Association of 25-hydroxy vitamin D with asthma and its severity in children: A case-control study

Background: Universally, asthma has high prevalence rates and this has led numerous studies done into its causes. Despite extensive study on asthma the association between 25-Hydroxy Vitamin D (25(OH) vit. D) and asthma remains uncertain. In this study, the associations of 25(OH) vit. D levels with asthma and with the severity of asthma were evaluated. Methods: This was a case-control study performed in 2015 in the city of Isfahan. In this study 520 children were studied. Children with asthma were classified as cases and children who were referred for reasons other than respiratory problems and asthma were considered as controls. Serum 25 (OH) vit. D levels were then examined and compared between the two groups. Differences among groups were stated to be statistically significant when P-values < 0.05. Results: There were 260 asthmatic children and 260 controls in the present study. The mean 25 (OH) vit. D levels in the case group was 25.5 ± 16.62 and 16.76 ± 31.40 the control group and this difference was statistically significant (P < 0.05). 25(OH) vit. D levels were found to be 28.05 ± 16.98 in non-severe asthma and 21.41 ± 15.20 in severe asthma. Consequently 25(OH) vit. D level had inverse relationship with asthma severity (P = 0.002). Conclusions: As the results of this study showed, the lower level of 25(OH) vit. D correlated with the higher severity of asthma manifestations. Therefore, it is recommended that 25(OH) vit. D levels get routinely checked especially in severe asthma cases and if the deficiency presents, appropriate therapeutic measures be used to reduce the asthma severity. © 2020 The Author(s)

Ophtalmic dirofilariasis

Background: To report a case of orbital dirofilariasis from a patient in Abadan city Southwest Iran.Case report: A 54- year- old woman referred to Abadan oil company hospital, Southwest Iran with the symptoms of tearing, irritation, swelling, and itching of the right eye. In ophthalmoscopy, a live worm was observed in sub- conjunctival space. The worm was removed and sent to the laboratory. The worm was white in color with a length of 105 mm. Based on morphological characterization identified as Dirofilaria repns.Results: We found that vitamin D3 suppresses the mRNA expression of TLR2 and TLR4 in patients with type II diabetes. TLR2 and TLR4 expression in the patients exposed to vitamin D3 were significantly decreased in comparison with patients who were not treated with vitamin D3.Conclusion: This is the second report of ocular dirofilarisis from Southwestern tropical region of Iran. Increasing of human dirofilariasis may be attributed to environmental changes with global warming, humidity and increase of mosquito vectors and breeding, agricultural development and change in social conditions, traveling and outdoor living

The acute effects of Water-pipe smoking on Ankle Brachial Index: A cross-sectional Study

Introduction: Numerous studies have shown that waterpipe smokers as well as cigarette smokers are at increased risk of cardiovascular diseases. In this study we sought to evaluate the acute effects of waterpipe smoking (WPS) on ankle brachial index (ABI), an indicator of atherosclerosis and an independent predictor of mortality.Methods: This prospective cross-sectional study was conducted in October 2017. Twenty nine healthy male volunteers who had a history of WPS were enrolled. Demographic data and cigarette and WPS status were recorded via self-reporting questionnaire. Resting heart rate and brachial systolic and diastolic blood pressures of participants were recorded first and ABI measurements were done. Then subjects smoked waterpipe for about 20 minutes and ABI was measured immediately after WPS.Results: A total of 29 male adults with a mean age of 32 ± 9 years were included. The right-sided ABI was 1.05 ± 0.11 before WPS and significantly decreased to 0.98 ± 0.13 after WPS (P value = 0.006). The left-sided ABI before and after WPS were 1.09 ± 0.20 and 0.95 ± 0.18 respectively and the decrease was statistically significant (P value = 0.037). Vital signs before and after one session of WPS showed significant changes in heart rate (P &lt; 0.001) and no significant changes in systolic and diastolic blood pressures (P = 0.09, and P = 0.14, respectively).Conclusion: WPS has an acute effect on ABI as well as heart rate so it should be considered as a potential risk factor for cardiovascular diseases

Oral l-citrulline malate in patients with idiopathic pulmonary arterial hypertension and Eisenmenger Syndrome: A clinical trial

