with T2DM. Low-cost, long-term effect, low risk of hypoglycemia, and ease in utilization are considered as significant benefits of metformin compared with other therapies. Numerous studies have explored that medicinal intervention particularly metformin administration not only can decrease high blood glucose in patients with T2DM but also can avoid or postpone the beginning of clinical T2DM in pre-diabetic cases. Protective effect of metformin on renal cells by different mechanisms is described here. Gentamicin is an important factor that affects kidney function and structure. Nephrotoxicity is one of the serious side effects of gentamicin (an aminoglycoside antibiotic). Numerous investigation showed the protective effect of metformin against the gentamicin nephrotoxicity. On the other hand, lactic acidosis is known as an uncommon but serious side effect of metformin that should be mentioned. Signs of lactic acidosis are defined by plasma lactate levels higher than 5 mmol/L and pH smaller than 7.4. Conclusions: Different small series and large experimental investigations have discovered the association between metformin and lactic acidosis summarized here

Deficiency of adenosine deaminase 2: a challenging differential diagnosis of polyarteritis nodosa

Deficiency of adenosine deaminase 2 (DADA2) is an autosomal recessive that was first described in 2014. It is a monogenic disease that is caused by loss-of-function variants in the ADA2 gene. DADA2 involves small- and medium-sized vessels and its clinical presentations include polyarteritis nodosa (PAN)-like features such as livedoid rash, early-onset stroke, hypogammaglobulinemia, hematological abnormalities, and systemic inflammation. Early diagnosis and treatment of DADA2 are crucial as the clinical features could be potentially life-threatening but might be treatable. The first-line treatment of choice in DADA2 is tumor necrosis factor (TNF)-inhibitors. We aimed to give an overview of the known pathophysiology, clinical presentations, diagnosis, and treatment of DADA2. A clearer knowledge of DADA2 may help to better diagnose, manage, and improve the clinical outcome of DADA2 patients. However, further studies are required to investigate the genotype-phenotype associations and exact pathophysiology of DADA2

QT Dispersion: Does It Change after Percutaneous Coronary Intervention?

Background: Myocardial ischemia is one of several causes of prolonged QT dispersion. The aim of this study was to evaluate the effect that percutaneous coronary intervention has on the depolarization and repolarization parameters of surface electrocardiography in patients with chronic stable angina.Methods: We assessed the effects of full revascularization in patients with chronic stable angina and single-vessel disease who underwent percutaneous coronary intervention. Twelve-lead electrocardiograms were recorded before intervention and 24 hours subsequently. We measured parameters including QRS duration, QT and corrected QT durations, and JT and corrected JT duration in both electrocardiograms and compared the values.Results: There were significant differences between the mean QRS interval (0.086 ± 0.01sec vs. 0.082 ± 0.01 second; p value = 0.01), mean corrected QT dispersion (0.080 ± 0.04 sec vs. 0.068 ± 0.04 sec; p value = 0.001), and mean corrected JT dispersion (0.074 ± 0.04 sec vs. 0.063 ± 0.04 sec; p value = 0.001) before and after percutaneous coronary intervention. No significant differences were found between the other ECG parameters.Conclusion: Our data indicate that the shortening of corrected QT dispersion and corrected JT dispersion in patients undergoing percutaneous coronary intervention is prominent