AbstractBackground and purposeCitrulline is an amino acid which is produced by the urea cycle and also a precursor for NO, that is, a vasodilator for normal function of pulmonary vasculature. Thereby, enhancing l-citrulline malate in patients with idiopathic pulmonary arterial hypertension and those with congenital heart disease identified as Eisenmenger Syndrome results in reduction of pulmonary hypertension.Methods and subjectsIn this clinical trial before and after study, we assigned 25 patients with arterial pulmonary hypertension (idiopathic or Eisenmenger Syndrome) to receive l-citrulline malate 1g three times daily for two weeks. The primary measurement was the change in exercise capacity, as considered as a result of the total distance walked in six minutes, from baseline to week 2. We also assessed mean pulmonary artery pressure, the change in the quality of life, and the change in pro-brain natriuretic peptide (BNP) level. The study was not powered to evaluate mortality.ResultsThe mean walking distance in six minutes was significantly increased by about 44m (p=0.005) after receiving l-citrulline malate. Mean pulmonary artery pressure significantly reduced from 83.34mmHg before receiving l-citrulline malate to 79.1mmHg after that (p=0.01). All dimensions of the quality of life had statistical differences after receiving l-citrulline malate except limit due to physical health, limit due to emotional health and social functioning (p>0.05). Finally, pro-BNP difference was not statistically significant (p=0.9).Conclusionl-Citrulline malate improves the distance walk in six minutes and also the quality of life of patients with idiopathic arterial pulmonary hypertension and Eisenmenger Syndrome and also reduced mean arterial pulmonary hypertension

Prophylactic Fibrinogen Decreases Postoperative Bleeding but Not Acute Kidney Injury in Patients Undergoing Heart Transplantation

The present study is the premier clinical attempt to scrutinize the practicability of prophylactic fibrinogen infusion in patients undergoing heart transplantation (HT). A total of 67 consecutive patients who had undergone HT between January 2012 and December 2014 were assessed. After exclusion of some patients, 23 patients were given preoperative 2 g fibrinogen concentrate over a period of 15 minutes after the termination of cardiopulmonary bypass pump and complete reversal of heparin, and 30 patients were not given. Some laboratories were measured before general anesthesia and at 6 and 24 hours after surgery. In addition, major adverse events were also evaluated during hospitalization. The mean age of the patients was 39.5 ± 11.4 years, with a predominance of male sex (77.4). All laboratories at baseline were comparable between groups. The length of hospital stay was longer in the control group compared to the fibrinogen group (20 16-22 vs 16 12-19 days; P =.005). There was a trend for patients in the fibrinogen group to have more acute kidney injury (AKI) after surgery (10% vs 30.4%) and less reoperation for bleeding (20% vs 8.7%). The amount of postoperative bleeding was significantly higher in the control group compared to the fibrinogen group (P <.001). The number of packed red blood cell transfused during 24 hours after surgery was significantly lower in the fibrinogen group (P <.001). The transfusion of fibrinogen in patients undergoing HT may be associated with reductions in postoperative bleeding, the number of packed red blood cells, and hospital length of stay; however, it may enhance postoperative AKI. © The Author(s) 2017

Incorporation of Active DNA/Cationic Polymer Polyplexes into Hydrogel Scaffolds

The effective and sustained delivery of DNA and siRNAs locally would increase the applicability of gene therapy in tissue regeneration and cancer therapy. One promising approach is to use hydrogel scaffolds to encapsulate and deliver nucleotides in the form of nanoparticles to the disease sites. However, this approach is currently limited by the inability to load concentrated and active gene delivery nanoparticles into the hydrogels due to the severe nanoparticle aggregation during the loading process. Here, we present a process to load concentrated and un-aggregated non-viral gene delivery nanoparticles, using DNA/polyethylene imine (PEI) polyplexes as an example, into neutral polyethylene glycol (PEG), negatively charged hyaluronic acid (HA) and protein fibrin hydrogels crosslinked through various chemistries. The encapsulated polyplexes are highly active both in vitro and in vivo. We believe this process will significantly advance the applications of hydrogel scaffold mediated non-viral gene delivery in tissue regeneration and cancer therapy

Exhaled nitric oxide is not a biomarker for idiopathic pulmonary arterial hypertension or for treatment efficacy

BACKGROUND: Idiopathic pulmonary arterial hypertension (IPAH) is a fatal illness. Despite many improvements in the treatment of these patients, there is no unique prognostic variable available to track these patients. The aim of this study was to evaluate the association between fractional exhaled nitric oxide (FeNO) levels, as a noninvasive biomarker, with disease severity and treatment outcome. METHODS: Thirty-six patients (29 women and 7 men, mean age 38.4 ± 11.3 years) with IPAH referred to the outpatient's clinic of Masih Daneshvari Hospital, Tehran, Iran, were enrolled into this pilot observational study. Echocardiography, six-minute walking test (6MWT), FeNO, brain natriuretic peptide (BNP) levels and the functional class of patients was assessed before patients started treatment. Assessments were repeated after three months. 30 healthy non-IPAH subjects were recruited as control subjects. RESULTS: There was no significant difference in FeNO levels at baseline between patients with IPAH and subjects in the control group. There was also no significant increase in FeNO levels during the three months of treatment and levels did not correlate with other disease measures. In contrast, other markers of disease severity were correlated with treatment effect over the three months. CONCLUSION: FeNO levels are a poor non-invasive measure of IPAH severity and of treatment response in patients in this pilot study

Sarcopenia and Sarcopenic Obesity in Chronic Obstructive Pulmonary Disease Patients with Different Levels of Severity

Background: Sarcopenia is defined as loss of muscle mass with attendant loss of muscle strength and physical function and is associated with advancing age. Inflammatory condition of chronic disease leads to more rapid progression of this syndrome, which may adversely affect quality of life. The aim of this study was to determine the relationship between chronic obstructive pulmonary disease (COPD) and sarcopenia.Methods: This study included 108 COPD patients who were treated in the pulmonary clinic at Masih Daneshvari Hospital. Patients were categorized into three groups based on Global Initiative for Obstructive Lung Disease criteria. Sarcopenic parameters including muscle mass, muscle strength, and physical performance were measured by Bioimpedance Analysis, hand grip dynamometer, and the Short Physical Performance Battery test, respectively. According to the European Working Group on Sarcopenia in Older People cutoff points and the definition of sarcopenic obesity, sarcopenic patients were diagnosed and categorized based on different COPD severity scores.Results: The relationship between sarcopenia and COPD grading, which was assessed using multiple regression models with adjustment of confounding factors, including age, chronic diseases, and smoking, was statistically insignificant. However, by using forced expiratory volume in 1 second (FEV1) or ratio of FEV1 to forced vital capacity in this model, the results were significant (P = 0.026). A positive linear correlation was observed between skeletal muscle index (SMI) and spirometric data, which was assessed by Spearman’s correlation test. By exploring the association between sarcopenia and obesity with the one-way analysis of variance test, sarcopenic patients represented to have the minimal spirometric measures. However, this difference was only significant for actual measurements.Conclusion: This study showed that sarcopenic COPD patients had smaller spirometric measurements and that sarcopenia and magnitude of SMI were positively correlated with obstruction severity

Pulmonary Kaposi's sarcoma after heart transplantation: a case report

ABSTRACT: INTRODUCTION: Kaposi's sarcomas have been associated with different conditions of immunosuppression and are also known to be a typical complication of solid organ transplantations. CASE PRESENTATION: We report of a 65 year old man of Turkish origin with a history of heart transplantation 10 months ago who presented for clarification of his dyspnoea. The patient had a known history of chronic obstructive pulmonary disease and a smoking history of 40 pack years. Radiologically, three progressively growing intrapulmonary nodules were detected. The histology was diagnostic for a Kaposi's sarcoma. Visceral and especially primary intrapulmonary Kaposi's sarcomas are very rare and have been described to have a rather unfavourable prognosis. CONCLUSION: Even with a history suggestive for conventional lung cancer, Kaposi's sarcomas should be considered in patients after transplantation of solid organs. It should be noticed that in a minority of cases this tumour exists in the absence of the typical cutaneous lesions

Evaluation of random forest and ensemble methods at predicting complications following cardiac surgery

Cardiac patients undergoing surgery face increased risk of postoperative complications, due to a combination of factors, including higher risk surgery, their age at time of surgery and the presence of co-morbid conditions. They will therefore require high levels of care and clinical resources throughout their perioperative journey (i.e. before, during and after surgery). Although surgical mortality rates in the UK have remained low, postoperative complications on the other hand are common and can have a significant impact on patients’ quality of life, increase hospital length of stay and healthcare costs. In this study we used and compared several machine learning methods – random forest, AdaBoost, gradient boosting model and stacking – to predict severe postoperative complications after cardiac surgery based on preoperative variables obtained from a surgical database of a large acute care hospital in Scotland. Our results show that AdaBoost has the best overall performance (AUC = 0.731), and also outperforms EuroSCORE and EuroSCORE II in other studies predicting postoperative complications. Random forest (Sensitivity = 0.852, negative predictive value = 0.923), however, and gradient boosting model (Sensitivity = 0.875 and negative predictive value = 0.920) have the best performance at predicting severe postoperative complications based on sensitivity and negative predictive value